What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) is a form of talk therapy that helps you identify unhelpful or negative thought patterns affecting your emotions and actions. CBT teaches you to challenge unhelpful thoughts (cognition) so you can choose healthier responses to stress (behaviors).

As you investigate the relationship between your thoughts, feelings, and behaviors, you can learn to interrupt cycles of anxiety, depression, and other mental health challenges using tools and techniques to navigate stress in a more self-compassionate way.

The cognitive triangle

The “cognitive triangle” is a way of picturing how our thoughts, feelings, and behaviors (the triangle’s three points) interconnect and shape our experience of the world. When we struggle with anxiety, depression, posttraumatic stress disorder (PTSD), or other mental health disorders, we can feel stuck in specific patterns of the triangle. These patterns may be so ingrained that we aren’t even aware of them until a therapist points them out.

Distressing thoughts → overwhelming emotions → unhelpful behaviors

Imagine a scenario that could make you feel anxious at work: Your boss emails out of the blue asking you to come to her office after lunch. Your anxiety may take you down a familiar pattern of thoughts, feelings, and behaviors:

• Thoughts: “This can’t be good. My boss knows I don’t belong here. I’m getting fired.”
• Emotions: You feel panic, fear, dread, and shame.
• Behaviors: Feeling so upset that you can’t eat, you spend your lunch hour searching for other jobs, convinced you’re going to be laid off and there’s nothing you can do about it.

Distressing thoughts → CBT techniques → steadier emotions → healthier behaviors

CBT can help you reevaluate and change this unhelpful pattern. The guiding idea behind this kind of therapy is that you can learn new behaviors to use when distressing thoughts arise, resulting in calmer emotions and healthier reactions. Over time, unhelpful thoughts will have less power over you or may disappear entirely.

Let’s go back to that email from your boss. Following CBT, your thoughts, feelings, and behaviors might look something like this:

• Thoughts: “I feel a little anxious. That’s okay. This meeting might be about something good, challenging, or trivial. Whatever happens, I know I can handle it.”
• Emotions: You feel brief anxiety followed by calm, steadiness, and self-assuredness.
• Behavior: You take some calming breaths, and then go enjoy your lunch.

Related therapies

CBT shares characteristics and techniques with other types of therapy intended to positively influence your thoughts, feelings, and behaviors. These include:

• Dialectical behavior therapy (DBT)
• Relapse prevention (RP)
• Mindfulness-based cognitive therapy (MBCT)
• Prolonged exposure therapy (PE)
• Integrative behavioral couples therapy (IBCT)

What is CBT used for?

Therapists use CBT for a number of mental health disorders, including:

• Anxiety
• Depression
• Bipolar disorder
• Posttraumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Substance abuse
• Grief
• Phobias

CBT can also help people without a specific disorder who are experiencing a stressful situation or a tough transition. Depending on the frequency of your sessions, it’s possible to make progress in only a few weeks or months of treatment.

How does cognitive behavioral therapy work?

1. Identify a problem/set a goal

The first step in CBT is to figure out what problems you’re facing and how you hope to solve them. It’s important to be specific when identifying those issues and setting goals to address them. For example, a patient with an eating disorder may tell his therapist that he’s losing weight at an unhealthy rate (the problem). Together, he and his therapist can discuss ways to help the patient nourish his body in a healthy way (the goal).

2. Discover your thoughts, emotions, and beliefs

Once you’ve identified a problem, your therapist will help you discover your existing thoughts, emotions, and beliefs about it. They’ll also help you identify the assumptions at the center of most of your thoughts and feelings. These are known as your “core beliefs.”

You can discover your core beliefs through a number of CBT exercises, such as:

• Guided questioning
• Journaling
• Self-talk
• Other forms of “homework” (activities done on your own between therapy sessions)

3. Identify distortions

Once you’ve figure out what sorts of thoughts and beliefs drive your emotions and actions, it’s time to investigate them with your therapist’s help. Your goal isn’t to judge your thoughts and beliefs as “good” or “bad,” but instead to identify whether they’re “true/helpful” or “untrue/unhelpful.”

Untrue or unhelpful thoughts and beliefs are called “cognitive distortions.” These patterns of thought may have served a useful purpose before, but they no longer do. For many patients, cognitive distortions are left over from past protective measures or coping strategies used to survive trauma.

Examples of cognitive distortions include:¹

• All-or-nothing thinking
• Overgeneralization
• Mental filtering
• Discounting the positive
• Mind reading
• Fortune telling
• Emotional reasoning
• “Should” statements
• Blaming
• Labeling
• Catastrophizing

Once you identify which thoughts and beliefs no longer serve who you are in the present moment, you can learn to reshape them into truer, more helpful ways of thinking.

4. Reshape unhelpful thoughts and beliefs

Cognitive behavioral therapy offers a variety of exercises and techniques you can use to counter your negative distortions. Examples include:

• Mindfulness: Mindfulness practices can keep you from spiraling into negative thought patterns that get more overwhelming over time. With mindfulness, you can ground yourself in the present moment by using your five senses. You can then bring your awareness to your thoughts and feelings without judging them.
• Exposure: People struggling with PTSD, phobias, or OCD may be triggered by objects, images, or situations that are perfectly safe in reality but cause feelings of stress, fear, or anxiety. By exposing yourself to what you fear with your therapist’s help, you can learn to disconnect your negative emotions or memories from a trigger.
• Self-questioning: When you have a negative or unhelpful thought, you can learn to interrupt your thought pattern by questioning it. CBT can help you identify the cognitive distortions (such as labeling or blaming) behind your unhelpful thought patterns.
• Self-compassion: Many people who struggle with their mental health feel like they can offer grace, love, and forgiveness to everyone except themselves. Self-compassion techniques can help you treat yourself like you would a friend. This helps you learn to see yourself as worthy of love and connection.

What to expect in a CBT session

During your first appointment, your therapist will ask you questions so they can learn more about you and what sorts of problems you may be facing. Feel free to ask your therapist questions as well. It’s important to make sure your therapist is a good fit for your specific situation.

Your sessions will mostly consist of you and your therapist talking about the problems you’re facing and different ways for you to identify and disrupt any distortions. It can be uncomfortable or even distressing to uncover and name the negative beliefs you may hold about yourself—that’s why it’s important to choose a therapist you trust. You need someone who can encourage you to continue with your therapy even when it’s hard.

Eventually you’ll begin to make progress and feel improvement in your daily life. Although your distorted thoughts may never completely go away, you’ll now have the tools you need to respond to them in a healthy way.

Get help now

To find a CBT therapist near you, browse our directory. If you’re in crisis, help is available immediately: Call or text the free, confidential 988 Lifeline at 988. It’s available 24 hours a day, 7 days a week.

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What is cognitive processing therapy?

Cognitive processing therapy (CPT) is a type of cognitive behavioral therapy (CBT) developed to treat posttraumatic stress disorder (PTSD).

CPT helps people identify, address, and challenge negative or unhelpful thoughts, feelings, and behaviors following a traumatic event. It also helps people evaluate and understand the beliefs that motivate their feelings and behaviors. CPT’s two main goals are reducing PTSD symptoms and getting “unstuck.”

Cognitive processing therapy for PTSD

CPT can help reduce PTSD symptoms, which generally fall into four categories¹:

1. Intrusive memories: Unwillingly remembering or reliving a trauma through memories, flashbacks, or nightmares
2. Avoidance: Adjusting your life to avoid any triggers (including people, places, thoughts, situations, and memories) associated with the trauma
3. Changes in mood or thinking: Having feelings of hopelessness, numbness, or detachment; struggling to remember either the trauma or other unrelated information
4. Reactivity: Constantly feeling on guard (or “hypervigilant”) or struggling to manage your reactions to stress (such as irritability, angry outbursts, or intense guilt and shame)

Getting unstuck

In CPT, “stuck points” are the beliefs a person develops about a trauma that prevent their recovery. They may be beliefs about themselves, others, or how the world works.

Stuck points are often rooted in shame, guilt, or fear. They involve extreme beliefs, exaggerations, negativity, and black-and-white thinking, meaning they don’t always reflect reality. An example of a stuck point would be a car accident survivor believing it’s their fault that other people died.

It’s difficult to move forward without addressing stuck points, especially if a person is also experiencing intrusive memories or other PTSD symptoms. With cognitive processing therapy, people can identify their stuck points, learn to challenge them, and discover how these extreme beliefs affect their self-esteem, intimate relationships, and ability to trust.

Benefits of CPT

In addition to reducing PTSD symptoms and helping you get unstuck, CPT can help you:

• Put words to what you’ve been through: It can be cathartic to express what happened to you in your own words while in a safe place. It can also help you identify any unhelpful beliefs you may have developed in response to trauma.
• Learn to challenge unhelpful thoughts: Even if you know your thoughts aren’t helpful, it can be difficult to push back on them. CPT gives you tools to identify and overcome these thoughts in a productive way.
• Apply what you’ve learned: You can apply the skills you develop in CPT (like identifying unhelpful thoughts and challenging your own beliefs) in a variety of contexts, including applying them to parts of your life that aren’t related to your trauma. CPT skills can also help if you go through a stressful or traumatic situation in the future.

Is CPT effective?

Cognitive processing therapy has proven effective in treating PTSD.² It’s especially helpful for people with complex PTSD (in which someone experiences multiple forms of trauma, chronic trauma, or some combination of both).

CPT is effective for both military veterans and the general public. However, it may be not be a good fit for people who struggle to complete weekly assignments or express themselves through writing, which is a key component of treatment.

How does CPT work?

Before starting treatment, the therapist assesses the client’s emotional stability and potential risk factors, such as suicidal ideation, thoughts of harming themselves or others, substance abuse requiring medical intervention, or psychosis.³ If the client is found to be at high risk, those issues may need to be addressed before trauma processing begins.

Even if there’s no immediate threat of danger, it’s common for clinicians to recommend preparatory therapeutic work before beginning CPT. Unfortunately, there’s limited research supporting the benefits of this preparation.⁴

CPT can take place as individual or group therapy. It follows a 12-week program divided into four phases.

Phase one: Education

In the first session, your therapist will explain PTSD symptoms and the body’s trauma response. They’ll also give you a brief overview of what to expect during treatment.

First disclosure

You’ll briefly discuss your trauma with your therapist. This first discussion isn’t meant to be detailed—it just gives your therapist an idea of what you’ll be exploring together. If you’ve experienced multiple traumas in your life, you may choose to focus on the one you feel has impacted you the most.

Impact statement

At the end of your first session, your therapist will ask you to write about how the traumatic event has affected you. This is called an “impact statement.” Keep in mind that you will not be asked to relive the trauma through writing. Instead the focus is on the thoughts, feelings, behaviors, and beliefs that the traumatic event has caused you to carry.

Phase two: Processing trauma

The second phase of treatment focuses on helping you process your trauma. Your therapist will review your impact statement with you and look for stuck points. You’ll learn to identify your emotions and make connections between your everyday behaviors and your thoughts and feelings about the trauma.

First trauma account

During this time, your therapist will ask you to write a trauma account. Instead of writing about how the trauma affected you, this account will be about the trauma itself: what happened, who was involved, how you felt in the moment, and other details. This can be a difficult exercise, and it may take a few tries to write everything down.

It’s normal to feel uncomfortable while writing or talking about traumatic memories, but these feelings are often temporary and should improve through the CPT process. The long-term benefits tend to outweigh any short-term discomfort.⁵ Your therapist is there to offer support and help you feel as safe as possible in each phase of treatment.

You’ll be asked to reread your account to yourself in the days leading up to your next session. Then you’ll read the account to your therapist.

Writing, reading, and sharing your account is important because it allows you to address intense emotions that may have been stopping you from processing what happened. Your therapist can also help you identify stuck points more effectively if they hear your story from your point of view.

Second trauma account

After talking with your therapist, you’ll write a second trauma account, this time applying what you’ve learned.

In this account, you may find that some of your stuck points have been resolved. For example, instead of writing “I should have done something to prevent this,” you might write something like, “I wish I could have done something to prevent this.”

Some stuck points will likely still be present, but now you’ll be able to recognize them as you write them down. Being able to identify these unhelpful beliefs is key to the next stage of treatment.

It’s worth noting that while a written trauma account can be helpful, it isn’t strictly required for everyone who undergoes CPT. Evidence suggests that people can still find relief from PTSD symptoms without this part of treatment.

Phase three: Challenging unhelpful thought patterns

In the third phase of treatment, you’ll learn to question and challenge unhelpful thought patterns. Now that you’ve identified your stuck points, your therapist can help you question them in a meaningful way.

Some trauma survivors already know some of their beliefs are unhelpful, but they don’t know what to do about them. A person may understand logically that their assault wasn’t their fault, for example, but they still feel and behave as if it were. Questioning and challenging during CPT sessions can help bridge the gap between what you know and what you truly believe.

Cognitive distortions

A person usually arrives at stuck points because of “cognitive distortions”—flawed shortcuts in thinking that rely on extremes, stereotypes, or biases to provide an answer. Cognitive distortions offer people simple narratives that make them feel safe and in control, even if that narrative paints a negative picture of themselves or others.

Common cognitive distortions include:

• Magnification: Exaggerating the importance of a shortcoming or failure
• Minimization: Discounting the value of a success or achievement
• Overgeneralization: Making broad assumptions based on an isolated event
• Mind reading: Assuming you know what other people are thinking and feeling
• Catastrophizing: Assuming the worst will happen, and that more disasters are sure to follow
• Labeling: Applying descriptions of events (“I failed my math test”) to yourself (“I’m a failure”), typically in negative ways

Phase four: Trauma themes

In your final sessions, your therapist will help you identify how the unhelpful beliefs you developed in response to trauma affect you in five areas of life:

1. Safety
2. Trust
3. Power and control
4. Esteem
5. Intimacy

You’ll discuss each area in terms of yourself, others, and the world. For example, your therapist will help you explore your ability to trust yourself; your ability to trust friends, family, and others; and your ability to trust that most people in most circumstances aren’t intent on hurting you.

Second impact statement

At the end of your eleventh session, you’ll write a new impact statement. This is an opportunity to rethink what your trauma means and how it affects you in light of what you’ve learned during therapy.

During your last session, you’ll share your new impact statement with your therapist. You’ll then go over your first impact statement together and see the progress you’ve made during treatment. Together, you’ll identify any further treatment you may need and any goals you want to work toward in the future.

Other treatments for PTSD

CPT is a form of cognitive behavioral therapy that specifically targets PTSD. Other types of therapy can also help treat the effects of trauma, including:

• Cognitive behavioral therapy (CBT) can help people identify and change unhelpful thoughts that impact their behavior.
• Eye movement desensitization and reprocessing (EMDR) helps trauma survivors to reprocess memories and make new connections in their brains.
• Prolonged exposure therapy enables people to confront traumatic memories in a safe, controlled environment.
• Somatic therapies help heal the mind-body connection that trauma often damages.

To find a licensed mental health professional near you, browse our directory.

Get help now

If you’re in crisis and need help right away, the following helplines offer free, confidential support 24/7:

• 988 Suicide & Crisis Lifeline: Call or text 988
• Crisis Text Line: Text HOME to 741741
• National Domestic Violence Hotline: Call 1-800-799-SAFE (7233)

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Insomnia is a sleep disorder that involves regularly having trouble falling or staying asleep. People often use medication, supplements, or lifestyle changes to help manage insomnia, but a specialized form of cognitive behavioral therapy (CBT) may offer a more structured, well-rounded approach.

What is cognitive behavioral therapy for insomnia?

CBT is a therapy approach that centers on the ways thoughts, behaviors, and emotions connect to and affect each other. It helps clients identify and change patterns or distortions that negatively affect their lives. Cognitive behavioral therapy for insomnia (CBT-I) is a form of CBT that specifically focuses on addressing the underlying thoughts, emotions, behaviors, and patterns that contribute to sleep problems.

CBT-I uses a few key strategies to help people improve their sleep patterns:¹

• Sleep hygiene focuses on establishing a regular sleep schedule and creating a restful sleep environment. It includes recommendations such as avoiding naps, minimizing caffeine and alcohol intake, and keeping the bedroom dark, quiet, and comfortable. This step is foundational in creating an environment conducive to sleep. 
• Stimulus control helps you learn to associate the bedroom with sleep, encouraging you to use your bed only for sleep and intimacy. It includes avoiding activities like watching TV or using electronic devices in bed.
• Sleep restriction (or “sleep consolidation”) involves limiting the time you spend in bed so it more closely matches the actual amount of sleep you get. Staying awake and out of bed builds your sleep drive, improving sleep efficiency.
• Cognitive restructuring involves challenging and replacing negative thoughts and beliefs about sleep with more positive and realistic ones. For example, you might learn to notice thoughts like “If I don’t sleep eight hours tonight, I’ll be useless tomorrow” and replace them with “I’m capable of managing my day even when I’m tired.” This can help reduce anxiety and worry related to sleep.
• Relaxation techniques such as deep breathing, progressive muscle relaxation, and guided imagery help promote relaxation and quiet the mind and body before bedtime.

CBT-I can be delivered in various formats including face-to-face individual or group sessions, telephone sessions, and on digital platforms with therapist guidance or through self-led modules.

The CBT-I process

CBT-I usually begins with a structured assessment. Your therapist will ask about your bedtime routine, sleep schedule, nighttime awakenings, naps, and other factors like caffeine, alcohol, or screen use. The therapist will also review your medical and mental health history and any medications that could affect sleep. Based on this information, you’ll work together to set clear goals and begin treatment.

Treatment typically involves a daily sleep diary. Outside of sessions with your therapist, you’ll be asked to keep track of your sleep patterns, including when you went to sleep, when you woke up, the quality of the sleep, and other similar questions.

The length of CBT-I treatment varies depending on the person and the format, but you can expect it to last several weeks. Standard CBT-I treatment is usually delivered over the course of six to eight sessions, with sessions ranging from 30 to 90 minutes in length.² But CBT-I delivered via phone, mobile app, or other digital platforms may involve 8 to 12 sessions of differing lengths.³

Using the strategies discussed above, as well as any additional techniques you and your therapist collaboratively find effective, CBT-I will help you slowly build new habits around sleep. You’ll likely identify thoughts, feelings, and behaviors related to sleep and test them to find out if they’re true. If they’re not, you’ll work on replacing them with more accurate thoughts or helpful behaviors.

Actively participating in the therapy process both in and outside of sessions is crucial. This can mean a good deal of “homework,” including keeping the sleep diary, practicing relaxation techniques on your own regularly, adhering to a set sleep schedule, and actively challenging negative thoughts about sleep. It requires commitment and consistency, but CBT-I has shown promising results.

How much does CBT-I cost?

The cost of CBT-I varies widely depending on the delivery format, your location, provider credentials, and insurance coverage. Research comparing treatment costs found that digital CBT-I programs were the most cost-effective option.⁴

You can explore our guide on how to find free or affordable therapy options here or search our directory for mental health professionals that accept your insurance.

CBT-I effectiveness

CBT-I is the most effective non-pharmacological treatment option for chronic insomnia, showing results that are similar to medication.⁵ Additionally, CBT-I is associated with better sleep long after the last session has ended. While medication can be effective, it tends to work by masking the symptoms of insomnia. CBT-I, on the other hand, helps patients understand and learn how to support their body’s natural sleep cycle.

In some cases, CBT-I may be used alongside medication.⁶ It’s sometimes used as an alternative for people who want to stop taking medication or when the medication isn’t producing the desired results. When medication is involved, it’s important to include your healthcare team in decisions and discuss any changes before making them.

Though CBT-I is effective, many people don’t know about it as an option for treating insomnia. In addition to doctors being more likely to prescribe medication, there’s also a shortage of trained CBT-I practitioners, which makes it more difficult for people to access this form of therapy.⁷

Who can benefit from CBT-I?

CBT-I is a viable option for almost anyone who wants to improve their sleep patterns, regardless of the underlying cause of their insomnia. However, it may be particularly beneficial for people with chronic insomnia or those who may be experiencing insomnia alongside other mental health conditions, such as depression or anxiety^.8,9

CBT-I has also been shown to help people whose insomnia is related to certain physical or mental health conditions, including pregnancy, posttraumatic stress disorder (PTSD), cancer, alcohol use disorder (AUD), osteoarthritis, and age-related cognitive decline.^{10,11,12,13,14,15}

How to get started with CBT-I

If you’re interested in individual CBT-I sessions online or in-person, visit our directory to search for a therapist in your area. You can refine your search by filtering results by therapist specialties and checking the box for sleep disorders.

If you’re open to exploring digital options, you may want to consider an app or online platform like Sleepio or Stellar Sleep. Some digital CBT-I programs are covered by employers or health insurance plans, are HSA-eligible, or offer limited free versions for those without coverage. Be sure to research the specific platform you’re interested in, as not all platforms are appropriate for all users.

Lastly, the US National Center for PTSD offers two free mobile apps that can help with insomnia. The first, Insomnia Coach, was designed as a self-care tool to be used by adults without certain co-occurring concerns. The second, called CBT-i Coach, is built to be used while in treatment with a CBT-I therapist.

Unsure which option is best for you? It’s always a good idea to consult with your doctor or a mental health professional who specializes in sleep disorders. They can help determine the most appropriate treatment plan for your specific needs.

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If you’re exploring therapy for yourself or a loved one, it helps to know what you might learn or practice in sessions.

Behavioral therapy techniques are commonly used in the course of treatment across different therapy modalities. They focus on specific actions and practical solutions, teaching you skills you can use in daily life.¹ They center on the idea that we learn behaviors from our environment, and we can learn new, healthier ones too.

Below are common behavioral techniques you, or your loved ones, might learn or practice in therapy. Each one teaches a lesson or skill you can practice and bring into your daily life.

Exposure and desensitization techniques

Exposure techniques allow you to practice contact with fears until anxiety declines.² “In vivo” exposures happen in real life, “imaginal” exposures involve vivid mental rehearsal, and “interoceptive” exposures target feared body sensations. Exposure is sometimes used in cognitive behavioral therapy (CBT), especially in the treatment of anxiety and related disorders.³

Flooding is a technique that introduces you directly to your most feared situation for a sustained period, after coping skills are learned and can be applied.⁴ The idea is that repeated, intense exposure leads to habituation, so fear decreases. This approach is used for posttraumatic stress disorder (PTSD), specific phobias, and other anxiety disorders.

Systematic desensitization is a behavioral therapy approach that incorporates several techniques and helps you face fears step by step. You first learn deep muscle relaxation techniques, followed by listing fear-based situations from easiest to hardest to manage. You then gradually face each situation, while concentrating on keeping your body relaxed.

Over time, the fear response  becomes less intense.⁵ The approach can be used in the treatment of many mental health concerns, including lowering competitive anxiety and building confidence in athletes.⁶

Reinforcement-based techniques

Shaping is a technique that involves rewarding small steps toward a bigger goal. For example, if regular exercise feels too daunting, you might start with a short walk and build up, rewarding yourself as you increase the intensity. Computational models show that gradually tightening the “window” of what gets reinforced over time—especially with steady, continuous adjustments—can help new habits stick.⁷

Token systems (or token economies) reward desired behaviors with points or tokens that can be traded for items or privileges. This technique can be used in individual therapy, but it’s also used in classroom behavior management and other institutional settings.^8,9

Contingency management is an intervention that links proof of positive behavior to immediate rewards.¹⁰ It has strong evidence for use in the treatment of substance use disorders, but has also been shown to be effective in increasing treatment attendance and medication adherence in other settings.

Social learning techniques

Behavior modeling involves learning by watching others.¹¹ In therapy, you can see a skill demonstrated, pay attention to key steps, and then practice it yourself. Modeling is practical and works for simple and complex skills.

Role-playing lets you rehearse tough conversations or social situations in a safe setting. Guided scenarios can build communication, empathy, and problem-solving skills. Structured programs are even being developed to use tabletop role‑playing games to improve social skills by incorporating CBT strategies.¹²

Assertiveness training helps you speak up respectfully for your needs while being clear and direct. In an eight‑week internet-based CBT study that emphasized assertive behavior, participants increased healthy assertiveness, lowered social anxiety, and improved well‑being, with gains lasting at least one year.¹³

Cognitive behavioral techniques

Cognitive restructuring teaches you to spot and question unhelpful thoughts.¹⁴ You learn to test them against evidence, spot distortions, and consider more balanced views. In theory, identifying unhelpful thoughts allows you to change the behaviors they lead to that create negative impacts in your life. Cognitive restructuring is a core CBT strategy used for anxiety, depression, and stress-related problems.

Behavioral activation helps you plan and schedule small, realistic actions that build a sense of pleasure and accomplishment. This can be especially helpful for depression, which often leads to pulling back from activities that bring reward or meaning. In a youth prevention trial, brief app-based behavioral activation challenges predicted lower depression symptoms at three months.¹⁵

Problem-solving techniques involve teaching you to break down stressors into specific parts and think through each step to test solutions. In attention-deficit/hyperactivity disorder (ADHD) treatment research, problem-solving techniques were linked to reduced inattention.¹⁶ They also contributed to improved treatment response when combined with other CBT components.

Relaxation and coping techniques

Progressive muscle relaxation (PMR) teaches you to tense and then relax muscle groups from head to toe. This helps you notice tension and let it go. In adults, PMR has been shown to reduce stress, anxiety, and depression.¹⁷ It can also work even better when paired with other tools like music or guided imagery, and can be a helpful, self-led exercise to incorporate into your day.

Deep breathing can calm your body’s stress response. Techniques like “box breathing” or “4‑7‑8” breathing are simple ways to practice. These paced methods support the “rest and digest” system and can lower feelings of stress and anxiety when used regularly.¹⁸

Self-monitoring means keeping track of your own behavior, like physical activity, screen time, sleep, or mood. When you combine tracking with simple goals and regular feedback, it can help you change habits in a steady way. In a school wellness program, students who tracked their behaviors online more often reported an increase in daily physical activity and less screen time than those who tracked less.¹⁹

Try starting small: Choose one behavior, set a weekly target, check in each day, and note what helped or got in the way. Over time, the data can guide smarter goals and better results.

How behavioral interventions can help

The great thing about behavioral therapy techniques is they’re practical. You come away with tools you can use at home, work, or school. They target actions and thoughts linked to troubling patterns, then build healthier skills for coping through repetition and reinforcement.

Many techniques have solid evidence in real-world settings—from substance use and anxiety to social skills and medication adherence—so you can feel confident about the approach.

CBT, in particular, is broadly effective across various mental health conditions. Large real‑world clinic data show moderate to large improvements with very low rates of symptom worsening, which means many people feel better in routine care.²⁰ For depression, both behavioral activation and CBT reduce symptoms.²¹ Studies suggest they work about as well, and behavioral activation can be a simple, practical option for many people.

If you decide to pursue behavioral therapy, your clinician will help match these skills to your goals. You’ll set small goals, practice between sessions, and celebrate progress. Over time, these habits can add up to meaningful change.

Visit our directory to find a therapist who can help you choose the path that best fits your needs, schedule, and preferences.

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What are cognitive distortions?

Cognitive distortions are systematic errors in thinking that often don’t follow logic.¹ They can make you believe negative things even when facts suggest otherwise. These distorted thought patterns show up especially in stressful situations.²

In some ways, cognitive distortions are faulty filters. They twist how you see yourself, other people, and situations. The tricky part is they happen automatically, often without you even realizing it.

Why your brain gets it wrong

Your brain uses shortcuts to process information quickly. Usually, this helps you. But sometimes these shortcuts lead to flawed conclusions.

Negative thinking patterns often come from past experiences, stress, or ongoing anxiety. When you’re anxious or overwhelmed, you’re more likely to fall into these patterns. This creates a cycle where negative feelings trigger more distorted thoughts, which then create more negative feelings.³

Common cognitive distortions

There are many types of cognitive distortions that affect how people think.⁴ Some common ones include:

All-or-nothing thinking, in which you see things in extremes, often as completely good or completely bad. There’s little to no middle ground. This may look like getting a B on a test and feeling like a failure because it isn’t the A you were aiming for.

Overgeneralization happens when you take one bad event and turn it into a pattern or rule about your life. You may use words like “always” or “never” in the thoughts that accompany it. For example, you might experience one rejection and think “This always happens, I never get what I want.”

Mind reading happens when you assume you know what others are thinking or intending without evidence to support it. For example, you may think that a friend is angry at you because they haven’t called you in a few days when they’re actually just busy with other things.

Fortune telling involves predicting bad outcomes with no real reason. You may predict things like “This presentation is going to be a disaster” even if you worked hard and past presentations have been a success.

Catastrophizing happens when you jump to worst-case scenarios. One small mistake at work makes you think you’ll get fired. Manageable situations may feel unbearable or impossible to overcome.

Emotional reasoning is when you make decisions based on feelings instead of facts. If you feel anxious about something, you conclude that it must be dangerous. Your emotions feel true and forceful, so you focus more on them and less on objective evidence.

Labeling happen when you assign yourself or others fixed labels based on isolated events or behaviors. “I made a mistake” becomes “I’m a failure.” Rather than recognizing actions as just one piece of a person’s identity, you make broad judgements about what they mean.

Minimizing is when you dismiss or undervalue good experiences or your own strengths. If you accomplish something, you may think “This must not be as hard as people think if I can do it.” If someone compliments you, you may think they’re just being polite.

Should statements involve focusing on rigid rules about how things “should” or “must” be. You feel pressure to live up to these rules, and falling short creates feelings like guilt, shame, or defeat. When others break them, you feel frustrated even if it’s understandable why they acted the way they did.

Personalization and self-blame involve assuming you’re responsible for bad things, even when you’re not. For instance, if a friend seems upset, you instantly think you must be the reason. This can be especially harmful in relationships where self-blame prevents you from seeing who’s responsible for certain patterns.

Recognizing these patterns in yourself? It can be hard to identify negative patterns in thinking in yourself, especially when you’re actively caught up in them. A therapist can help you identify which distortions show up most in your life and teach you practical skills to challenge them. You don’t have to manage overwhelming thoughts or emotions alone.

How cognitive distortions impact mental health

These thinking patterns aren’t harmless. Evidence shows that distorted thinking patterns are deeply connected to mental health problems in adults, particularly anxiety and depression.⁵

In depression, distortions have been shown to reduce healthy coping skills and increase unhealthy patterns.⁶ People with more depressive symptoms tend to expect negative outcomes and have less flexibility in their thinking.⁷

Cognitive distortions also play a critical role in loneliness, which affects millions of people worldwide. The most common distortions in lonely individuals are essentializing (believing “I’m just the kind of person who tends to be lonely”), mind reading (assuming others think negatively about you), and catastrophizing (viewing loneliness as unbearable).⁸

These distortions can create a harmful loop. When lonely people believe others are rejecting them or that they’re destined to be alone, they often withdraw further, making loneliness worse. Research shows that the relationship between loneliness and stress is also directly linked to these three distortions.

In these and many other ways, distortions have the power to reinforce unhelpful patterns and make situations feel unmanageable.

How to spot and challenge distorted thinking

The good news is that in some cases you can learn to identify and challenge unhelpful thought patterns on your own. “Cognitive restructuring” is a set of techniques taught in many forms of psychotherapy that helps you spot automatic thoughts, look at evidence, and consider other explanations.⁹

Practical steps for building these skills include:

Practice noticing your thoughts. Mindfulness asks you to notice thoughts without judging or feeling controlled by them. Even a few minutes of mindfulness practice daily can boost your self-awareness.

Record your thoughts. Use an app or write down your thoughts in a journal so you can examine them. These records can help you identify any repeating thoughts that may be keeping you stuck. The goal is to learn how to check your own thinking and notice patterns.

Ask questions. Treat your thoughts as guesses, not facts. Ask yourself:

• What’s the evidence?
• What are other explanations?
• What are the realistic consequences?

Practice self-compassion. Treat yourself the way you’d treat a good friend. When you catch distorted thinking, respond with understanding instead of harsh judgment.

Avoid extremes. Balanced thinking doesn’t mean forcing yourself to be positive. It means giving yourself the chance to seeing situations from different angles. Instead of “I’m terrible at my job,” it’s okay to say “I messed up this project, but I’ve done good work on others.”

These techniques can be helpful starting points, but they may be challenging to follow on your own, especially if you’re feeling distressed or overwhelmed. Working with a trained therapist may be a better option for anyone who needs additional support, guidance, or structure, especially when first learning these skills.

CBT for cognitive distortions

If cognitive distortions are impacting your daily life and mental health, it may help to work with a mental health professional who specializes in cognitive behavioral therapy (CBT).

CBT is an evidence-based treatment that has been shown to effectively manage symptoms of depression, anxiety, eating disorders, substance abuse, personality disorders, and other mental health concerns.¹⁰ Treatment typically involves 8 to 12 weekly sessions, though the actual number varies widely depending on the person and concern.

In sessions, you and your therapist work together to spot negative thoughts and examine evidence for and against them. Sessions generally include mood checks, goal setting, reviewing homework, and practicing new skills. Together, you and your therapist will examine how your thoughts, behaviors, and emotions shape each other and what needs to change for you to feel better.

Studies show that as you change distorted thoughts, your mood begins to improve.¹¹ And as your mood improves, it helps change more distorted thoughts. This can create a slow upward spiral of improvement.

If you’re ready to take the next step, browse our therapist directory to find a mental health professional near you.

The post Cognitive distortions: How to recognize and challenge them appeared first on therapist.com.

What is neuroticism?

Neuroticism is a personality trait that increases your tendency to feel negative emotions, especially when something feels threatening or frustrating.¹ It’s one of the “Big Five” personality traits alongside openness, conscientiousness, extraversion, and agreeableness.²

This personality trait involves specific thinking patterns that stay relatively stable over time and affect how you handle daily life.³ While experiencing negative thoughts and emotions from time to time is normal, people with higher neuroticism tend to feel these emotions more intensely (and more often) than others.

Signs of neuroticism

Neuroticism sits on a spectrum. Your level of the trait, often described as “low” or “high,” influences how you handle stress and difficult emotions.

The trait shows up differently for everyone, but there are some common patterns seen in high neuroticism to look for:⁴

• Worry and anxiety about what might happen
• Sensitivity to criticism from others
• Strong reactions to everyday stress
• Self-consciousness in social situations
• Small problems feeling bigger than they are
• Quick mood changes throughout the day

Low neuroticism, on the other hand, might make it easier to:

• Stay calm under pressure
• Bounce back from setbacks quickly
• Maintain a stable mood most of the time
• Recover faster from disappointments

If you’re struggling with high neuroticism and it’s affecting your daily life, consider reaching out to a mental health professional. They can help you develop coping strategies that work for your specific situation.

Causes of neuroticism

Neuroticism develops from a variety of factors, with genetics being a major contributor.

Genetics: Twin and family studies show that neuroticism is a heritable trait; it’s estimated that genetics account for about 48% of how neuroticism presents.⁵ This means that if a person’s family tends to show certain high-neuroticism traits, it increases the likelihood they will have the same ones.

Early life experiences: Childhood abuse, including emotional abuse and neglect, can increase the likelihood of developing neuroticism.⁶

Brain differences: People with high neuroticism tend to have weaker functional connections between the amygdala (the brain’s alarm system) and parts of the prefrontal cortex (which helps regulate emotions).⁷

How neuroticism affects mental health and well-being

Higher neuroticism can change how you think and feel on a daily basis. It’s associated with a “negative bias” in attention, meaning you might focus more on what’s going wrong rather than what’s going right.⁸

People who score high on neuroticism are at a much greater risk for developing anxiety, mood disorders, and substance abuse disorders.⁹ This doesn’t mean everyone with high neuroticism will develop these conditions, but their vulnerability is higher.

Impact on daily life

Neuroticism can make everyday stressors feel incredibly challenging or even impossible to tackle.

Work: People with high neuroticism often struggle in the workplace due to being distracted by emotions or feeling exhausted.¹⁰

School: One study of medical students found that those with high neuroticism were at an increased risk for psychological distress and burnout when they faced increased academic stress.¹¹

Relationships: Married people with higher levels of neuroticism tend to report feeling less satisfied with the relationships they have with their spouses and report more frequent negative interactions with them.¹²

Physical fitness: Research shows a negative association between physical activity and neuroticism.¹³ This suggests a potential a cycle where less exercise leads to worse mood, which makes it even harder to get moving.

Overall physical health: People with higher neuroticism have higher odds of also experiencing certain health problems.¹⁴ Specific health problems associated with neuroticism include:

• Diabetes (3 times higher odds)
• Kidney/liver disease (2.5 times higher risk)
• Stomach problems (2.3 times more likely)

Daily coping: High-neuroticism individuals report more interpersonal stressors and use less-adaptive coping strategies like hostile reactions.¹⁵ This means you might:

• Have more conflicts with friends, family, or coworkers
• React with anger or hostility when stressed
• Feel more distressed even when using coping strategies
• View daily events more negatively than others would

How to manage neuroticism

The good news is that neuroticism doesn’t have to control your life. There are proven ways to manage these traits and feel better. Neuroticism treatment options include the following:

Psychotherapy: Professional help can make a real difference. The Unified Protocol is a form of cognitive behavioral therapy (CBT) that has been shown to be an effective treatment for managing neuroticism and other emotional problems.¹⁶ This type of therapy helps you learn better ways to handle and express your emotions.

Educational and wellness programs: Programs that teach emotional skills in schools and communities can help reduce expressions of neuroticism and lessen the impact it has on relationships. These programs teach emotional regulation skills that can last a lifetime.

Pharmacotherapy: Neuroticism is responsive to medication and can effectively lower levels of the personality trait.¹⁷ If you’re struggling, this might be an option to discuss with a doctor.

Self-help and lifestyle strategies

You don’t have to wait for professional help to start feeling better. Here are a few simple but effective strategies you can use right now:

Mindfulness techniques can help you stay grounded when neurotic thoughts pop up, teaching you to notice your emotions without letting them take over.¹⁸ Mindfulness meditation can be as simple as starting with five minutes a day focusing on your breath.

Progressive muscle relaxation can help ease the physical tension that accompanies intense emotions. The technique involves tensing and releasing each muscle group, beginning with your toes and moving up, helping you get better at spotting and letting go of stress in your body.

Gratitude journaling can shift your focus from worries to good stuff in your life. Begin by jotting down three things you’re grateful for every day, even if they’re tiny. This helps retrain your brain to notice positive things.

Remember, managing this trait is a process, not a quick fix. Be patient with yourself as you try different strategies. What works for one person might not work for another, so it’s okay to experiment and find what helps you feel better.

When to seek professional help

While self-help strategies can be very effective, sometimes you need extra support. Remember that there’s no marker you need to reach to justify involving a professional.

You might benefit from reaching out to a mental health professional if:

• Your neuroticism is significantly affecting your work, relationships, or daily life
• You’re experiencing symptoms of anxiety, mood disorders, or substance abuse
• Self-help techniques aren’t providing relief
• You’re having thoughts of self-harm

A therapist can help you develop personalized coping strategies and provide additional treatment options that work best for your specific situation. Visit our directory to find a therapist online or near you.

The post Neuroticism: Definition, signs, causes, and how to manage it appeared first on therapist.com.

Meditation has been practiced for thousands of years across the globe. It’s often tied to spiritual disciplines or practices, such as worship or prayer, but it can also be practiced outside of the context of faith.

What is meditation?

Meditation involves using various techniques to encourage a heightened state of awareness and focused attention. It typically aims to train attention and awareness to achieve mental clarity, emotional calmness, or stability.

Meditation can involve focusing the mind on a particular object, thought, activity, or sensation. It can be used to train attention and awareness, or to achieve a mentally clear and emotionally calm state. Various types may draw focus to different things (such as your breathing or a mantra) with the goal of maintaining mental focus.

Types of meditation

There are hundreds of different forms of meditation. In general, these techniques all fall within one of seven categories:¹

1. Mindful observation: Paying close attention to your surroundings or thoughts and emotions without judgment to stay anchored in the present moment.
2. Body-centered: Focusing on bodily sensations or scanning the body to promote awareness and relaxation.
3. Visual concentration: Either fixing the gaze on a visual object or visualizing within the mind. This is done to sharpen focus and calm the mind.
4. Contemplation: Reflecting deeply on specific ideas or questions, often with the aim of gaining personal insights.
5. Affect-centered: Directing attention towards emotions, often with the intention of cultivating positive feelings like compassion or gratitude.
6. Mantra: Repeating a word, phrase, or intention silently to help focus and quiet the mind.
7. Meditation with movement: Incorporating physical movements, such as yoga or tai chi, to engage the body in mindful awareness. This can also involve progressive muscle relaxation, where you systematically tense and relax different muscle groups to release tension.

Benefits of meditation

Meditation can help you practice mental health skills like self-care, stress management, emotional self-awareness, attention, and self-regulation. Starting a regular practice can help you:

• Relax your body, tune into physical sensations, and alleviate tension.
• Reflect on specific thoughts, chants, prayers, or mantras.
• Regulate your feelings and reframe negative or unhelpful thoughts.
• Reconnect with your sense of self, your relationship to others, and your place in the universe.
• Redirect your energy away from anxious or unhelpful thoughts and toward the present moment instead.
• Remember to practice compassion toward yourself and others.

In addition, it can ease symptoms of conditions including:

• Stress: Research shows that meditation can reduce stress by lowering certain hormones such as cortisol.²
• Anxiety: Meditation for anxiety helps people pay more attention to what’s happening in the present instead of getting stuck in their own thoughts.³
• Depression: Meditation can be an effective part of treatment for mild to moderate depression.⁴
• Insomnia: Some studies show that meditation can improve sleep quality.⁵
• Chronic pain: Some research suggests that meditation can help reduce the perception of pain, which may help with chronic pain management.⁶
• Posttraumatic stress disorder (PTSD): Meditation and mindfulness may help in reducing symptoms of PTSD, though more research is needed.⁷
• Substance abuse: Some studies suggest that meditation can help people reduce cravings and improve their ability to manage stress, which is often a trigger for substance use.⁸
• Attention-deficit/hyperactivity disorder (ADHD): Research indicates that meditation may improve emotional dysregulation and executive function in people with ADHD.⁹
• Disordered eating: Meditation practices may help reduce both binge eating and emotional eating.¹⁰ It may also help with negative body image.¹¹

Meditation in therapy

Some types of therapy incorporate meditation and mindfulness to address mental health issues. They include:

• Mindfulness-based stress reduction (MBSR), an eight-week program that teaches participants how to practice mindfulness.
• Mindfulness-based cognitive therapy (MBCT), which combines cognitive behavioral therapy (CBT) with MBSR. It was originally developed to treat depression.
• Certain somatic therapies, which may use meditation to explore the mind-body connection.

Additional therapies, such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), are based on mindfulness principles but don’t specifically require meditation. 

If you’re interested in finding a therapist who incorporates meditation or mindfulness into their treatment, browse our online directory. 

Guided meditation

Guided meditation is a format you can incorporate into many different practices. Many of the above practices—including body scanning, prayer, or yoga—can also be done with the help of a guide.

In a guided meditation, a person verbally leads you through the meditative process. The person may be a teacher leading an in-person group, or it could be a voice on a meditation app or podcast. You can even record your own guided meditation to use later.

While guidance isn’t necessary for meditation, it can be helpful for beginners who want someone to walk them through the experience.

Meditation for beginners 

It can be difficult to know where to start with meditation. Below are some best practices for getting started.

Be realistic with your time.

It’s important to set realistic goals for yourself as you start your meditation journey. You don’t have to meditate for an hour every morning at dawn.

Be honest with yourself about your obligations and energy levels at different times of the day. Are you a morning person or a night owl? Can you spare 15 minutes a day, or do you only have an extra five? Maybe it’s easiest for you to meditate in the five minutes every night where you get ready to fall asleep.

If you’re stretched for time, keep in mind that meditation can happen anywhere. If you miss a meditation session, try counting your breaths while on a walk, or over the kitchen sink as you wash dishes. You may be surprised at how easy it is to connect to the present moment in the middle of a normal task. 

Create a dedicated space.

You can meditate anywhere, anytime—but you may prefer to create a specific space to for it. You can designate an entire room or simply reserve one corner of a convenient space for your practice. If you have the option, consider choosing a spot with a view of nature, or adding objects that symbolize relaxation and connection.

Take your intention seriously.

Set a reminder on your phone at a specific time every day to practice. Put a note on the door to prevent family or roommates from interrupting. Allow yourself to commit fully to this new practice of mindfulness. 

Commit to finishing.

When you first start, you may feel silly, or be tempted to end your practice at the first distraction. But your goal shouldn’t be five minutes of perfect, distraction-free meditation. A successful meditation is simply one you see through to the very end. 

Don’t be afraid to set an alarm for five minutes during your first few sessions. If it’s hard to get past the first thirty seconds, let go of the judgment that you’re falling short and simply return to your breath. 

How to meditate properly

1. Settle: Find a position that’s comfortable for you. That could mean sitting cross-legged on the floor, sitting on your couch, or lying in your bed.
2. Focus: You can either close your eyes or leave them open. Take deep breaths, focusing on how you feel as you inhale and exhale. Some meditative practices may focus on words, phrases, or prayers, but breath is a great place to start.
3. Notice: Keep active attention on your breath. Notice where it goes, how your body feels, and what happens if you breathe more deeply. The point is not for your mind to go blank—it’s to be aware in the present moment.
4. Return: Your mind will likely wander from your breath. That’s okay. When you notice your mind has wandered, simply bring your attention back to your breath without judgment or condemnation.
5. End: You may choose to set a specific amount of time for your practice before you begin, or you can end when you feel it’s time. Notice your state of mind and how you feel before disengaging. Consider ending with kind thoughts or gratitude toward yourself.

If you find it challenging to practice on your own, consider using a dedicated app or podcast or podcast as a guide. They can provide structure and support as you build your practice.

Keep in mind that there’s no one right way to grow in your practice. Experiment with different techniques and find what works best for you. Consistency is key—try to meditate at the same time each day, even if it’s just for a few minutes.

If you’re struggling with a physical or mental health condition, talk to your doctor or a mental health professional to determine if meditation is the right path for you.

The post Meditation: Types, benefits, and techniques for beginners appeared first on therapist.com.

The first time I had a panic attack, I didn’t know I was having one. I was sitting on a tour bus in the Cayman Islands with my family, about to leave for a day trip.

Having just recovered from a 24-hour flu I’d caught onboard our cruise ship, I was still weak, a bit woozy—and very afraid of feeling nauseated on the bus. With that thought, I suddenly felt intense anxiety rush through my body. I began to lose control of my breathing. I was certain I would start hyperventilating and pass out.

The feeling passed after a few minutes, and I carried on like nothing had happened. It took me years to realize I’d experienced my first panic attack that day.

How to spot a panic attack

On that family vacation at age 21, I’d heard of panic attacks, but I didn’t know what they looked or felt like. Years later, while researching the topic for a professional project, I learned about the telltale signs:¹

• Rapid heartbeat
• Shortness of breath
• Chest pain
• Hot flashes or cold sweats
• Dizziness
• Nausea
• Shakiness

Anxiety attack vs. panic attack

I thought I’d had anxiety attacks before. But then I found out there isn’t really such a thing as an anxiety “attack”—it’s just regular anxiety. Because everyone experiences anxiety differently, there’s no diagnostic definition for that type of attack.

A panic attack is a sudden and much more intense episode of anxiety. Anxiety is usually triggered by something, but a panic attack can come out of nowhere.

Anxiety and panic attacks have similar symptoms, but panic attacks can make you feel like you’re losing control of your brain and body. If this happens to you frequently, or you find yourself worrying about when it might happen again, that may be a sign of panic disorder.²

5 ways to calm down during a panic attack

I’m lucky my first panic attack lasted only a few minutes and went away on its own. Panic attacks tend to peak within 10 minutes, but for some people, they can last for hours. If you ever find yourself having one, here’s how to help calm yourself down.

4-4-4 breathing

Deep breathing is one of the best things to do when you feel stressed.³ The 4-4-4 breathing method, also known as box breathing, uses increments of four seconds as follows:

1. Close your eyes.
2. Exhale completely through your nose.
3. Inhale through your nose for four seconds.
4. Hold your breath for four seconds.
5. Exhale through your nose for four seconds.
6. Repeat. 

Another option is the 4-7-8 breathing method, which follows the same steps—except you hold your breath for seven seconds and exhale for eight. The slightly longer hold and exhalation may help you feel more relaxed.

Relax your muscles

Anxiety and panic can cause you to tense up and feel even more uncomfortable. By relaxing your muscles, you can help reduce some of the physical symptoms of anxiety.⁴

Try this progressive muscle relaxation technique, starting at the top of your head and working your way down:

1. Tense the muscles in your face, including your jaw, eyebrows, and forehead.
2. Hold for five seconds.
3. Loosen your facial muscles and let go of the tension.
4. Next move down to your neck and shoulders. Tense the muscles by shrugging your shoulders up to your ears.
5. Hold for five seconds.
6. Let go of the tension and feel the muscles relax.
7. Continue down your body, tensing and relaxing each muscle group for five seconds before moving on to the next: arms, chest, stomach, legs, and feet.
8. Once you’ve gone through all the muscle groups, take a deep breath and let your whole body relax.

It may seem strange to tense up on purpose right before or during a panic attack, but it really does help your muscles relax. Try practicing this tactic when you’re not having an attack, so when you sense one coming on, you’ll be better prepared to release tension and calm yourself down.

Move your body

Sitting or standing still during a panic attack can make your symptoms feel worse. Getting up and moving—even if it’s just pacing back and forth for a few minutes—can help you feel more in control.⁵

If you can, go for a walk outside or do some light stretching. Taking yourself out of the environment that’s causing your anxiety may also help ease your symptoms.

If you feel a panic attack coming on when you’re somewhere you can’t get up and move, like a bus or a plane, try these basic hand movements to help ground yourself and reduce the intensity of the attack.

• Clench and unclench your fist
• Rub your hands together
• Place the palms of your hands in prayer position and push them against each other
• Tap your fingers on a hard surface

Doing something with your hands can help take your mind off anxiety and refocus it elsewhere. The movement might also help release some of the physical tension you’re feeling.

Focus on an object

When you’re in the middle of a panic attack, it’s hard to think about anything else. But if you can find another focal point, it may help take your mind off your symptoms and calm you down.

Look for something in the room that you can fix your gaze on: a picture on the wall, a pattern in the carpet, a crack in the ceiling. Once you pick your focal point, concentrate on it intently and try not to let your mind wander.

If you wear a watch with a dial, try this technique:

• Look at your watch and pick a spot on the dial.
• Without taking your eyes off that spot, mentally trace the shape of the numbers around it.
• Once you’ve gone all the way around, start over and trace the shape again.
• Repeat until your panic attack subsides.

Focusing on an object is another way to help take your mind off what you’re feeling. The repetitive tracing can be soothing and help ease panic attack symptoms.

Repeat a mantra to yourself

A mantra is a phrase you repeat to yourself over and over. It can be something as simple as “I am calm” or “This will pass.”

Saying the mantra out loud can help, but if you’re in a public place and don’t feel comfortable with that, just say it silently to yourself. Make sure to enunciate the words clearly in your mind.

You can also try this similar strategy:

1. Pick a word with personal meaning to you, like “love” or “peace.”
2. Repeat the word over and over, out loud or silently, until the panic subsides.
3. Be sure to enunciate each syllable clearly.

Repeating a mantra can help refocus your mind and ease panic symptoms.⁶ It may also help you feel more in control and less fearful.

How to prevent nighttime panic attacks

Nighttime panic attacks can be especially frightening. They have the same symptoms as regular panic attacks, but they also wake you up and can make it difficult to fall back asleep. Even though they’re fairly common, experts don’t really know why they happen.

If you find that your panic attacks strike at night, make sure you’re following a good sleep hygiene routine:

• Create a relaxing bedtime ritual, such as reading, journaling, or meditation.
• Avoid caffeine, alcohol, and other substances before going to bed.
• Eat your last meal of the day at least three hours before bedtime.
• Making sure your bedroom is cool, dark, and well ventilated.
• Take a hot shower or bath before going to bed.

How to get help

As someone who understands firsthand how debilitating panic attacks can be, I want you to know there’s no shame in reaching out for help. A mental health professional can help you understand your anxiety and develop coping mechanisms to deal with symptoms. Some medications can also be effective at treating anxiety and panic disorders.

Visit our directory to find a licensed therapist near you.

The post How to calm down during a panic attack appeared first on therapist.com.

Anxiety disorders affect an estimated 31.1% of U.S. adults at some point in their lives.¹ But you don’t need a clinical diagnosis to experience anxiety symptoms.

The connection between breathing and anxiety

When anxiety strikes, your breathing may become shallow and rapid—a pattern called thoracic or chest breathing.² This breathing style can actually intensify feelings of stress and anxiety, creating a troubling cycle.

Controlled breathing techniques work by activating your parasympathetic “rest and digest” nervous system.³ By deliberately changing how you breathe, you can interrupt the anxiety cycle, triggering calming responses throughout your body and mind.

Here are five effective breathing techniques to help manage anxiety in your daily life.

It’s important to note that not all breathing exercises are safe for all people. Consult a medical or mental health professional before making breathing exercises a part of your routine, especially if you have respiratory conditions or a history of trauma or panic disorders.

If these breathing exercises are not an accessible option for you, other grounding techniques like visualization or progressive muscle relaxation may be useful.

Exercise 1: Belly (or “diaphragmatic”) breathing

Diaphragmatic breathing, also known as belly breathing, involves breathing deeply into your diaphragm rather than shallowly into your chest.

This technique has been shown to reduce both physical and psychological stress in adults, including lowering cortisol levels (a stress hormone), blood pressure, and breathing rate.⁴

How to practice:

1. Sit or lie comfortably with one hand on your chest and the other on your stomach.
2. Breathe in slowly through your nose, feeling your stomach expand (your chest should move only slightly).
3. Exhale slowly through pursed lips as if you’re whistling, feeling your stomach fall.
4. Repeat for at least five minutes.

Exercise 2: Cyclic breathing

Cyclic breathing (also called “cyclic sighing”) emphasizes a double inhale followed by a prolonged exhale, which can create a powerful calming effect on your nervous system.

Research shows that cyclic sighing is more effective at improving mood and reducing respiratory rate than both mindfulness meditation and other breathing techniques.⁵ These results also appear to last over time.

How to practice:

1. Find a comfortable position sitting or lying down.
2. Inhale slowly through your nose, feelings your lungs expand.
3. Take a second inhale to fully fill your lungs (this second breath will likely be shorter than the first).
4. Exhale slowly and completely through your mouth.
5. Repeat for five minutes.

Exercise 3: Mindful breathing

Mindful breathing combines controlled breathing with focused attention on the present moment and bodily sensations. It’s often taught as part of mindfulness meditation.

One small study showed mindful breathing can reduce test anxiety, increase positive thoughts, and improve mood.⁶ It may be even more effective than training focused on identifying and changing negative thoughts.

How to practice:

1. Sit comfortably with your back straight.
2. Focus your attention on your breath.
3. Notice the sensation of air entering and leaving your body.
4. When your mind wanders (which is normal), gently redirect your focus back to your breath.
5. Practice for at least five minutes daily.

Exercise 4: Bhastrika pranayama (“bellows breath”)

“Pranayama” refers to a set of breath control techniques from the yoga tradition. While there are many types, Bhastrika pranayama (or “bellows breath”) is particularly effective for anxiety.

A four-week randomized controlled trial focused on Bhastrika pranayama found participants had less anxiety and negative emotions while also reporting more positive feelings.⁷ Brain scans also revealed changes in regions critical for emotional regulation.

How to practice:

1. Sit comfortably with your spine straight.
2. Take a few regular, deep breaths in and out through your nose and mouth.
3. When you’re ready to begin, exhale forcefully through your nose while contracting your abdominal muscles.
4. As soon as you’ve finished exhaling, inhale with equal force.
5. Do 10 rounds of forceful inhales and exhales. They should be audible.
6. After the last exhale, take a deep breath in and hold briefly.
7. Exhale slowly and rest for a moment before repeating two more times.

It’s important to note that this breathing exercise in particular could increase abdominal pressure and may not be safe for people who are pregnant or those with certain health concerns.

Exercise 5: 4-7-8 breathing

The 4-7-8 breathing technique was developed by Dr. Andrew Weil with inspiration from the pranayama practice.⁸ It’s been shown to reduce anxiety as well as lower heart rate and blood pressure.⁹

One study of patients after bariatric surgery found that 4-7-8 breathing was even more effective at reducing anxiety than standard deep breathing exercises.¹⁰

How to practice:

1. Sit comfortably with your back straight.
2. Place the tip of your tongue against the ridge behind your upper front teeth.
3. Exhale completely through your mouth, making a whoosh sound.¹¹
4. Close your mouth and inhale quietly through your nose for a mental count of four.
5. Hold your breath for a count of seven.
6. Exhale completely through your mouth for a count of eight, making the whoosh sound again.
7. Repeat the cycle three to four times.

How to get the most out of these exercises

To get the most that you can from these breathing techniques, follow these guidelines.

How long to practice: Research suggests you only need five minutes sessions to create strong results, though sessions any shorter than that aren’t as reliably effective.¹²

How often to practice: Practicing daily has been shown to yield strong results.¹³

Getting the technique right: While these instructions are a great starting point, guided instruction can make all the difference. Apps, videos, and in-person classes can all help ensure you’re performing techniques correctly and adding to your toolbox.

Building it into your routine: Try incorporating these breathing exercises into natural pauses in your day. That may be when you first wake up, during your commute, before important meetings, or as part of your bedtime routine. You could also try:

• Setting reminders on your phone for breathing breaks throughout the day
• Practicing before stressful events or meetings
• Using breathing techniques at the first sign of anxiety

When to seek additional help

While breathing techniques can be powerful tools for managing everyday anxiety, they aren’t a replacement for professional treatment.

Seeking professional help may be especially useful if:

• Your anxiety interferes with daily activities or relationships
• You experience panic attacks
• Your anxiety continues despite using self-help strategies
• You have thoughts of harming yourself

If you or someone you know is having thoughts of self-harm or suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

Remember that you don’t need to experience any particular amount of anxiety to justify seeking help. A mental health professional can provide a proper diagnosis and recommend appropriate strategies for whatever challenges you’re facing.

Visit our directory to find qualified mental health professionals in your area who specialize in anxiety management.

The post 5 of the best breathing exercises for anxiety appeared first on therapist.com.

What is progressive muscle relaxation?

Progressive muscle relaxation (PMR) is a simple relaxation technique you can use to calm your body and mind. It involves tensing and release different muscle groups to help you relax.

When you practice PMR, you’re using both “top-down” (brain-led focus) and “bottom-up” (body signals to the brain) processes.¹ Your brain tells your muscles to tense and then relax, and your muscles send calming signals back to your brain. This two-way loop helps many people feel relief quickly.

How to do progressive muscle relaxation

PMR sessions can be quick and effective for relaxation. Many people start with 10 to 15 minutes and build from there.² Here’s a simple step-by-step process:³

1. Settle into a comfortable position, sitting or lying down, in a space with as few distractions as possible.
2. Start at your feet. Gently curl your toes to create light tension for about 5 seconds, then slowly release. Notice the sensation as the muscles soften.
3. Move your focus to your lower legs. Tighten your calves briefly (5 seconds), then relax them slowly over several seconds, paying attention to the difference between tight and loose.
4. Engage the hips and buttocks. Tense gently for 5 seconds, then let go slowly, allowing the area to relax.
5. Tighten the stomach and chest a comfortable amount for 5 seconds, then release over several seconds, feeling the breath and the ease that follows.
6. Lift your shoulders toward your ears to create mild tension for 5 seconds, then drop them and relax for 10 seconds.
7. In your face, make a gentle “scrunch” (for example, lightly squeeze the eyes) for 5 seconds, then soften for 10 seconds.
8. Form a soft fist with each hand for 5 seconds, then open and relax your fingers for 10 seconds, noticing the release.

Note: Keep tension gentle, never to the point of pain, and breathe slowly throughout. If any area is sore or injured, skip or modify that step. If you have medical conditions that restrict movement, PMR may not be a good fit. For relaxation techniques tailored to your needs, consider working with a licensed therapist to get supportive care.

Benefits of progressive muscle relaxation

Lower stress, anxiety, and depression

Across 46 publications involving more than 3,400 adults, PMR reduced stress, anxiety, and depression.⁴ Benefits were even greater when PMR was combined with other techniques.

Another study found stressed teens who practiced PMR for eight weeks reported lower anger and better quality of life.⁵

Improved sleep

If you want better sleep, try PMR before going to bed. In a laboratory study with healthy young adults, doing PMR before a 90-minute nap increased slow-wave sleep (deep, restorative sleep) by about 10 minutes compared to listening to music.⁶

PMR can also improve sleep in people with certain health challenges. In patients with chronic obstructive pulmonary disease (COPD) and COVID-19, PMR was linked to better sleep quality and less anxiety in multiple trials and reviews.⁷

Pain relief and better quality of life

PMR can help ease pain and boost daily well‑being. In a review of 12 randomized trials with cancer patients, PMR reduced anxiety and pain and improved quality of life.⁸ Thoughmore research is needed, PMR could be a helpful support of mental health during treatment.

One study found that a four‑week program combining guided imagery and PMR lowered pain and fatigue and improved health‑related quality of life in patients undergoing chemotherapy.⁹ Pairing PMR with relaxing music during cancer treatment also supported better mood and sleep, which can make pain easier to manage day to day.^10,11

Improved vital signs and blood pressure

PMR may support physical health when used as part of a broader care plan. In one study of people with essential hypertension, four weeks of PMR (alone or with slow breathing) reduced heart rate, breathing rate, blood pressure, and perceived stress.¹²

PMR and mindfulness

In a small study of dialysis patients, 12 weeks of mindfulness meditation combined with PMR improved strength tests and multiple quality‑of‑life measures.¹³ This suggests that when paired with complementary mind‑body strategies, PMR could help positively effect outcomes.

Ready for support?

Progressive muscle relaxation is a powerful regulation tool, and it can be even more effective with guidance. A therapist can help you build a toolkit of coping skills best suited to you. They can also help you create routines that work in your life. If you’d like tailored support, visit our therapist directory, to connect with a licensed mental health professional.

The post Progressive muscle relaxation (PMR): What it is and how to practice appeared first on therapist.com.

Whenever I start a new workout regimen, I can’t seem to stick with it. I always find myself returning to old habits just a few weeks later. Every time this happens, I feel like a failure who can’t accomplish anything. Sometimes I get so fed up and angry that I give up on all my healthy habits.

Sound familiar? Feelings like this are common, thanks to what’s known as an “inner critic.”

Why we self-criticize

We criticize ourselves for two main reasons. First, our brains evolved to solve problems, which helps explain why we fixate on them. And second, we’ve all been raised or influenced by others to believe certain things about ourselves or treat ourselves in certain ways.

Parents, older siblings, teachers, peers, bullies, and society in general all impact how we learn to think about ourselves. Even if we were raised by loving and supportive people, it’s still very common to feel like we’re lacking something or that we’re not good enough.

As a result, we find ourselves unconsciously refusing to accept and embrace certain parts of who we are. We think we need to change to become better, and most of us do this the only way we know how—by criticizing and punishing ourselves.

Silencing your inner critic through self-compassion

Thoughts are powerful. They have the capacity to shape our behavior, which is why moving toward a more self-compassionate frame of mind is the key to overcoming self-criticism.

Being self-critical doesn’t work to bring you closer to who you want to become. If you’re too focused on finding fault or even rejecting yourself, it’s hard to find space for growth. 

The term “self-compassion” was coined fairly recently, although the concept has been practiced by Buddhists for much longer.¹ In a nutshell, it means treating yourself the way you’d treat a close friend or family member. Think of it as a way of relating to yourself through kindness, mindfulness, and a sense of common humanity.

When you’re self-compassionate, you’re not giving up or being weak—you’re simply acknowledging and accepting your flaws alongside your strengths. Research has shown that self-compassion is associated with lowering stress and depressive symptoms.² It may also indirectly help improve physical health by empowering people to adopt healthy lifestyle habits and behaviors.³

It’s easier to grow and transform as a person when you’re willing to accept your whole self, and self-compassion is a powerful tool that can help you get there.

How to practice self-compassion

Becoming more compassionate with yourself is easier said than done, especially when it comes to negative thoughts. Here’s how to get started.

Forgive and accept yourself

The key to accepting yourself lies in understanding that your past mistakes and failures don’t define you. What really matters is that you’re here now—and able to move forward.

If accepting yourself as you are now feels difficult:

1. Take some time alone to sit with yourself and feel your emotions.
2. Name those emotions.
3. Identify your strengths, your values, and what you’ve learned from past mistakes.
4. Talk yourself through what you would have done differently if you’d known then what you know now.
5. Optionally, write yourself a letter about how you feel. After reading it out loud to yourself, destroy the letter (safely, of course).

Notice negative self-talk

It can be hard to put a stop to negative self-talk if you’ve been doing it for years without realizing. The first step is to become mindful of when it happens.

Heighten your level of awareness. Take note of when your internal voice turns critical. Does it happen in certain situations? At certain times of the day? When you’re with certain people? The simple act of noticing these thoughts, examining them, and realizing that they’re only thoughts, not facts, can be enough to spark a shift.

Identify patterns. Many of our thoughts repeat on a daily loop. Try to notice negative statements you might make to yourself regularly, like “I can’t do this” or “I’m such a loser.”

Tune into how you feel. Are you angry, sad, or frustrated when you hear your inner critic? Turning your awareness to your emotions and observing them for what they are can help stop negative self-talk in its tracks.

Have constructive conversations with yourself

Your inner critic isn’t the only voice you have. It only seems that way because you’ve been listening to it for so long that it’s overpowered everything else.

You can learn to shift your inner critic to a much more understanding, supportive, and positive voice by identifying and engaging with it. The goal is to challenge what your inner critic tells you.

You can do this by:

• Talking back to negative thoughts by questioning their validity
• Asking yourself questions about your value as a person
• Using positive affirmations to reinforce the direction you want to go in your life

Be grateful

Gratitude is a simple practice you can do anytime and anywhere to shift your inner voice away from negative self-talk. Even if all you do is appreciate yourself for waking up on time or remembering to put your car keys in your bag, it makes a difference. When practiced regularly, gratitude has been scientifically proven to make us happier.⁴

Always be kind to yourself

Your inner critic was created by you, for you, by gathering all the negative thoughts and doubts that have held you back in life. In some respects, it’s trying to be protective and keep you from getting hurt again, but that doesn’t mean it can’t hurt you on its own.

Talking back to your inner critic can you help you show yourself some understanding. Ultimately this is about changing the way you think, not about trying to shut off your thoughts or lower your level of intuition.

Ask for support if you need it

If you find it difficult to handle your own negative self-talk and it continues to affect your everyday life, you may benefit from working with a therapist. Cognitive behavioral therapy (CBT), for instance, is a very popular and effective type of therapy that involves identifying negative thoughts and challenging them.

Browse our therapist directory to find someone who can help you take control of your inner critic and start treating yourself with the kindness, compassion, and love you deserve.

The post How to be more self-compassionate appeared first on therapist.com.

What is caffeine addiction?

“Caffeine addiction” is a term that refers to a behavioral condition where you feel a compulsive need to consume caffeine regularly. Being dependent on caffeine can make cutting back difficult, even when you’re aware of the negative effects.

Can you be medically addicted to caffeine?

The line between habit and addiction can sometimes be unclear. Caffeine use disorder involves consuming caffeine even though it causes problems, but it isn’t an official clinical diagnosis.¹

So far, researchers have found that caffeine can affect people similarly to addictive drugs, raising health concerns.² However, we need more studies to fully understand how common and serious caffeine addiction and dependence truly is.

Caffeine addiction vs. dependence

Many people who think they’re addicted to caffeine actually have a dependence. Addiction involves uncontrollable use even when there are harmful consequences. Dependence, on the other hand, means needing it to avoid withdrawal and function properly. Despite these differences, some people might use these terms interchangeably.

Dependence on caffeine is hardly unusual. It’s the most popular psychoactive substance in the world, with an estimated 75% to 80% of the global population consuming it regularly.³

How long does it take to get addicted to caffeine?

Developing an “addiction” to caffeine can vary greatly depending on the person. Research shows that caffeine dependence can develop quickly.⁴ Consuming caffeine for as little as a week can cause tolerance, requiring higher doses for the same effects.

Am I addicted to caffeine?

Recognizing a dependence on caffeine can be tricky since it’s such a popular stimulant. Here are some signs of a potentially unhealthy relationship with caffeine:

• Strong cravings: You feel an intense urge to consume caffeine and find it hard to resist.
• Increased tolerance: Over time, moderate amounts of caffeine stop being effective and you need more to feel the impact.
• Physical withdrawal: Skipping your regular caffeine dose leads to headaches, irritability, or fatigue.
• Inability to cut back: You’ve tried to reduce consumption but failed.
• Large amounts consumed: Your intake of caffeinated products, even pills, is in large quantities despite knowing the risks.
• Interference with daily life: Your need for caffeine affects your daily responsibilities or social interactions.

Knowing these signs can help you determine if your relationship with caffeine might be problematic. A therapist can help you manage and address any underlying issues that may contribute to your caffeine use.

Caffeine addiction withdrawal symptoms

A caffeine addiction or dependency can lead to withdrawal symptoms when you try to go without. Caffeine withdrawal, while milder than drug or alcohol withdrawal, can still cause discomfort and disrupt daily activities.

Symptoms of caffeine withdrawal include:

• Headache
• Sleep problems
• Fatigue
• Depressed mood
• Irritability
• Anxiety 
• Trouble concentrating
• Hand tremors
• Low energy
• Brain fog

The severity of these symptoms depends on how much caffeine you typically consume. People who consume large amounts of caffeine are more likely to experience severe symptoms.

How to stop caffeine addiction the healthy way

To stop caffeine addiction, it’s important to understand that gradual reduction is more successful than going cold turkey. Going straight to zero caffeine can lead to uncomfortable withdrawal symptoms that may be hard to cope with.

Instead, try these tips:

Cut back gradually. Lower your consumption by 10% to 25% per week until you reach a comfortable level.

Replace caffeinated beverages with decaf versions. Decaf coffee, herbal tea, sparkling water, and caffeine-free sodas are all great options.

Limit caffeine to certain times of day. Try limiting yourself to one caffeinated serving in the morning or giving yourself a cut off time after which you don’t have caffeine.

Stick to only one source of caffeine. Chocolate, certain supplements, and some over-the-counter medications contain caffeine. Try limiting yourself to only one form of caffeine in a day.

Caffeine addiction treatment options

Treatment for caffeine addiction often includes behavioral strategies. A single session of cognitive behavioral therapy (CBT), for instance, has been shown to help people cut back on caffeine.⁵ Research suggests that more people are seeking treatment to help cut back on or eliminate caffeine use.⁶

Keep in mind that breaking the caffeine cycle can take time and depends on the person. It could take as little as a few days or weeks to as long as several months to completely overcome addiction.

Can caffeine be good for you?

Caffeine isn’t all bad. When consumed in moderation, it can actually offer some health benefits. The most notable ones include:

Improved cognitive function. Studies have shown that caffeine can improve reaction time, alertness, and logical thinking even when you’re low on sleep.⁷

Anti-aging effects on the brain. Caffeine may help prevent dementia and cognitive decline.⁸ Studies also show a link between higher caffeine intake and a lower risk of developing Parkinson’s disease.⁹

Improved physical performance. Caffeine improved anaerobic performance in both elite and amateur athletes.¹⁰

Decreased risk of heart disease. Consuming two to three cups of coffee daily may lower cholesterol and the risk of diabetes and fatty liver disease.¹¹

How much caffeine is safe?

Consuming up to 400 milligrams of caffeine per day is safe for most adults—that’s the equivalent of about four cups of coffee.¹² Keep in mind that some people are more sensitive to caffeine than others. You may need to limit your intake further to avoid side effects like anxiety, “the jitters,” or difficulty sleeping. 

Caffeine can be perfectly safe and even healthy, but don’t forget about all the other ingredients in your caffeinated beverages or food. For example, sugary syrups, milk, and creamers can cause their own health impacts when consumed regularly.

Get help with your caffeine addiction

If you’re struggling to break your caffeine dependency on your own, consider speaking with a doctor or mental health professional. They can help you get to the root of the problem and teach you healthy ways to cope with stress or anxiety. Visit our directory to connect with a licensed therapist near you.

The post Caffeine addiction: What it is and how to break it appeared first on therapist.com.

Are you wondering if you have attention-deficient hyperactivity disorder (ADHD)? It’s typically diagnosed in childhood, but sometimes it can go unrecognized until adulthood.

ADHD can be hard to pinpoint because symptoms are often mistaken for bad habits or a lack of motivation. It’s easy to dismiss your behavior as something you do to cope with everyday stress, but if it’s impacting your work, relationships, and daily life, it may be time to talk with a mental health professional.

How is adult ADHD different from childhood ADHD?

ADHD is a brain-based disorder that affects attention, impulsivity, and hyperactivity. It’s the same disorder in children as it is in adults, but the symptoms may look different.

Symptoms tend to be easier to notice and identify in children because their brains and bodies are still developing. In kids, ADHD often manifests as impulsive behavior, hyperactivity, and trouble paying attention. In adults, it may present as disorganization, procrastination, and forgetfulness.

ADHD is more likely to be diagnosed in boys and missed in girls because of how differently they express symptoms.¹ Some children outgrow their symptoms as they age, but others don’t. Those who don’t often learn coping mechanisms as they develop into their adult selves, so their symptoms may be more subtle than in childhood.

Types of adult ADHD and their symptoms

There are three different types of ADHD in adults: mostly inattentive, mostly hyperactive-impulsive, or a combination of the two.

Inattentive ADHD

Inattentive ADHD involves struggling to focus and follow through on tasks. Symptoms may include:

• Trouble paying attention: You may find it hard to focus on work or conversations. Your mind may wander, and you may miss important details.
• Trouble remembering details: You may forget to do things like pay bills or return calls. You may also have trouble following directions and keeping track of conversations.
• Disorganization. You may have trouble completing tasks, meeting deadlines, and keeping track of your belongings. Your home and office may be cluttered, and you may feel like you’re always behind.
• Procrastination. You may start projects but have trouble finishing them. You may put off tasks that you don’t want to do or that seem overwhelming.

Hyperactive-impulsive ADHD

Hyperactive-impulsive ADHD is characterized by impulsive and hyperactive behavior. Symptoms may include:

• Restlessness: You may feel like you’re always on the go, even when you’re not. You may also have trouble sitting still for long periods of time and find it difficult to resist fidgeting.
• Excessive talking: You may find yourself talking nonstop, even when it’s inappropriate or you’re not sure what you’re saying.
• Trouble waiting your turn: You may have trouble waiting in line or taking your turn to speak. You may interrupt others or blurt out answers before people have finished asking a question.
• Acting without thinking: You may do things without thinking about the consequences. You may make impulsive decisions, like buying something you don’t need or engaging in risky behavior.

Causes of adult ADHD

The exact cause of ADHD is unknown, but it’s thought to come from a combination of genetic and environmental factors. This disorder often runs in families, so you may be more likely to have it if your parents or siblings do.²

ADHD isn’t caused by poor parenting, eating too much sugar or processed food, playing a lot of video games, or watching too much TV. Certain brain injuries or problems with the structure or function of the brain may contribute to ADHD, though. For example, babies born prematurely have a higher risk of receiving an ADHD diagnosis in their lifetime.³

Environmental factors like exposure to toxins or stress may also play a role. An example of exposure to toxins would be parents who smoke and drink alcohol while pregnant. Those who do are more likely to have children with ADHD.⁴

How is adult ADHD diagnosed?

About 30 to 60% of children with ADHD continue to show significant symptoms of the disorder into adulthood.⁵ For any ADHD diagnosis, the symptoms must have started before age 12, although how it looks in any one person may change over the years.

Problems must appear in at least two settings (such as work, home, community, or school) and interfere with how you function in these settings.

Many different health care professionals can diagnose ADHD in adults, including:

• Primary care doctors
• Psychiatrists
• Neurologists
• Clinical psychologists
• Nurse practitioners
• Clinical social workers
• Other licensed counselors or therapists

Your health care provider may gather information by:

• Asking about your family history of mental health
• Reviewing symptoms that started before age 12 (using self-reports, school records, etc.)
• Ruling out other mental health conditions
• Identifying how your symptoms affect work, community, or home functioning
• Using ADHD screening tests

If you’re diagnosed with ADHD as an adult, your health care provider will work with you to develop a treatment plan.

Treating adult ADHD

There are several treatment methods that can help you manage ADHD symptoms effectively. These may include:

Medication: Stimulant medications such as methylphenidate (Ritalin) and amphetamines (Adderall) are commonly used to treat ADHD. These drugs can help improve focus, concentration, and impulsivity. Nonstimulant medications, such as bupropion (Wellbutrin), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs), may also be used to treat ADHD.

Psychotherapy: Individual, group, or family therapy can help you identify and manage your symptoms, as well as improve your relationships with others. Counseling can also support you in developing problem-solving and coping skills.

Self-help or support groups: These groups provide social and emotional support from others with ADHD. They also provide an opportunity to share tips for managing symptoms, work through challenges, and gain insight into your condition. Many local Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD) chapters offer free or low-cost support groups for adults with ADHD.⁶

Complementary and alternative therapies: Some people find relief from symptoms of ADHD by using therapies such as neurofeedback, acupuncture, omega-3 supplements, and yoga. Please keep in mind that these therapies are not a replacement for evidence-based treatments like medication and psychotherapy.

No one treatment works for everyone, so it’s important to work with your health care provider to find a plan that’s right for you. In many cases, health care providers recommend a combination of medication, therapy, and lifestyle changes to manage adult ADHD.

Living with adult ADHD

If you’ve been diagnosed with adult ADHD, there are steps you can take to manage your symptoms and live a healthy, productive life. At work, these may include:

• Clearing your workspace of distractions
• Getting a visible clock and using timers for tasks
• Creating a to-do list and using a planner
• Creating checklists for projects, including how much time each step may take
• Breaking up big tasks into smaller ones
• Giving yourself more time than you think you need to complete tasks
• Using an electronic filing system
• Recording instructions or meetings, and asking for written instructions
• Asking a colleague to be your “accountability buddy” to help each other stay on track
• Finding a mentor to help you prioritize tasks

To manage adult ADHD at home, try the following:

• Staying organized with lists and alerts on your phone or computer
• Using a wall or digital calendar to keep up with appointments, events, and deadlines
• Designing a daily routine and sticking to it as much as possible
• Minimizing distractions by turning off the TV, radio, or social media when you need to focus on a task
• Automating certain tasks like paying bills
• Cleaning your home with a robotic vacuum
• Asking for help from friends or family members with tasks like cooking, cleaning, and childcare
• Exercising regularly to help relieve stress and improve focus
• Getting enough sleep to help improve concentration and energy levels

With a proper treatment plan, many people with ADHD can lead productive, successful lives. If you think you may have adult ADHD, browse our directory to find a mental health professional who can help.

The post Do I have adult ADHD? appeared first on therapist.com.

There’s nothing quite like stumbling across a terrible news story online and wanting to absorb every aspect of it for seemingly no good reason. Some people do it because they’re bored, some as an escape from reality, and others because they’re genuinely curious. 

It’s called doomscrolling—or sometimes doomsurfing. And as the name suggests, it’s a phenomenon specific to browsing the internet. 

What is doomscrolling? 

Imagine yourself scrolling through your social media feeds or your favorite news sites, only to find nothing but negative news. You continue to scroll or read through them anyway. This is exactly what doomscrolling is. 

Even though these news stories can trigger strong negative thoughts and feelings, the pull to keep scrolling is stronger than the desire to stop. You’re “scrolling into doom,” so to speak. 

The COVID-19 pandemic is a good example of a worldwide event that led to an increase in doomscrolling as news about the virus broke.¹ There was a lot happening in the world and fewer options for distractions, so doomscrolling quickly became a common and convenient habit for many.

Other doomscrolling examples 

Most people doomscroll without even realizing it. Here’s what it can look like: 

On Facebook, you find yourself interested in clicking on news stories related to climate change. The algorithm picks up on this, and soon every article you scroll through is another story about how climate change will cause wars or famine, or how it will increase the number of natural disasters. You can’t stop scrolling, clicking, scrolling, and clicking. 

On Twitter, you notice a news story about a missing person’s case and begin replying to tweets about it. Soon after, you start seeing tweets about missing people’s cases all over the country. The more you scroll, the more depressing and violent stories you come across. 

On a local news website, you click on a story and scroll down to the comments section, where you see people complaining about the municipal government. The more you read through the comments, the more negative people’s responses get. 

Why do we doomscroll? 

Believe it or not, our brains are hardwired to pay attention to and absorb negative news—and we have evolution to thank. 

Since the dawn of humankind, our brains have learned to give more weight to negative information than positive information. This used to help us predict the future so we could try to avoid danger. 

Unfortunately, we now regularly see and hear bad news everywhere we go, and our brains haven’t evolved enough to tell the difference between what’s a real threat to our survival and what isn’t. As a result, it takes a higher level of awareness to overcome the human instinct to see perceived threats for what they really are. 

When we’re most likely to doomscroll 

Doomscrollers are typically more likely to scroll through new stories in the evening or late at night because that’s when most of us are tired and looking for a way to relax with minimal effort. Decision fatigue also contributes to doomscrolling. This psychological phenomenon involves making worse decisions as the day goes on because your mind is tired from having to make decisions all day. 

How doomscrolling negatively impacts mental health 

It’s completely normal to pay attention to some negative news, but too much doomscrolling can be bad for your mental and emotional health. It can contribute to: 

• Stress 
• Fear 
• Anxiety 
• Sadness 
• Depression 
• Anger or aggressive behavior 
• Procrastination 
• Insomnia or trouble sleeping 
• Relationship problems 

People who struggle with anxiety may be especially drawn to doomscrolling because it can give them a false sense of control. In the long run, however, it can also make them feel worse. 

Negative news can also transcend time and location. It’s not uncommon for doomscrollers to ruminate on negative news when they go to sleep and first thing in the morning. Sometimes they experience sudden urges to check the news, then worry that they’re not getting enough information. These feelings can lead doomscrollers to think about the news even when they don’t want to. 

If doomscrolling is making you feel very anxious or depressed—or is impacting your ability to function in everyday life—you may want to seek help from a therapist. 

How to stop doomscrolling 

You can’t control the news, but you can control how you consume it. Here are some practical tips: 

Notice when something you see online makes you feel bad. Staying aware of your emotional responses to news can help you pinpoint the urge to doomscroll before it takes hold. This mindfulness skill can help you in more ways than just this one. 

Keep another activity on hand to replace doomscrolling easily. Journaling, doodling, or even playing an online game are healthier activities to try instead when you feel the urge to doomscroll. 

Know when you’re most likely to doomscroll. Is it when you get home from work? When you’re sitting on your couch after dinner? You’ll be better prepared to resist giving into the urge to doomscroll when you understand which environments, times of day, and emotional states are most likely to trigger this behavior for you. 

Limit your screen time. Keep smartphones out of the bedroom, shut down your computer when you’re not using it, and consider taking advantage of mobile apps that help you break bad screen time habits. 

Follow reputable news sources only. You can’t trust rumors or sensationalized headlines to provide you with an accurate picture of what’s happening in the world. Stick to established news outlets—especially those that fact-check their content. 

Avoid reading negative comments on social media from other users. While it’s natural to feel curious about what others think about a particular news story, many people can take their opinions too far, leaving you with a false or negative impression about what’s actually happening. 

Take advantage of social networking “mute” and “hide” buttons. You don’t necessarily need to unfollow or unfriend someone if you don’t want to see their content. Once the person has cooled down a bit, or after a news story has run its course, you can unmute or unhide them from your news feeds. 

Be aware of the media’s intentions. Bad news sells, plain and simple. Don’t let yourself believe that you’re being completely objective when reading the news—or that the news itself is necessarily objective. This is especially true when you choose to read something with a noticeably negative slant. Put the media’s motivations into perspective whenever possible, remembering that they can be biased regardless of their intentions. 

Read positive news stories, too. It’s not all bad news. Uplifting stories can help bring clarity to the negative ones. Of course, even positive headlines don’t always tell the whole story, but they can provide you with an opportunity to look on the bright side every once in a while. 

It doesn’t have to be all doom and gloom 

Becoming more conscious of how you spend your time and energy is the key to breaking your doomscrolling habit. The more you practice, the better you’ll get at resisting the temptation to get lost in a sea of negativity online. 

Start small. Apply one idea from the list of suggested tips above at a time. You don’t need to be perfect—you just need to get on the right track. And remember, the world may seem terrible at times, but perspective changes everything. 

The post Doomscrolling: What it is and how to stop appeared first on therapist.com.

Along with feelings like happiness, anger, and fear, sadness is one of the most basic emotions we feel throughout our lives.

While it’s normal, common, and even necessary, sadness can be incredibly tough to deal with. Unlike happiness, which is associated with reward, sadness is often associated with loss—a difficult experience people often try to push away rather than feel.

What does sadness feel like?

Sadness can involve many other emotions, including grief, sorrow, regret, disappointment, and loneliness. The overarching theme of these feelings is that something important has been lost—whether it was real (a relationship, a loved one, good health) or imagined (a dream, an opportunity).

Emotional effects

Sadness can make you feel:

• Overwhelmed
• Unable to focus or concentrate
• Disconnected from people and things you care about
• Guilty, worthless, or ashamed
• Helpless or powerless
• As if things are in disarray

In many cases, sadness can trigger other emotions like anger or frustration. For instance, sadness over losing a job might turn into anger toward your former employer, or frustration with the job market.

Another secondary emotion sadness can trigger is anxiety. People may worry about the future, ruminate on what could have been, or dwell on the past.

Physical signs

Like other emotions, sadness can also cause physical responses. When someone is sad, they may:

• Droop or slump
• Have trouble expressing themselves
• Be tearful
• Feel tense
• Get an upset stomach or headache
• Feel a sinking sensation
• Lack energy or be fatigued
• Eat more or less than usual
• Have problems with sleep

Many of these emotional and physical signs of sadness are also symptoms of depression, a serious mental health condition that requires professional treatment. If your sadness isn’t subsiding or is making it hard to function, please seek help from a mental health professional.

If you’re in crisis, help is available now: Call or text the free, confidential 988 Lifeline at 988 or text HOME to 741741 to reach the Crisis Text Line. Both resources are available 24/7.

Why we feel sad

Sadness and even low levels of depression are adaptive emotions that can serve a purpose,  encouraging us to make up for a loss or work toward healing.¹

Attachment (the emotional bonds you form with others) can often be a source of sadness. These bonds and connections help give life meaning, joy, and purpose, which is why losses involving them can be so hard.

Some of the most common ways people experience loss include:

• Grief: You may grieve the loss of a loved person, animal companion, or relationship.
• Transitions: Even positive changes like starting a new job or becoming a parent can involve loss.
• Loss of control: Getting sick, having financial troubles, or going through a divorce can make a person feel like they have less agency.
• Loss of self-esteem: Receiving criticism, experiencing rejection, or not meeting a goal can lower your confidence in your own worth.
• Unfulfilled expectations: When something meaningful you hoped for doesn’t come to pass, it’s a kind of loss.

There are many other reasons why you might feel sad in addition to the above. Stress, trauma, isolation, relationship conflict, substance abuse, chronic pain, generational trauma, bad news, and many other factors can all play a role in how we feel.

How sadness can help

The sadness you feel may be unpleasant and even feel unbearable at times, but it can also serve an important purpose. Depending on how you’re able to cope with it, sadness can offer benefits including:

Education, perspective, and growth. Experiencing and acknowledging difficult emotions can help you learn more about who you are, what you really think and feel, and what you care most about. Difficult feelings can also offer an opportunity to learn to deal with emotions in healthy ways—for instance, learning to be present in the moment without judgment.

Motivation. Sadness can be a powerful motivator. It can push you to make positive changes, find new meaning, and appreciate the good parts of life.

Empathy and connection. Sadness can prompt you to reach out to others, whether they’re loved ones or totally new acquaintances. Sadness can also help you gain understanding and sympathy for people going through their own difficult experiences. That understanding can make it easier to connect and offer support.

Release and healing. Expressing sadness and other emotions you may have been bottling up can be a relief. It can also help you start the healing process.

Physical health benefits. It’s normal to feel a complicated mix of positive and negative emotions, and some research suggests that engaging with this mix of feelings is linked to better physical health.²

How to cope with sadness

Sadness often passes naturally, but there are some things you can do to care for yourself and cope in a healthy way.

Allow yourself to feel sad. Acknowledging and accepting your sadness without judgment can help you move through it more quickly.

Practice self-compassion. Try to treat yourself with the same kindness you would offer to someone else.

Talk to people. It can help to open up with trusted friends or family members who can offer understanding, support, or encouragement.

Connect regularly. If you’re feeling lonely or isolated, seek out or set up regular opportunities to interact with others. Even short, friendly interactions with strangers can be a helpful part of your day.³

Get outside. Spending time in nature can make you feel less stressed and more connected to the world.

Get moving. Physical activity can boost your mood and energy. Even a short walk around the block can make a difference.

Write down your thoughts and feelings. Putting your thoughts into words can help you express what you’re feeling, make sense of your emotions, and develop a plan for moving forward.

Express yourself creatively. Activities like painting, drawing, writing, or playing music are excellent ways to release emotions.

Make time for relaxation. Techniques like meditation, stretching, or deep breathing can help calm your mind and body.

Set healthy boundaries. Establishing respectful parameters in your relationships and around your time, energy, and preferences can help your happiness by reducing stress and conflict.

Do something you love. Hobbies or activities you enjoy can be satisfying distractions as well as a source of pleasure.

Help others. Doing something nice for someone else can have a wide range of physical and mental health benefits. It can also shift your focus from yourself and help you feel connected and appreciated.

Find things to be grateful for. Focusing on the good things in your life while still acknowledging the sadness you feel can balance your perspective and make difficult emotions easier to bear.

Be patient. It’s important to remember that sadness doesn’t last forever and that you will eventually feel better.

Seek professional help if needed. Sadness may be a normal emotion, but that doesn’t mean you have to deal with it on your own. If you’re struggling, a therapist or counselor can offer help and support. Visit our directory to find a therapist today.

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What is codependency?

Codependency, also called “relationship addiction,” involves sacrificing your own needs to focus on those of a partner, friend, or family member. In a codependent relationship, one person relies on the other to meet their emotional, mental, financial, spiritual, or physical needs, and to validate their self-worth.

One or both people in a relationship can have codependent behaviors, and codependency can happen in almost any kind of relationship—including between family members, friends, romantic partners, coworkers, and caregivers and their charges.

Is codependency a mental illness?

Codependency is a learned behavior, not a mental illness—but it can be linked to or worsened by mental health concerns including:

• Anxiety
• Depression
• Addiction
• Low self-esteem
• Stress
• Narcissism

While codependency isn’t a mental illness, seeing a therapist can help you learn if a mental health disorder may be contributing to your codependent behavior.

What causes codependency?

Codependency is usually learned in childhood, and it’s heavily influenced by the family dynamic we grow up with. Risk factors for developing codependent behaviors include:

• Dysfunctional family dynamic: Growing up with bullying or criticism can make us feel insecure in relationships.
• Childhood neglect: A parent or caregiver who ignores a child’s needs, or who puts their own needs above their child’s, may promote codependency.
• Childhood abandonment: Having one or both parents leave can make us fear abandonment in other relationships.
• Anxious attachment: We can form an anxious attachment when a caregiver alternates between being affectionate and present, then distant and unavailable.
• Overcontrolling parents: A controlling or overprotective guardian can prevent children from learning how to set boundaries for themselves and understand safe limits.
• Childhood abuse or trauma: Physical, emotional, and sexual abuse and other childhood trauma can lead to codependency.
• Parents with undiagnosed or untreated mental illness: A caregiver’s untreated mental health condition (such as borderline, narcissistic, or dependent personality disorder) may cause a child to suppress their own needs.

Signs of codependency

It can be difficult to recognize or admit to our own codependent behaviors. The following can be signs of codependency:

• Low self-esteem: Struggling with your self-worth, believing you don’t deserve happiness, or searching for validation from others
• Lack of boundaries: Struggling to set boundaries with others; having a hard time saying no and putting your own needs first
• Perfectionism: Struggling to accept criticism, holding yourself to unrealistic standards, or becoming insecure when you make an error
• The need to save others: Feeling that it’s your job to protect your loved ones and fix problems for them
• Control issues: Feeling like your own self-worth depends on the well-being of others, and needing to help others (which may come off as being controlling)

What does a codependent relationship look like?

A codependent relationship lacks balance, with one person (or both) taking on the role of “giver” while struggling to voice or consider their own needs.

Signs of codependent behavior in a relationship include:

• Feeling the need to ask for the other person’s permission before doing daily tasks
• Feeling a sense of “walking on eggshells” around the other person to avoid conflict
• Trying to change or rescue the other person from abusive behaviors or addiction
• Feeling responsible for the other person’s actions
• Needing approval or validation from the other person
• Doing things for the other person even if it causes personal discomfort
• Giving up all alone time for the other person
• Feeling a lost sense of self because of a relationship

Examples of codependency

Spotting codependent behaviors in our own relationships can be especially challenging. Here are some examples of what it looks like:

• A woman’s partner has a substance use disorder: She thinks they’ll get sober for her if she shows them enough affection. She may blame herself for any relationship conflict and put their needs before her own.
• A recent graduate is offered his dream job out of state: But because of his mother’s mental health concerns, he decides to turn down the offer and stay close to home.
• A college student moves back in with their parents: Instead of looking for a job, they watch TV all day. Their parents still support them financially and let them stay for as long as they want.

Treatment for codependency

If it isn’t addressed, codependency can lead to or worsen anxiety, depression, low self-esteem, and feelings of emptiness. Codependent people often have an unclear sense of who they are and are at risk of forming less meaningful relationships or facing loneliness and isolation.

If you’re struggling with codependency, a therapist can help you begin to form healthier relationships with yourself and others. Some common treatment approaches include:

• Cognitive behavioral therapy (CBT) focuses on changing unhealthy thought and behavior patterns. It can help you reshape negative codependent thoughts and beliefs.
• Couples therapy offers a safe space for codependent couples to learn communication techniques, practice expressing their needs more effectively, and improve their independence.
• Family therapy can help address codependency (and its causes) among family members. 

Codependency is a learned behavior, which means that in many cases it can be unlearned. With a therapist’s help, you or your loved one can begin to move toward a healthier relationship approach. Browse our directory to find a licensed mental health professional near you.

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Why the cultural competence model needs to evolve

The idea behind cultural competence is simple: learn about your clients’ cultures so you can provide better care. This approach has helped many therapists connect with clients from different backgrounds.

But there are problems with thinking we can become “competent” in someone else’s culture. Research has shown that the competence model, while useful, can sometimes contribute to stereotyping or othering of patients.¹ When we think we know a culture, we might make assumptions about clients based on our interpretation of it alone.

The competence model also suggests that culture is somehow fixed, or experienced in a uniform way. But in reality, culture is always changing. It’s shaped by many factors, including where someone lives, their family history, and their personal viewpoint. No two people from the same cultural group are exactly alike.

Another issue is power dynamics. Cultural competence places therapists in the expert role. This can create problems if the therapist claims knowledge of a client’s cultural experience and the client doesn’t feel empowered to contradict them.

The shift toward cultural humility

Cultural humility offers a different approach. Instead of pressure to become “competent” in other cultures, it asks therapists to stay curious, humble, and open to learning.

The concept was first introduced by doctors Melanie Tervalon and Jann Murray-García in 1998.² They defined cultural humility as “a lifelong commitment to self-evaluation and critique, to redressing power imbalances … and to developing mutually beneficial partnerships with communities.”

Cultural humility is built around several core themes:

• Lifelong learning: You never stop learning about culture and diversity
• Self-reflection: You regularly examine your own biases and assumptions
• Power balance: You work to reduce power imbalances in therapy
• Client expertise: You recognize that clients are experts on their own lives

This approach adds nuance to how we think about the therapist-client relationship. Instead of the therapist being cast as a cultural expert, the client becomes the teacher about their own experience.

Cultural competence vs. cultural humility: Key differences

While these two concepts have different focuses, they actually work well together. Here’s how they compare:

Cultural competence:

• Focuses on gaining knowledge about different cultures
• Emphasizes skills and training
• Provides important foundational knowledge

Cultural humility:

• Focuses on attitude and approach to learning
• Emphasizes ongoing self-reflection
• Represents a lifelong process with no endpoint
• Addresses power dynamics

The key insight from recent research is that we need both.³ Cultural competence provides the “what”—the knowledge and skills we need. Cultural humility provides the “how”—the right mindset and approach to use that knowledge respectfully and effectively.

Some experts now use the term “competemility”—combining competence and humility.⁴ This recognizes that effective cross-cultural therapy requires competence and humility be used in tandem, rather than viewing them in competition to each other.

Why cultural humility matters for therapists

Cultural humility improves therapy in several ways:

• It builds stronger therapeutic relationships through curiosity
• It helps therapists recognize and address implicit bias
• It creates “cultural safety” where clients feel respected
• It leads to better understanding and stronger alliances

Beyond individual practice

Cultural humility isn’t just about individual therapists—it’s also about the organizations where we work. Mental health agencies, clinics, and hospitals must also practice institutional humility. This means examining policies, hiring practices, and service delivery models.

The National Association of Social Workers (NASW) recommends organizations create “culturally competent services and programs” and maintain “meaningful inclusion of clients and community members representing relevant cultural groups in decision-making.”⁵ When both individual therapists and their organizations embrace cultural competence and humility, it creates a more supportive environment for culturally responsive care.

Putting cultural humility into practice

Cultural humility isn’t just a nice idea to incorporate on occasion; it’s something therapists can practice every day. Here are some concrete ways to build cultural humility:

Start with self-reflection. Journal about interactions with clients in which you felt out of your depth or learned something new about their culture. Did you leave enough space to understand their perspective? Is there something you would have done differently?

Admit what you might be missing. If you’re worried you’re missing context, ask for clarity. This can be as simple as saying “It feels like there’s more layers to what you’re telling me. Can you help me understand everything going on in this moment?”

Address power imbalances. Be honest about the power dynamics in the therapy room. Acknowledge to clients that you don’t know all, and empower them to tell you when you’ve misinterpreted.

Seek continuing education. Take courses, attend workshops, and read about different cultures and communities. But remember that learning never ends.

Use supervision and consultation. Seek out peers and mentors with perspectives and backgrounds different from yours. Ask for feedback on how you’re handling cultural differences in therapy.

Practice cultural safety: Make your office welcoming to all clients. Use inclusive language. Have materials that represent different communities.

Moving forward

The shift from cultural competence to cultural humility isn’t about abandoning knowledge—it’s about approaching cross-cultural work with curiosity and respect. Cultural competence gives us knowledge. Cultural humility gives us wisdom. Together, they help us provide respectful, effective therapy.

The goal isn’t perfection. It’s about staying curious, keeping our clients’ experiences at the center, and viewing cultural learning as a lifelong journey.

Dr. Sonja Sutherland, PhD, LPC, BC-TMH, ACS has provided individual, group, and family therapeutic services for adolescents and adults for more than 20 years. She is a core faculty member at Adams State University and the founder and CEO of Legacy Changers Worldwide, an organization dedicated to providing family education and resources for mental and emotional wellness. She provides continuing education workshops in the areas of racial trauma, cultural competence development, the provision of culturally responsive clinical intervention and supervision, and social justice advocacy.

Disclosures: Dr. Sutherland receives a speaking honorarium and recording royalties from PESI, Inc., the parent company of therapist.com.

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What is conversion therapy?

Conversion therapy is a set of harmful practices aimed at changing a person’s sexual orientation or gender identity. It’s also called “reparative therapy,” “gender critical therapy,” or “sexual reorientation.”

The goal of conversion therapy is to change the sexual orientation of LGBTQIA+ individuals to heterosexual. It also seeks to make transgender or nonbinary people identify with their birth-assigned gender (cisgender).

It’s important to note that so-called conversion “therapy” is dangerous, deeply damaging, and unsupported by scientific evidence. The American Psychological Association refers to conversion therapy as “sexual orientation change efforts (SOCE)” or “gender identity change efforts (GICE)” to separate it from accepted, evidence-based forms of therapy.

As of December 2023, there are over 1,300 conversion therapy practitioners across the United States.¹ Because conversion therapy is often promoted and practiced secretively, the true number may be much larger.

What happens in conversion therapy?

Conversion therapy methods can be physical or non-physical.² Physical methods involve disturbing practices such as physical or sexual abuse, kidnapping and imprisonment, electroconvulsive therapy, hormone treatments, and aversion therapy.

Non-physical methods usually take the form of talk therapy, peer counseling, or pastoral counseling. This may include enforcing gender stereotypes, urging recipients to cut family ties, or advocating for celibacy.

A therapist or person who practices conversion therapy may hold what they truly believe are positive intentions. For instance, they may want to help someone fit into their family or religious community. However, regardless of their intentions or therapeutic approach, conversion therapy is ineffective and harmful to both mental and physical health.³

The impact of conversion therapy on mental health

Conversion therapy is associated with an increased risk for mental health concerns including depression and internalized homophobia.⁴ A study found that LGBTQIA+ youth who experienced conversion therapy had a suicide attempt rate over double that of those who did not undergo the therapy.⁵

Professional medical and human rights associations strongly oppose conversion therapy practices, as overwhelming evidence shows it is both harmful and ineffective.^6,7 Organizations that stand against conversion therapy include the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, and the American Psychiatric Association, among many others.

Why conversion therapy is harmful

Conversion therapy is a shame-based practice. It undermines a person’s sense of self and discredits their sexual orientation or gender identity. It doesn’t help LGBTQIA+ people explore their identity or find support. Instead, it encourages them to suppress and feel ashamed of who they truly are.

Along with shame, conversion therapy can result in:⁸

• Suicidal behavior
• Depressive symptoms
• Feelings of anger
• Feelings of grief
• Loss of sense of identity
• Substance abuse
• Dissociation
• Emotional numbness
• Lower levels of life satisfaction

Identifying as LGBTQIA+ isn’t harmful. It also isn’t a mental disorder or illness. All major psychological associations agree it’s a normal part of human sexuality and gender expression.

The history of conversion therapy is rooted in the belief that being LGBTQIA+ is a mental illness or disorder. In the past, variations in sexual orientation and gender identity were not seen as natural or healthy aspects of human diversity.

Unfortunately, depathologizing the spectrum of human sexuality and gender identity has taken many decades. The American Psychiatric Association finally removed homosexuality from its diagnostic manual in 1973 and “gender identity disorder” was only eliminated in 2013.^9,10

Members of the LBGTQIA+ community are at higher risk for depression, anxiety, substance use disorders, and other mental health concerns.¹¹ The challenges associated with being LGBTQIA+ comes from social stigma and lack of support, not the identity itself.

Societal oppression and discrimination put LGBTQIA+ people at an increased risk for mental health struggles, homelessness, and violence. They may also experience trauma from family and religious rejection, pressure around coming out, and inadequate physical and mental health care.

Can your sexuality or gender identity change?

Your sexual orientation and gender identity are determined through self-discovery. This means you may identify as one gender or sexual orientation and discover later that a different identity feels more suited to your internal experience. 

Your sexual identity and gender identity can’t be changed by external forces or pressure. These efforts may cause you to feel shame and change how you express your identity, but they can’t change you internally. 

Is conversion therapy legal in the US?

Currently there is no federal law preventing conversion therapy in the United States. A bill designed to limit the practice was proposed in June 2023, but has not yet been passed.¹²

A growing number of US states have issued conversion therapy bans. States that have banned conversion therapy for minors include:

• California
• Colorado
• Connecticut
• Delaware
• Hawaii
• Illinois
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• Oregon
• Rhode Island
• Utah
• Vermont
• Virginia
• Washington

As it stands today, conversion therapy remains legal in the majority of states. According to an estimate from June of 2019, 16,000 young people in the US will undergo conversion therapy before they turn 18.¹³ 

Mental health resources

Exploring your sexual orientation and gender identity is a normal and healthy part of life. And it’s not unusual to be overwhelmed by the experience. 

If you’re struggling to understand or fully express your sexual or gender identity, help is available. A licensed mental health professional can work with you to address past trauma, understand your identity, and help you live a healthier, more authentic life. Search for an LGBTQIA+-affirming therapist near you today. 

If you’re in crisis and need help now, call or text one of the following helplines for free, confidential support, 24/7: 

• The Trevor Project: Call 1-866-488-7386 or text START to 678-678
• Crisis Text Line: Text HOME to 741741
• 988 Suicide & Crisis Lifeline: Call 988

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If you’re worried about your pornography use or concerned about someone you care about, you’re not alone. Many people struggle with what experts call problematic pornography use (PPU), and recognizing when things feel out of control is the first step toward getting help.¹

Is porn addiction a real disorder?

In this article, we use the term “porn addiction” to describe certain behaviors and challenging patterns related to pornography as it’s how the media and general public often refer to it. However, pornography addiction isn’t officially recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the leading diagnostic tool used in the United States.

The reality is, online sexual behaviors are complex. Despite lacking a DSM diagnosis, research suggest that some forms of pornography use share similarities with certain recognized addictions.² Additionally, the World Health Organization’s diagnostic tool, the ICD-11, contains a Compulsive Sexual Behavior Disorder (CSBD) diagnosis under which certain patterns of pornography use would fall.

Though debate continues and more exact lines continue to be drawn, understanding when sexual behaviors become a concern can help you recognize when you need help. Certain patterns of pornography use can affect your mental health, relationships, and daily life in significant ways.

Porn addiction symptoms

Experts have identified several core signs that can characterize problematic pornography use (PPU) in some people.³ These symptoms help distinguish between casual use and use that’s become problematic, but it’s important to remember that there’s an enormous range of healthy sexual expression.

Being regularly preoccupied with pornographic content

Preoccupation, also called “salience,” refers to pornography becoming one of the most important things in your life, dominating your thoughts and behaviors. It could be a sign of trouble if you find yourself constantly thinking about pornography, planning when you can use it next, or having difficulty focusing on work, school, or relationships because of these thoughts.

Research shows that people with addictive behaviors around pornography often develop an attentional bias toward it, meaning their attention automatically gravitates toward pornographic content.⁴ This bias is also linked to feelings of craving, which may create a reinforcing compulsive pattern.

Using porn to boost mood

While most people start out using pornography for enjoyment, over time it can shift into a coping mechanism for dealing with difficult emotions. Some people use it as a means of modifying their mood, using pornography to alter their emotional state rather than for pleasure.⁵

Eventually, they might turn to pornography whenever they’re feeling:

• Stressed or anxious
• Depressed or lonely
• Bored or restless
• Overwhelmed by life’s challenges

This symptom appears across different profiles of problematic users.⁶ When pornography becomes your go-to method for emotional regulation, it can prevent you from developing healthier coping strategies.

Experiencing withdrawal

Porn addiction withdrawal symptoms can be quite uncomfortable. When you try to stop or cut back on pornography use, you might experience:⁷

• Frequent sexual thoughts that are difficult to control
• Irritability and mood swings
• Increased arousal
• Sleep problems
• Restlessness

These withdrawal symptoms resemble what people experience in certain recognized behavioral addictions. The discomfort of these symptoms often makes it challenging to abstain, leading many people to return to pornography use for relief.

Needing more to get the same effect

Building a tolerance to pornography means you need more of it—or more intense or extreme versions—to achieve the same sense of pleasure you once got from less.⁸

Over time, you might notice:

• The content that once interested you no longer feels stimulating
• You need longer sessions to feel satisfied
• You seek out more extreme or varied material
• Regular sexual experiences with a partner feel less exciting

This increased need for stimulation can negatively impact your sexual satisfaction and relationship quality.⁹

Experiencing conflict

Conflict is one of the central symptoms of problematic porn use, and it can come in two forms: interpersonal and intrapersonal.^10,11

Interpersonal conflict includes problems in your relationships, such as:

• Decreased sexual satisfaction with your partner
• Arguments about pornography use
• Reduced emotional intimacy
• Trust issues

Intrapersonal conflict refers to the internal struggle you feel when your pornography use clashes with your personal values or beliefs. This moral conflict can create distress and increase the likelihood that you view yourself as addicted.¹² You might feel ashamed, guilty, or disappointed in yourself, which can create a negative cycle.

It’s important to note that frequency of use alone doesn’t predict whether porn use will cause conflict or distress.¹³ Some people might use pornography more frequently without experiencing negative consequences, while others may use it less often but still struggle with these core symptoms.

Recognizing when sexual behaviors have become compulsive, or are creating larger issues, can be complicated. If you’re recognizing these symptoms in yourself, talking to a licensed therapist can help. They can provide judgment-free support and help you develop healthier coping strategies.

Treatment options for porn addiction

Online self-help programs

Research shows that structured online self-help programs can be highly effective. A six-week web-based program has demonstrated positive results, including:¹⁴

• Reduced problematic pornography use
• Decreased craving
• Lower frequency of use
• Increased confidence in avoiding pornography

Though these courses aren’t widely available online yet, they may soon become an accessible first step for many people. Despite promising results, it’s important to note that the participants in the study’s intervention group had a very high dropout rate. This limits how generalized the results can be, and more research is called for.

Professional help

While self-help strategies may work for some people, professional treatment may be necessary for others. Remember that there’s no benchmark you need to reach to justify involving a professional in your care.

Cognitive behavioral therapy (CBT) is commonly used in addiction treatment and can help you:

• Identify triggers and problematic thought patterns
• Develop positive coping skills
• Address underlying issues like depression or anxiety
• Improve relationship communication

If you’re also dealing with other addictive behaviors or mental health concerns, working with a therapist who specializes in these areas can be especially helpful.

Visit our directory to find mental health professionals who can provide personalized guidance and support. You don’t have to navigate this alone.

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Struggling with sleep problems is a very common experience. About 10% of adults deal with insomnia, and another 20% have trouble sleeping at least occasionally.

The good news is that several effective treatments can help you get the rest you need. Here are some of the different interventions you can try and what research tells us about how well they work for restoring sleep.

Cognitive behavioral therapy for insomnia (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia.¹ This therapy combines several strategies to help you sleep better:²

• Sleep restriction: Limiting time in bed to match your actual sleep time
• Stimulus control: Creating strong connections between your bed and sleep
• Cognitive restructuring: Changing unhelpful thoughts about sleep
• Relaxation training: Learning techniques to calm your mind and body
• Sleep hygiene education: Understanding healthy sleep habits

Research shows that CBT-I works remarkably well. In studies of adolescents with insomnia, CBT-I produced significant improvements in several areas.³ Teens who received CBT-I fell asleep faster, spent less time awake during the night, slept longer overall, and had better sleep efficiency.

But what makes CBT-I so effective? A large study analyzed 241 trials involving over 31,000 adults to find out which parts of cognitive behavioral therapy for sleep problems matter most. The researchers found that four components stood out:⁴

• Cognitive restructuring (challenging negative thoughts about sleep)
• Mindfulness and acceptance techniques
• Sleep restriction
• Stimulus control

The study also found that in-person sessions with a therapist worked better than other delivery methods. These four components working together produced the best results.

Ready to get started with CBT-I? Our directory can help you connect with a qualified professional who specializes in sleep problems. Find a therapist near you to begin your journey toward better sleep.

Digital cognitive behavioral therapy for insomnia (dCBT-I)

Not everyone can access in-person therapy. For some people, digital options may be a helpful and more accessible alternative. Digital CBT-I delivers the same core techniques through apps, websites, or online programs—without requiring face-to-face sessions with a therapist.

The US Food and Drug Administration (FDA) has authorized at least one digital CBT-I program called SleepioRx. In a nationwide study of 336 adults with insomnia, this fully automated program produced impressive results. People using SleepioRx showed meaningful improvements in insomnia severity that lasted at least six months after treatment ended.⁵

This is exciting news because digital programs can reach far more people than traditional therapy, making effective treatment more accessible to those who might not otherwise get help.

Sleep restriction therapy (SRT)

Sleep restriction is a key component of CBT-I, but it can also be effective as a standalone treatment option. Sleep restriction therapy (SRT) focuses on one key principle: less time in bed can lead to better sleep.⁶ This might sound backward, but it often works.

SRT works by limiting your time in bed to match how long you actually sleep. This creates mild sleep deprivation, which strengthens your body’s natural sleep drive and reduces arousal before and during sleep. The result is more consolidated, efficient sleep. Once your sleep improves, you gradually increase time in bed.

SRT has been shown to improve:

• Insomnia severity
• Sleep efficiency (the percentage of time in bed actually spent sleeping)
• How long it takes to fall asleep
• Time spent awake during the night

The effects were especially strong in the short term. However, more research is needed to understand how well these improvements last over time. Additionally, like other self-led lifestyle changes, it can be difficult to sustainably make sleep restriction a part of your routine without structured support.

ACT-based interventions

Acceptance and commitment therapy (ACT) focuses on accepting uncomfortable feelings and thoughts while still taking action toward what matters to you. A form of ACT called acceptance and behavioral changes to treat insomnia (ABC-I) combines ACT principles with behavioral sleep strategies similar to those seen in CBT-I.

In a study of women veterans, researchers compared ABC-I to standard CBT-I. The results showed both treatments worked equally well at improving insomnia.⁷ ABC-I showed some advantages in helping people stick with certain behavioral parts of treatment.

While it’s still being tested and expanded in availability, ABC-I may soon offer a solid alternative for people who don’t respond well to CBT-I or prefer a different approach.

Mindfulness-based therapy for insomnia (MBTI)

Mindfulness-based therapy for insomnia (MBTI) combines mindfulness meditation practices with behavioral sleep strategies. Generally, it teaches you to:

• Pay attention to the present moment
• Accept thoughts and feelings without judgment
• Reduce the mental activity that can interfere with sleep

In one small study, researchers compared MBTI to a program in which participants followed a sleep hygiene and exercise-focused program. Both groups improved their sleep quality significantly, but MBTI showed greater improvements in insomnia severity, and these benefits lasted through six months of follow-up.⁸ The study found that MBTI improved both reported sleep quality and objective measurements from sleep monitors.

For people whose insomnia doesn’t respond to standard treatments, MBTI may offer particular benefits. A study of treatment-resistant patients found that MBTI produced large reductions in insomnia symptoms, depression, and racing thoughts at bedtime.⁹ Nearly 58% of participants no longer had clinical insomnia when measured after treatment. While some effects decreased over six months, improvements in insomnia and nighttime mental activity remained significant.

Alternative therapies for sleep problems

Some people prefer non-psychological approaches or want to combine traditional therapy with other methods. Research-backed alternative therapies include acupuncture and self-administered acupressure.

Acupuncture

Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles at specific points on the body. In a study of 160 cancer survivors with insomnia, both acupuncture and CBT-I produced meaningful improvements. CBT-I reduced insomnia severity more than acupuncture did, but both treatments showed benefits that lasted for months, and both were safe with few side effects.¹⁰

A review of 46 studies involving 3,811 patients found that acupuncture appeared effective for treating insomnia when compared to no treatment or medication.¹¹ However, the researchers noted that many studies had quality issues, so more rigorous research is needed.

Self-administered acupressure

Acupressure is similar in concept to acupuncture but uses pressure on the surface of the body instead of needles. Unlike acupuncture, which involves working with a certified acupuncturist to administer the needles, many people can learn to do acupressure on themselves safely at home.

In a study of 200 people with insomnia, participants learned self-administered acupressure in just two training sessions. Compared to sleep education alone, the acupressure group showed significantly better improvements in insomnia severity at both four and eight weeks.¹² They also reported less anxiety and depression and better overall quality of life.

Finding the right treatment for you

The right treatment depends on your situation, personal preferences, and what’s available to you. CBT-I remains the first-line treatment recommended by experts, with the strongest research support. Digital versions make this evidence-based approach more accessible than ever before.

Take the first step toward better sleep today. Browse our directory of online and in-person therapists who can help you find the right treatment approach for your sleep problems.

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What Is Schizophrenia?

Schizophrenia is a serious mental health disorder that can create a distorted view of reality and can affect how a person thinks, behaves, and feels. Schizophrenia may include hallucinations, incoherent thoughts, delusions, and disordered behavior and speech. According to John Hopkins Medicine, about 1% of Americans are affected by schizophrenia. It affects 20 million people globally.

Although schizophrenia is a long-term, complex mental health disorder, treatment can help individuals experiencing schizophrenia with daily functioning, personal relationships, and achieving independence.

Psychosis vs. Schizophrenia: What’s the Difference?

Although the terms psychosis and schizophrenia have sometimes been used interchangeably, they are different. Psychosis is a symptom of mental illness and refers to a disconnect from shared reality. Schizophrenia is a mental health disorder that includes a range of symptoms, one of which is psychosis.

An individual with schizophrenia may experience psychosis, but not everyone who experiences psychosis has schizophrenia. Other mental health disorders, drug use, brain injuries, some health issues, and neurological disorders can also create episodes of psychosis.

Both psychosis and schizophrenia are treatable. Diagnosis requires both medical and psychological evaluation which can determine if the psychosis is related to schizophrenia or one of its other causes.

Types of Schizophrenia

In the past, scientists used different types of schizophrenia to classify and diagnose cases. However, these types did not prove to be distinctly different disorders. Now, schizophrenia is thought to be a spectrum disorder.  Rather than trying to separate schizophrenia symptoms into types, therapists look at which symptoms an individual has and how severe they are when making a treatment plan.

Related Conditions

There are also several conditions related to schizophrenia.

• Schizophreniform disorder: Symptoms of schizophrenia, but the symptoms have not been present for more than six months.
• Schizoaffective disorder: A chronic mental health disorder that is characterized by symptoms of schizophrenia and symptoms  of a mood disorder, such as depression or mania.

Schizophrenia Symptoms

Schizophrenia involves a range of symptoms that affect how someone thinks, feels, and behaves. The symptoms may vary from person to person, but they include hallucinations, delusions, and disordered thinking.

Diagnosis of schizophrenia typically occurs in a person’s teens, twenties, or thirties, with men getting diagnosed earlier and women, later. Sometimes, symptoms may begin in childhood. However, the early symptoms of schizophrenia can be difficult to diagnose in teens because the onset may be gradual before the first episode of psychosis. They can involve withdrawing from friends and family members, a drop in grades, or having trouble sleeping, but many other teenage issues can produce these behaviors.

Positive Symptoms

The “positive” symptoms of schizophrenia are those that are new to the individual, including hallucinations, delusions, and disorganized speech.

Hallucinations 

Hallucinations involve experiencing something with your five senses that isn’t there. They feel real to the person experiencing them and are often characterized by negativity. If a person hears voices, for example, it’s likely that those voices are criticizing or threatening them.

Common types of hallucinations include:

• Visual (seen): Seeing something that isn’t there, such as seeing a person or animal in the corner of the room
• Auditory (heard): Hearing something that isn’t there, such as hearing the voice of a god speaking directly to you
• Olfactory (smelled): Smelling something that cannot be reasonably coming from a nearby source, such as smelling the scent or perfume of your childhood bully
• Tactile (felt): Feeling like something is touching you when nothing reasonably can be or feeling other distinct sensations that are not actually occurring, such as feeling as if your skin is burning
• Gustatory (tasted): Tasting something that cannot be reasonably coming from something you recently ate or put in your mouth, such as tasting something incredibly foul or bitter

Delusions

Delusions are strong beliefs not based in reality. They persist even when presented with contradictory facts and evidence. Common delusions among people with schizophrenia include beliefs in being harassed, surveilled, or chosen by a higher power. 

Disorganized speech

Disorganized speech disrupts a person’s ability to communicate coherently. It affects both a person’s ability to speak as well as their ability to think clearly.

Negative Symptoms

The negative symptoms of schizophrenia are those that remove skills or behaviors from the affected individual, such as: 

• Flat affect: Individuals with a flat affect appear to have a lack of emotions. Speaking in a monotone is one of the most common signs of flat affect.
• Reduced cognitive ability: This includes trouble concentrating, paying attention, or remembering things. Individuals may experience difficulty in processing information to make decisions and may not be able to follow along with conversations.
• Diminished interest in life: A person struggling with schizophrenia may lose interest in both their hobbies and their responsibilities. Necessary self-care activities, such as bathing or eating, are often severely affected.

Schizophrenia Risk Factors

The causes of schizophrenia are unknown. However, research has identified risk factors that may put someone at a greater risk of developing schizophrenia, including:

• Genetics: Genetics play a big role in mental health. If you have a family member who has been diagnosed with schizophrenia, you may be at an increased risk.
• Brain chemistry: Studies indicate that differences in brain structure and the function of neurotransmitters (chemicals that carry messages in the brain) may be related to schizophrenia. These differences may begin developing before birth. While the differences seem to be connected to schizophrenia, scientists are still trying to understand how and why they lead to developing schizophrenia.
• Environmental factors: A number of environmental factors may influence the development of schizophrenia. Poverty, stress, and pregnancy and birth complications increase the risk of schizophrenia when combined with other risks. 
• Substance abuse: While drug use does not cause schizophrenia, it can trigger development in those with other risk factors. Some studies have shown that cannabis (marijuana) use increases the risk of schizophrenia when used by teens and young adults. Both younger ages and frequency of use appear to influence the amount of risk.

While a stressful or emotional event may trigger the onset of schizophrenia, it is unclear why some people at risk for schizophrenia will develop those symptoms and others will not.

Schizophrenia Treatment

The treatment of schizophrenia  includes both medication and therapy. The goal of treatment is to manage symptoms and the day-to-day issues that they may cause. 

Is Schizophrenia Curable?

Schizophrenia is not a “curable” mental disorder. Typically, individuals with schizophrenia will need treatment throughout their life, even if their symptoms subside. 

However, effective treatment and an active support system helps many individuals to manage symptoms and, for some, to work and live on their own.

Effective Treatments

Effective treatment for schizophrenia will vary from person to person, but there are some common treatments that individuals with schizophrenia may use.

• Antipsychotic medication: The most common medication prescribed for schizophrenia, antipsychotics are thought to help by blocking the effect of dopamine in the brain.
• Cognitive behavioral therapy (CBT): CBT helps people identify unhelpful or harmful thinking patterns and change them to more helpful or realistic interpretations.
• Job coaching: Supportive work settings with supervision, accommodation for disrupted periods, and ongoing structure is one of the most effective methods of restoring functionality and social engagement.
• Social skills training: This helps individuals with schizophrenia develop skills for social situations and independent living.
• Family therapy: Family therapy can help individuals with schizophrenia and their families find ways of coping with the disorder together.
• Electroconvulsive therapy (ECT): ECT uses electrical impulses to change the brain’s activity. It is used most often for those with severe schizophrenia symptoms.

Get Help for Schizophrenia

If you or someone you love has schizophrenia or is experiencing symptoms of schizophrenia, help is available. Contact a therapist today for treatment options.

The post Schizophrenia appeared first on therapist.com.

If you’ve ever wondered why someone might sit for hours doing nothing, or why basic self-care becomes impossible for some people, avolition might help explain what you’re observing.

What is avolition?

Avolition is a decrease in motivation to start and continue working toward goal-oriented tasks or activities.¹ It affects people both internally (making them losing interest and drive) and in what they actually do (avoiding activities they used to start on their own). The lack of activity comes from an inner loss of motivation—not from outside factors.

It can occur on its own, but it’s most often a symptom of an underlying mental health condition.² Avolition and schizophrenia are closely related, as it’s a core negative symptom of the disorder. But it can also show up in other conditions, such as bipolar disorder or depression.³

People with avolition alone don’t necessarily feel sad or anxious, have trouble sleeping, or have thoughts of hurting themselves. Instead, they often feel emotionally empty or numb.

Signs of avolition

Avolition can throw up roadblocks in every part of life, from basic self-care to keeping up with friends. The symptoms mostly show up as a lack of motivation or energy for things that used to be easy.

Common signs include:⁴

• Losing interest in self-improvement in different life areas
• Stopping daily maintenance tasks like personal grooming or making meals
• Avoiding bigger responsibilities like jobs, school, or socializing
• Staring at the TV for hours without really watching
• Spending most of the day alone at home

If you’re experiencing any of the above symptoms and they’re impacting your daily life, or the life of someone you care about, consider reaching out to a mental health professional for evaluation and support.

What causes avolition?

Studies indicate that lack of motivation may be driven by problems with anticipating pleasure (anticipatory anhedonia).⁵

Your brain’s reward system typically motivates you by helping you anticipate good outcomes. But when you’re dealing with avolition, this anticipation system doesn’t work properly, which makes it hard to get started on tasks even when you know they’re important.

Avolition in mental health and medical conditions

In most cases, avolition is an underlying symptom of a complex mental health condition like schizophrenia, bipolar disorder, autism spectrum disorder (ASD), or some personality disorders.⁶

Avolition-like symptoms are also a key feature of inflammatory bowel disease (IBD).⁷ When people with IBD report feeling “fatigued,” what they’re actually describing is a lack of motivation to start and continue activities. This may suggest a broader link between motivational impairment and chronic illness fatigue.

Avolition can stem from a condition (primary) or other factors (secondary) like medications or factors in your environment, such as social isolation.⁸ This distinction matters for treatment.

Impact on daily life and well-being

In people with schizophrenia, avolition is a stronger predictor of poor functioning than cognitive ability.⁹ This means that motivation problems can have a bigger impact on daily life than memory or attention difficulties.

People with avolition do fewer productive activities and spend more time doing passive activities or nothing at all.¹⁰ When researchers ask them about their daily routines, they usually report doing just one thing at a time, and it’s typically something inactive.

Avolition is a major predictor of poor quality of life, even more so than other negative symptoms common in schizophrenia like blunted affect (reduced emotional expression).¹¹ The impact on relationships, work, and self-care creates a cycle where reduced activity leads to further isolation and decreased motivation.

Assessing avolition

Mental health professionals use structured interviews and rating scales like the Brief Negative Symptom Scale (BNSS) to identify avolition.¹² The assessment looks at both what patients report feeling and what can be observed in their behavior.

The assessment process takes time because avolition can be tough to measure objectively, requiring professionals to gather information from different sources to get the full picture.

Treatment options for avolition

Currently, no medications have been approved specifically for treating avolition.¹³ But specialized therapy programs which include tasks designed to boost motivation may be a good option.

Avolition can make it difficult for clients to participate in traditional therapy methods. However, one study showed promising results with “therapeutic invigoration” tasks that drew from cognitive behavioral therapy and guided imagery therapies.¹⁴ Much more research is needed, but treatments that cater specifically to a lack of motivation are being developed.

In some cases, transcranial magnetic stimulation (TMS) may be a viable option. TMS is a non-invasive treatment that uses magnetic fields to target specific brain regions. In patients being treated for schizophrenia, non-invasive brain stimulation seemed to work better for improving avolition and anhedonia than other symptoms.¹⁵

Research suggests that treating avolition can improve other negative symptoms too.¹⁶ This makes avolition a key target for comprehensive treatment.

Supporting someone with avolition

Whether you’re a family member, friend, or caregiver, understanding how to help someone with avolition makes a significant difference in their recovery. Helpful approaches include:

• Offering gentle support and structure
• Breaking large tasks into tiny, doable steps
• Celebrating small accomplishments
• Encouraging professional mental health support
• Being patient with the recovery process

If you or someone you know are struggling, visit our directory to find a mental health provider who can identify any underlying conditions and create strategies for coping. The right therapeutic relationship can make a significant difference in recovery.

The post Avolition: Meaning, signs, causes, impact, and treatment appeared first on therapist.com.

What is sociopathy? 

“Sociopathy” is a word used to describe certain traits within antisocial personality disorder (ASPD), a personality disorder involving a lack of remorse and a disregard for other people’s rights and feelings. 

People diagnosed with ASPD tend to act impulsively, struggle with anger management, and lack empathy. These qualities together can lead them to cross the line into criminal behavior. 

What causes sociopathy? 

Experts believe environmental factors like childhood trauma, abuse, neglect, or impoverishment are major influences in sociopathy: Instead of being born with these traits, people learn sociopathic behaviors to cope with unstable or chaotic living environments. Genetic factors may also play a role. 

Common risk factors for sociopathy include: 

• Genetics: If a family member has ASPD, you’re at greater risk for developing it. 
• Biochemistry: Mental health disorders like ASPD may come from a lack or suppression of certain brain chemicals. 
• Environmental factors: Growing up in an unpredictable, unstable, or abusive household may increase your risk. 
• Trauma: Unaddressed or untreated trauma can increase your risk. 
• Childhood mental illnesses: Mental illnesses that are usually diagnosed during childhood—like oppositional defiant disorder (ODD), ADHD, or conduct disorder—may increase your risk of ASPD. 

Symptoms of sociopathy 

You may hear the term “sociopath” in TV shows or movies that portray criminals. But most people with ASPD are not criminal masterminds—instead they react impulsively, hardly thinking through the consequences of their actions for themselves or others. 

People with ASPD often lack: 

• Conscience: People with ASPD frequently manipulate and exploit others for personal gain. They typically don’t follow an internal moral compass. 
• Honesty: People with ASPD will lie for convenience or strategic purposes. 
• Empathy: Most people with ASPD don’t consider the feelings of others, and they’re indifferent when they have hurt or mistreated someone else. 
• Responsibility: People with ASPD often neglect things like financial debts, job duties, legal requirements, and relationship or parenting obligations. 
• Remorse: When faced with the consequences of their behavior, people with ASPD rarely feel or express remorse. Instead, they often rationalize their actions and blame others. 
• Regard for others: People with ASPD don’t care very much about other people’s well-being. They may take risks that jeopardize their own safety and others’. 
• Self-control: People with ASPD react impulsively and don’t consider the consequences. They’re often verbally and physically aggressive. 

Examples of sociopathic behavior 

• Stealing 
• Lying or gaslighting 
• Abusing animals or people 
• Assuming fake identities when convenient 
• Taking action without planning first 
• Destroying property 

Does my child have ASPD? 

Childhood personalities are works in progress, so their features change frequently. Qualities like morality, honesty, empathy, responsibility, and remorse aren’t instinctual—they have to be learned as a child develops. A child who lacks those qualities doesn’t have ASPD. They’re simply still developing. 

Children can’t be diagnosed with antisocial personality disorder until they’re 18. But children may be diagnosed with other mental health conditions, such as ODD or conduct disorder, before then. Speak with your child’s doctor or therapist if you’re concerned about sociopathic behaviors. 

Treatment options for sociopathy 

If you or a loved one have symptoms like the ones listed above, help is available. Common treatments include: 

• Cognitive behavioral therapy (CBT): This form of talk therapy can help you change negative patterns of thinking and behaving that interfere with functioning. 
• Antipsychotic drugs: Although there aren’t approved medications for the treatment of antisocial personality disorder, antipsychotic drugs can decrease symptoms of impulsivity and aggression. 
• Mood stabilizers: Similar to antipsychotic medications, mood stabilizers don’t treat the underlying ASPD itself but can help manage symptoms of impulsive aggression. 

Barriers and access to treatment 

It can be challenging for people with ASPD to receive and benefit from help; if they aren’t motivated to change their behavior, they won’t believe they need treatment. 

Treatment isn’t always effective for sociopathy, but it does help some people. Success is more likely when people have milder forms of the condition, or when they have the internal motivation to change. 

Some people with ASPD seek therapy for other mental illnesses, such as anxiety or depression, and end up receiving treatment for sociopathy, too. Others must be compelled to get treatment, either through a family member’s ultimatum or through a legal obligation like a court order. 

If you or a loved one feel ready to start treatment, browse our directory of therapists.

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What is high-functioning depression?

High-functioning depression is an informal term used to describe people who experience symptoms of depression while largely maintaining their daily responsibilities and outward appearance.

Similar to “smiling” depression, people with high-functioning depression may appear happy on the outside while struggling internally with depression.¹ They’re often able to maintain successful careers, relationships, and social lives, making it difficult for others to recognize their condition.

Is high-functioning depression a mental illness?

There’s currently no official diagnosis for high-functioning depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It’s possible for a person to meet the diagnostic criteria for major depressive disorder (MDD) or persistent depressive disorder (PDD) while hiding many of the signs and symptoms. When this is the case, they may be informally described as having high-functioning depression.

PDD is a recognized mental health condition characterized by long-term, chronic bouts of depression. With PDD, symptoms persist for a longer duration than in MDD (typically two years or more).² People with PDD may experience periods of normal mood, but these are usually brief and don’t last more than two months.

High-functioning depression and PDD share similarities, but they’re not the same. The term “high-functioning depression” describes someone who mostly keeps up appearances despite depressive symptoms, rather than being a formal diagnosis like PDD.

If you think you or a loved one may be experiencing any form of depression, it’s important to seek professional help. A mental health expert can provide a proper diagnosis and recommend appropriate treatment options.

What does high-functioning depression look like?

Because it’s not an official diagnosis, high-functioning depression doesn’t have distinct symptoms. Warning signs of high-functioning depression, and of depressive disorders generally, can include:

• Persistent feelings of sadness or emptiness
• Difficulty concentrating or making decisions
• Low self-esteem and self-criticism
• Fatigue or low energy
• Changes in sleep patterns (insomnia or oversleeping)
• Appetite changes (increased or decreased)
• Irritability or restlessness
• Loss of interest in previously enjoyed activities (anhedonia)
• Feelings of hopelessness or pessimism
• Physical symptoms like headaches or digestive issues
• Thoughts of death or suicide

Depression can look different for everyone, and you don’t need to hit a certain benchmark before you seek help. If you’re in crisis or having thoughts of self-harm or suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

People with high-functioning depression may try to hide their symptoms from others, often out of fear or shame. A person attempting to hide symptoms of depression may:

• Maintain a busy schedule to avoid confronting emotions
• Overachieve or strive for perfection to mask feelings of inadequacy
• Use humor or sarcasm to deflect from their true feelings
• Isolate themselves from social situations while citing work commitments
• Engage in activities (such as exercise) obsessively
• Use substances as a coping mechanism

Causes of high-functioning depression

Because high-functioning depression isn’t a clinically recognized condition, its exact causes are not well defined. Generally speaking, the factors that contribute to depressive disorders can include:³

• Biological factors, such as imbalances in brain chemicals or hormonal issues.
• Genetic factors, most notably a family history of depression or other mental health disorders.
• Environmental factors, which might include childhood trauma, difficult life events, or stress.
• Psychological factors, such as personality traits and negative thought patterns.

Some research suggests that high-functioning depression specifically may be linked to socioeconomic factors like lower income, less education, and less skilled jobs.⁴ Additionally, cultural factors such as patriarchy and toxic masculinity can contribute to the development of depression.

The impact of high-functioning depression

Even when people with high-functioning depression can maintain their daily responsibilities, it can still have significant negative impacts on their lives.

People with high-functioning depression may think they’re not “ill enough” to seek help, leading to prolonged suffering and potential worsening of symptoms.

The constant effort to keep up appearances and meet expectations can lead to:

• Imposter syndrome, emotional exhaustion, and burnout
• Relationships struggles, loneliness, and isolation
• Difficulty in maintaining work-life balance
• Increased risk of substance abuse
• Physical health problems due to chronic stress
• Impaired decision-making abilities
• Reduced quality of life and overall satisfaction

It’s important to recognize and address symptoms of depression as early as possible. Remember that your depression doesn’t need to reach any kind of benchmark before you seek help. If you’re in crisis or struggling with depressive symptoms, call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

High-functioning depression diagnosis and treatment

As mentioned, high-functioning depression isn’t a diagnosable condition. However, a mental health professional can assess your symptoms and determine if they fit recognized conditions like MDD or PDD. Diagnosis typically involves a comprehensive evaluation, including medical history, physical exam, and psychological assessment.

High-functioning depression treatment options are the same as those for other depressive disorders. Proven options for managing symptoms of depression include:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Eye movement desensitization and reprocessing (EMDR)
• Medication (such as antidepressants)
• Support groups or peer counseling
• Mindfulness practices and meditation
• Lifestyle changes (including regular exercise and improved sleep habits)

Seeking help isn’t a sign of weakness. Even if coping with high-functioning depression seems possible on your own, you don’t need to manage without help. Treatment can help alleviate symptoms, improve quality of life, and prevent the condition from worsening over time.

Visit our directory to find a mental health professional near you who specializes in treating depression and related disorders.

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What is a phobia?

A phobia is an intense fear of (or aversion to) a particular object, situation, event, or activity. The fear is often irrational or disruptive and can’t be controlled. You may feel extreme dread about the source of the fear and go to great lengths to avoid it.

Are phobias a form of mental illness?

Phobias, also called “phobic disorders,” are a kind of anxiety disorder. Unlike generalized anxiety disorder (GAD), which involves extreme worry about a variety of topics, phobias are focused on specific fears. Common signs of GAD include excessive and hard-to-control anxiety, irritability, restlessness, difficulty sleeping, and trouble concentrating.¹

Types of phobias

There are many different phobias, including fear of snakes (ophidiophobia), fear of small spaces (claustrophobia), and fear of heights (acrophobia). The “Diagnostic and Statistical Manual of Mental Disorders” (DSM) recognizes several kinds:

• Agoraphobia is intense fear or anxiety related to public spaces and situations, or to places that feel hard to get out of.² People with agoraphobia may become very anxious or have a panic attack from being in crowds, using public transportation, or waiting in line. They may also avoid going out in public alone.
• Social phobia, also called social anxiety disorder, is marked by fear and anxiety around social situations. People with social phobia may dread performing in public, socializing at parties, or simply being observed.
• Specific phobias are intense, oversize fears of specific objects or situations.

The 5 types of specific phobias

Specific phobias are focused on one particular object or situation. Each specific phobia falls into one of five types³:

• Animal type phobias involve fear of a particular animal, such as snakes, insects, or dogs.
• Situational type phobias concentrate on certain situations or activities, such as flying or driving over bridges.
• Natural environment type phobias include fears related to natural features and events such as tornadoes, heights, oceans, or nighttime darkness.
• Blood-injection-injury (BII) type phobias involve people being fearful and anxious about seeing blood, receiving an injection, or getting injured.
• Other type phobias don’t fit into the first four categories. They include fears such as choking or loud noises.

What causes phobias?

People can develop phobias in early childhood, during adolescence, or later in life. There’s still debate about what exactly causes phobias, but possible causes include:

• Trauma: You may develop a phobia after an intensely frightening, stressful, or dangerous experience.
• Stress: If you have a stressful first encounter with an object, place, or situation, you may be more likely to have a phobia related to it.
• Learned behavior: If someone in your life has intense fear or anxiety related to an object or situation, you may also learn to fear it.
• Genetics: Having a family member with generalized anxiety disorder may put you at greater risk of developing anxiety problems yourself.⁴

Phobia symptoms

Fear is a natural emotion that helps protect us from danger. It’s a normal part of the human experience. Phobias, on the other hand, involve fear that’s more extreme than the situation calls for and can affect a person’s ability to function. The following symptoms can help identify a phobia.

Intense fear or anxiety
A common symptom of phobias is intense anxiety, fear, or dread related to a specific event or object.⁵ Unlike typical fears, phobias are so extreme that they prevent people from participating fully in everyday activities.

Avoidance
When a person has a phobia, their level of fear far outweighs the actual threat. It may cause them to avoid the source of their fear entirely, even if doing so has a negative impact.

Physical reactions
Just the idea of a certain object or event can be enough to make someone with a phobia react physically. They may sweat, have difficulty breathing, or feel tightness in their chest.

Panic attacks
Phobias can sometimes cause panic attacks. Signs of a panic attack include:

• Sudden, extreme anxiety
• Rapid heart rate
• Shortness of breath
• A choking sensation
• Chest pain
• Trouble speaking or forming thoughts
• Dry mouth
• Nausea
• Trembling or shaking
• Sweating
• A sense of doom

Panic attacks can be brought on by phobias, but they aren’t always a part of the condition.

Getting a diagnosis

Phobias and other anxiety disorders can have similar symptoms. Working with a therapist is the best way to find out whether you have a phobia or another anxiety disorder, or if a different condition could be the source of the problem. Browse our directory to find a licensed mental health professional near you.

Treatment options

There are many ways to treat phobias. A treatment plan may include one or more of the following:

• Cognitive behavioral therapy (CBT) can help you manage fears by changing the way you think about the object, situation, or place that causes you distress. With CBT, you can learn to reshape the negative thoughts you have about your fears, helping you gain control.
• Exposure therapy involves exposing you to your fears in a safe space while practicing relaxation techniques. It can help treat specific phobias as well as other anxiety disorders.
• Eye movement desensitization and reprocessing (EMDR) involves processing and accepting your past trauma in a controlled environment. During EMDR, a therapist can help you safely recall and process memories of negative encounters with the object, situation, or place that’s causing you distress.
• Hypnotherapy uses guided relaxation to place you in a state of focused concentration. A hypnotherapist can help you understand the root cause of your phobia and change your response.
• Biofeedback therapy can help you improve your mind-body connection. You can learn to recognize and control some of the physical signs of fear and stress, such as heart rate and muscle tension.
• Medication for anxiety or depression can also help treat phobias and ease symptoms.

If you think you may have a phobia, a mental health professional can provide a diagnosis, offer guidance on which type of therapy is right for you, and help you gain control of your fears. To find a licensed professional near you, visit our directory.

The post Phobias appeared first on therapist.com.

Psychopathy vs. antisocial personality disorder (ASPD)

The term psychopathy describes a disposition toward manipulative or harmful behaviors, combined with a lack of concern or guilt for their consequences.

Antisocial personality disorder (ASPD) is a mental health condition characterized by disregard for the feelings and rights of others. This disregard can lead to criminal behavior in some cases.

There’s quite a bit of overlap between ASPD and psychopathy. But clinically, psychopathy represents only one subset of traits within ASPD.

An estimated  1.2% to 4.5% of the general population exhibits some level of psychopathy.¹

Is psychopathy a mental illness?

Psychopathy is a recognized clinical construct frequently discussed in research and clinical practice. However, it is not a recognized, standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Some individuals with psychopathic traits may have additional qualities that cause them to fit the diagnostic criteria for antisocial personality disorder (ASPD), which is an official DSM-5 diagnosis.

Psychopathy vs. sociopathy

Sociopathy and psychopathy are often used interchangeably, but they actually describe distinct personality and behavioral traits associated with ASPD.

Psychopathy typically refers to a cluster of personality traits such as lack of empathy, callousness, lack of guilt, and manipulativeness. It’s often assessed in forensic and research settings using tools like the Hare Psychopathy Checklist-Revised.² Psychopathic behavior tends to be more cold, “calculated,” and controlled.

In contrast, sociopathy describes more erratic and impulsive antisocial behavior, often marked by emotional outbursts. While the term is common in popular culture and some clinical discussions, there’s no standardized criteria for assessing or measuring it specifically.

Signs and symptoms of psychopathy

Signs of psychopathy include: 

• Lack of empathy
• Manipulativeness
• Irresponsibility
• Aggressive behavior
• Calculating behavior
• Lack of remorse
• Pathological lying
• Reduced emotion
• Impulsiveness

Examples of psychopathy might include: 

• Not taking responsibility
• Lying with comfort and ease
• Gaslighting others
• Violating boundaries
• Hurting others without remorse
• Appearing fearless in risky or dangerous situations
• Chronic manipulation for personal gain

Can children show signs of psychopathy?

Some studies suggest that certain psychopathic tendencies may be detectable early in childhood, though behavioral problems more commonly emerge in adolescence or young adulthood.³

Psychopathic tendencies in childhood, often called callous-unemotional (CU) traits, could be an indicator that a person may one day meet the diagnostic criteria for antisocial personality disorder.

However, because ASPD cannot be diagnosed until after a person turns 18, childhood signs are thought of as risk indicators, not early psychopathy. Importantly, not all children with CU traits will go on to develop ASPD.

If you’re concerned about your child’s behavior, it’s important to seek professional help. A mental health professional can assess your child’s behavior, identify any underlying issues, and provide guidance and support going forward.

What causes psychopathy?

It’s impossible to pinpoint a single cause of psychopathic traits, or ASPD, in any given person. However, several risk factors are known to increase a person’s likelihood of presenting with them, including:

Genetics: Some studies indicate that certain psychopathic traits have a genetic component.⁴

Brain differences: A study by University of Wisconsin-Madison researchers found that people diagnosed with psychopathy show reduced connectivity between brain regions involved in empathy and guilt, and those that process fear and anxiety.⁵

Early childhood experiences: Growing up in a dysfunctional environment, including living through childhood abuse or neglect, can increase a person’s risk of developing psychopathic tendencies.⁶

Primary vs. secondary psychopathy

Some research distinguishes between two forms of psychopathy:

• Primary psychopathy presents as superficial charm and deliberate, calculated social behavior. It’s been proposed that primary psychopathy is influenced more strongly by genetic factors than environmental ones.⁷
• Secondary psychopathy is thought to develop in response to environment factors like high levels of stress or emotional trauma. It’s associated with high-anxiety, impulsive behavior and emotional reactivity.⁸

Treatment options for psychopathy

Psychopathy can be difficult to treat. But with ongoing effort and guidance from a mental health professional, symptoms can be managed. Treatment often involves a combination of approaches. 

Cognitive behavioral therapy (CBT): CBT addresses the connections between thoughts, feelings, and behaviors. It aims to interrupt harmful patterns triggered by certain thoughts or situations and replace them with healthier ones.

Antipsychotic medication: Some people with psychopathic traits may act aggressively or impulsively. In these cases, antipsychotic medication may be prescribed “off-label” by medical professionals to help reduce these behaviors, although they’re not specifically approved for treating psychopathy.

Mood stabilizers: These medications may also be used off-label to help control agitation and reduce the risk of aggression. But like antipsychotics, they are not approved specifically to treat psychopathy.

Barriers to treatment

Certain traits associated with psychopathy can make treatment particularly challenging:

• Difficulty engaging: People with psychopathy are often manipulative, so they may appear engaged in treatment while not taking it seriously. And because they may have blunted emotions and reduced empathy, they may not see the benefit of treatment and struggle to stay engaged long enough to make progress.
• Limited insight: People with psychopathy may lack the insight and emotional awareness necessary to understand why they need treatment or understand its purpose. Their disregard for social norms and lack of remorse can make it challenging to see why they would need to change.

If you or a loved one are concerned about psychopathic tendencies, help is available. Browse our directory of therapists to find a specialist in your area.

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What is separation anxiety?

Separation anxiety is a natural psychological response that causes a person—often a child—to feel distressed when close attachment figures, such as parents or caregivers, are not nearby.

While it’s most common in young children, separation anxiety can continue or develop later in life, affecting adolescents and adults as well.

Is separation anxiety normal?

In children, separation anxiety is a normal part of development. It typically appears between 6 and 12 months of age and lasts until around the age of three, then gradually decreases as the child grows older.¹

While normal in certain amounts, separation anxiety becomes a problem when it lasts longer than expected, makes daily life very difficult, or causes a lot of distress.

Separation anxiety disorder (SAD) is a condition that occurs when a person worries excessively about being separated from loved ones—especially more than is normal for their age. It differs from normal separation anxiety in how strong the anxiety is, how long it lasts, and how much it affects daily life. SAD can present in children or adults and can be evaluated and diagnosed by a licensed mental health professional.

Separation anxiety symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), key separation anxiety symptoms include:²

• Excessive distress when anticipating or experiencing separation from home or caregivers
• Continued and excessive worry about losing major attachment figures or that they’ll be harmed (by illness, injury, disasters, etc.)
• Excessive worry about events causing separation (such as getting lost, being kidnapped, getting into an accident, or falling ill)
• Reluctance or refusal to go out, away from home, or to school or work due to fear of separation
• Excessive fear of being alone or without major attachment figures in any setting
• Difficulty sleeping away from home or without being near an attachment figure
• Repeated nightmares that involve separation
• Physical complaints (headaches, stomach aches, nausea, vomiting) when separation either happens or is anticipated

Children’s separation anxiety can look different from that of adults. Children are more likely to cling to their caregivers, follow them closely as they move from room to room, and be unable to enter or remain in rooms alone. Importantly, some amount of this anxiety is normal and doesn’t necessarily indicate a disorder.

In adults, symptoms can include control behaviors when separated from loved ones (such as frequent texts or calls) and emotional symptoms including anxiety or panic attacks.³

When separation anxiety becomes a disorder

Separation anxiety may reach disordered levels when it lasts too long for someone’s age or causes severe distress.

Signs that separation anxiety could meet the criteria for diagnosis include:

• Symptoms lasting beyond expected developmental periods
• Significant interference with daily activities
• Extreme emotional distress
• Inability to function when separated from loved ones

For SAD to be diagnosed in children and adolescents, symptoms must have lasted for at least four weeks.⁴ In adults, it must have lasted much longer—typically six months or more. It must also be causing significant distress or impairment in social, academic, or other important areas and not be better explained by another disorder.

If you’re concerned about separation anxiety in a loved one or yourself, consider speaking to a mental health professional. Only a licensed professional can assess symptoms and give you a diagnosis. They can also create personalized treatment plans to support you in managing and overcoming the specific concerns impacting your life.

Causes and risk factors for separation anxiety

While normal separation anxiety is just part of being human, multiple factors can play a role in it developing into a disorder.

Biological and genetic factors

Genetics likely play a role in separation anxiety disorder. Twin studies show stronger inheritance patterns for identical twins than fraternal twins in the development of major anxiety disorders.⁵ This suggests there are genetic components to pathological anxiety development.

Research also shows that separation anxiety is linked to functional and structural differences in the brain. Increased reactivity of the amygdala and larger grey matter volumes are associated with higher separation anxiety scores.⁶ The amygdala is the part of your brain that processes emotions, especially fear.

Family and environmental influences

How parents respond to a child’s anxiety matters. When parents are overly protective, critical, or accommodating of a child’s anxious behaviors, it can contribute to anxiety through modeling and reinforcement.⁷

Additionally, children of parents with depression and anxiety disorders are at higher risk of also developing a disorder.⁸ This may be influenced by a combination of genetic factors and learned behaviors.

Traumatic events and life stressors

Life experiences can trigger or worsen separation anxiety. Risk factors include trauma or loss of loved ones, parental conflict/divorce, and environmental changes such as moving to a new school.⁹

Other important risk factors include female gender, childhood hardships, and lifetime traumatic events.¹⁰ These experiences and identities can make people more likely to develop separation anxiety.

Related conditions and behaviors

Separation anxiety is linked to other mental health problems, making it more likely that a person will experience them either at the same time or later in life. For instance, childhood separation anxiety significantly increases the risk a person will develop a panic disorder or other anxiety disorder in adulthood.¹¹

Research also shows links between depression and separation anxiety. In a study involving adult patients with major depressive disorder (MDD), 41% also experienced separation anxiety, with three-quarters having developed it in adulthood.¹²

In addition to clinical conditions, separation anxiety plays a role in unhealthy relationship patterns, including “love addiction” behaviors in young adults.¹³ Love addiction isn’t an official diagnosis, but an unhealthy pattern in which someone constantly looks for romantic relationships to avoid being alone. This often creates dependent relationships where it’s hard to set healthy limits with partners.

Impact of separation anxiety

On relationships

Separation anxiety disorder symptoms can strain relationships significantly. Adults with separation anxiety may use excessive calling, texting, and communication when separated, creating demands that frustrate family members and lead to resentment and conflict.¹⁴

Caregivers sometimes feel suffocated by extreme demands for attention and decreased privacy. This can create a difficult cycle where the person with separation anxiety needs reassurance even as their behavior pushes others away.

On well-being and functioning

When it reaches disordered levels, separation anxiety can lead to poorer mental and physical health outcomes, including sleep disturbances, poor academic performance, and physical complaints.¹⁵

Untreated anxiety disorders significantly impair quality of life and increase risk of other mental health conditions. This is one reason why early intervention matters so much.

Separation anxiety treatment options

A certain amount of separation anxiety is a normal part of development. If a child is only somewhat distressed or hesitant to leave their caregivers, they’ll likely move beyond it with normal support and encouragement over time.

For more challenging situations, there are evidence-based treatments that can help people manage and overcome separation anxiety.

Therapy for separation anxiety

Cognitive behavioral therapy (CBT) for separation anxiety is the most recommended and effective treatment.¹⁶ CBT techniques used in treatment will likely include education about anxiety, changing of unhelpful thought patterns, and gradual exposure.

In some cases, a licensed professional may recommend combining CBT and medication. While SSRIs are sometimes used “off label” for this purpose, there are currently no medications specifically approved to treat SAD.  Your health care provider can help determine if medication might be helpful alongside therapy.

Another type of therapy, called attachment-focused psychodynamic psychotherapy, may also help improve anxiety and overall functioning, according to one small pilot study.¹⁷ This approach focuses on understanding and healing attachment patterns that contribute to anxiety.

Tips for parents

Parents play a crucial role in helping children overcome separation anxiety. Parents can benefit from learning techniques that reduce anxiety in their children and encourage coping over avoidance.¹⁸ Some parents may also benefit from treatment for their own anxiety or mental health issues, as they can contribute to their child’s.

Coping techniques might include:

• Practicing short separations and gradually increasing them
• Maintaining consistent routines
• Staying calm during separations
• Providing reassurance without overprotecting
• Seeking support for your own mental health

Separation anxiety is treatable. Whether you’re dealing with separation anxiety in your child or experiencing it yourself, help is available. Browse our directory to find qualified therapists online or in your area who specialize in assessing and treating anxiety disorders.

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About six months after giving birth to my twin daughters, I was walking through the mall with their side-by-side stroller when I noticed a woman sitting away from the crowds, quietly nursing her baby while humming a lullaby. The scene stopped me dead in my tracks, and a familiar pain rose up from my belly. Nursing—another aspect of motherhood taken away from me.

That’s how I saw it back then, anyway. I’d always imagined I would breastfeed my girls, but the reality of nursing two babies and going back to work full-time turned out to be unsustainable for our family. Many parents of twins do breastfeed, but it wasn’t in the cards for us.

It was more than that at the mall, though. It was the stillness of the moment. The mother and baby in an embrace, as if the world were holding them close against its chest. Suddenly one of my girls cried out as her sister pulled her hair, and I was jolted back to reality. I tried not to cry as I loaded them into the car and headed home.

Having two babies at once will test every inch of you. It will challenge you physically, mentally, and emotionally. But what other people rarely see is just how lonely all that chaos can be.

Longing for connection

How can you feel lonely when you’re standing in the middle of a circus? Simple. Your identity becomes less mother and more ringmaster.

Psychologist Joan A. Friedman, PhD, grew up as a twin, raised twins of her own, and has written several books on twins. She thinks this parental loneliness stems from a lack of connection—one that she has experienced from every angle. “In my own upbringing, I was not connected to my parents, and I was overly connected to my twin,” Friedman says. “Then when I had my twin boys, I didn’t connect with them the way I had with my older singletons. There just wasn’t this sense of knowing them like I had with my other kids.”

But when I ask her about my experience at the mall, she wonders if loneliness was really at the root of it. “What you were feeling might have been jealousy and envy that you didn’t get to have a singleton experience,” says Friedman.

She’s absolutely right. I ached for the quiet, singular bond that other mother had.

Create one-on-one time

Having multiples can be isolating, but Friedman says parents of twins can remedy that and build the connection they want so desperately with their kids.

“I started to make time for each of my twins individually,” she says. “If I had to go to the market, I’d take one. If I had time to go around the block, I took one. It was a concentrated effort to carve out some alone time so that I felt I could be connected to who each of them was.”

However, Friedman admits, she was in the privileged position of being able to take those actions. Many parents of multiples are going it alone while their partner works long hours (like mine did) or isn’t in the picture.

If spending time alone with each twin is an option for you, consider these ideas:

• While the babies are napping, slip one out of their crib and rock them in another room.
• If you have a partner, each of you can care for one of the babies while you take turns going on a walk.
• Trade alone time with another parent in your social circle.
• Make the most of sick days. Even though my girls are 17 now, I take the time to baby each of them when they need a solo day home from school.
• Set a timer to encourage “alone time.” Give one twin a task or a fun project to work on while you take the other twin into a different room for a parent-kid hangout.

It sounds simple enough to focus on one child at a time. But if you’ve never had twins, you don’t know what you don’t know. In my case, I would always hit a wall when I thought about separating the girls. What if one was somehow getting more of me than the other? What if their experiences weren’t the same?

Don’t let fairness get in the way

When faced with many of the milestones unique to parents of multiples—like whether both kids should be in the same class at school, have the same friend group, and include each other on playdates—I felt like my ability to make decisions was hindered by my desire for my daughters to have identical experiences. This idea of equality was a constant presence, leading to an overwhelming sense of anxiety and guilt.

“Life is not fair, and twins are not equal,” says Friedman. “The reason this idea of fairness weighs so heavy on us is because parents of twins don’t have the chance to really work on their ambivalence.” When parents have more than one singleton, she adds, their favor shifts periodically from child to child, whether they want to admit it or not. This allows parents to get to know their children as individuals.

But because twins are often viewed as two copies of the same person, the idea of building separate connections with them can seem unjust. “I have five kids,” Friedman says. “I always say I loved them all, but I didn’t love them all the same. If I’d loved them all the same, it would have absolutely interfered with my getting to know each one.”

Letting go of the idea that we can create a level playing field for our kids relieves parents of a huge burden. It also teaches children an important life lesson: The world will not always be fair, but we keep moving anyway.

The only nonnegotiable

Raising twins feels different because it is. The single most important thing you can do as a parent, says Friedman, is be very intentional about helping them build separate identities. Otherwise they can become enmeshed, or one may slip into a caretaking role.

One night when my daughters were eight or nine, I was waiting for them to finish a soccer game when I started chatting with another parent. She said how lucky I was that my girls played the same sport. Her daughters, two years apart in age, had separate and equally time-consuming interests, which greatly complicated her life. “My girls like all the same things,” I said smugly. “It’s like I’m raising them as a unit.”

I cringe at that memory now, knowing just how wrong I was. My daughters didn’t choose the same things—they played the only sport I introduced them to, and they joined only the clubs I told them about. I wasn’t giving them options and asking them to pick; I was guiding their choices to make life easier for myself. What I learned to do as they grew older was encourage them to discover who they were beyond each other.

“Advocating for your twins is important,” says Friedman. “You have to teach the people in their lives to treat them differently also.” For example, ask your twins’ coach to have them play different positions or on different training squads. Ask other parents if you can trade off playdates. Work with their teachers to keep them as separate as possible.

Encouraging your twins to spend time apart is good for you as well. Having them in separate classes, sports, or clubs means you get to bond with them individually—another chance to experience and connect with them one-on-one.

Launching two at once

When my daughters became toddlers, then bigger kids and teens, my loneliness grew as they drew closer to each other. The bond between twins, especially identical twins, can be as intense as it is beautiful.

I was worried when my girls still hadn’t spoken well past their first birthday, but their doctor assured me this was normal for twins: They felt less urgency to talk to me because they were meeting one another’s communication needs. When they did speak, their first words were to each other. They shared the kind of language experts call cryptophasia or “twinspeak,” a made-up soup of syllables only they could understand.¹ I thought it was cute and funny, but it also felt like a language of exclusion at times—a way for them to communicate around me.

Other milestones seemed to come in waves, always close together: losing teeth, learning to read, starting school, making friends, experiencing heartbreak. I never had time to stand up without feeling the undertow at my feet. I also missed the chance to learn from one and get it right with the other. If I let one of them down, then I failed them both.

Lessons from the home stretch

Today my husband and I are preparing to send our daughters off to college. In less than two years, they’ll depart together—maybe not to the same place, but at the same time.

I envy friends who can launch one child from the nest and still have another in their care, extending parenthood by a few more wisps. I’m already beginning to feel the silence my girls will leave behind, as they both start driving and detaching from us as independent young women.

My heart has been in my throat so many times while I’ve watched them walk away from me toward uncharted territory, but I know they have each other’s backs. As much as their deep connection has left me on the outside, I’ve also grown to depend on it.

In my family, we like to joke that I have a team behind me: the two of them always together, always with me. The bond they first built inside my body has been amazing to witness out in the world. Despite the loneliness that comes with it, I wouldn’t have written my parenthood story any differently.

If you’re struggling with parenting twins or any number of kids, help is available. A therapist can support you in working through loneliness and other challenges. Visit our directory to find a licensed provider near you.

The post The loneliness of raising twins appeared first on therapist.com.

What is gentle parenting? 

Gentle parenting focuses on showing young children love and helping them manage emotions, rather than disciplining them. It emphasizes validating emotions before correcting behavior.¹

Childcare and parenting author Sarah Ockwell-Smith coined the term “gentle parenting” in her 2016 book. Though it isn’t a structured or systematic approach, gentle parenting has gained significant popularity on social media platforms and parenting forums. It’s viewed mainly as a mindset and philosophy for raising children from birth to age seven.

Because the approach to parenting is so new, there’s little empirical evidence for it. The first and only study to date on gentle parenting was published in 2024, which surveyed 100 U.S. parents who had kids aged 2 to 7.² About half called themselves gentle parents.

Gentle parenting vs. other parenting styles

Traditional parenting styles include:³

• Authoritarian, which involves strict rules and punishment with little warmth.
• Permissive, which has few rules or consequences with lots of warmth.
• Authoritative, which sets clear boundaries with warmth and support.
• Neglectful, which is when parents offer little involvement or guidance.

Of these four main parenting styles, gentle parenting most closely aligns with authoritative parenting. Gentle parenting, however, places an even larger emphasis on emotional intelligence and understanding the root causes of behavior.

Some people might mistake gentle parenting for permissive parenting because of its focus on empathy and avoiding punishments. But this is a misconception given that gentle parenting still maintains boundaries and expectations.

Gentle parenting techniques

Ockwell-Smith’s book discusses four main pillars of gentle parenting:

1. Empathy: Understanding and validating children’s emotions
2. Respect: Treating children as individuals with their own thoughts and feelings
3. Understanding: Learning about child development and age-appropriate behaviors
4. Boundaries: Setting clear, consistent limits while remaining calm and supportive

These principles can help parents build strong relationships with their children while teaching emotional regulation and problem-solving skills. Rather than using rewards and punishments, gentle parenting focuses on connection and natural consequences to guide behavior.

Based on these principles, parenting techniques might include:

• Active listening and reflecting feelings back to children
• Using “time-ins” instead of time-outs to process emotions together
• Explaining the reasons behind rules and expectations
• Modeling emotional regulation and healthy coping skills
• Creating safe spaces for children to express big feelings
• Offering choices within appropriate boundaries
• Using natural consequences instead of punishments
• Speaking calmly and avoiding harsh tones
• Acknowledging good behavior without excessive praise
• Focusing on connection during challenging moments
• Working with children to find solutions to problems
• Validating emotions while setting clear limits on behavior
• Using positive language and reframing negative situations

Gentle parenting examples

Here are some real-world examples of what gentle parenting might look like:

• Instead of a parent telling an upset child to stop crying, they might say, “I see you’re feeling sad. Would you like a hug?”
• Rather than putting a child in time out for hitting their sibling, they might say, “I understand you’re frustrated, but hitting hurts. Let’s take a break together and find a better way to handle this.”
• When a child refuses to clean up toys, instead of threatening punishment, a parent might say, “I know it’s hard to stop playing. Would you like to clean up the blocks or the stuffed animals first?”

These approaches can help children feel understood while learning appropriate behavior through guidance rather than force. For daily routine activities, gentle parenting might look like this:

• Bedtime: “It’s time to start getting ready for sleep. Would you like to brush teeth or put on pajamas first?”
• Mealtime: “I notice you haven’t eaten your vegetables. What could we do to make them taste better?”
• Morning routine: “Let’s work together to get ready. Which part would you like to do first?”

Giving children choices like these can help them develop autonomy while maintaining structure. Parents guide rather than control, fostering cooperation through understanding and respect.

If you’re struggling as a parent, consider reaching out to a mental health professional who specializes in parenting or family therapy. They can help you develop strategies tailored to your family’s needs and circumstances.

Gentle parenting pros and cons

Gentle parenting might seem like an ideal parenting style in theory, but it comes with its fair share of challenges. Parents should consider both the benefits and drawbacks when deciding if this approach fits their family.

Pros

• Gentle encouragement from parents helps shy toddlers feel less afraid and more comfortable in social situations, which can reduce their risk of anxiety.⁴
• When parents use gentle guidance, children are more likely to listen and cooperate, especially at home.⁵
• Parenting programs that use gentle techniques like positive reinforcement and nonviolent discipline may help reduce disruptive behavior in children, both in preventing problems and treating existing issues.⁶
• When combined with a strong, secure relationship between parent and child, gentle parenting helps children develop a strong moral compass, including good behavior, moral thinking, and a positive self-image.⁹
• Responsive parenting, a key part of gentle parenting, is strongly linked to better thinking skills and behavior in children.¹⁰

Cons

• Gentle parenting requires significant patience, consistency, and emotional energy from parents. This can make it challenging to maintain during stressful times, in public settings, or when parents are exhausted.
• Gentle parents who are highly self-critical or have perfectionist tendencies are more likely to struggle with their self-confidence in parenting.¹¹
• Gentle parenting approaches—including warmth, appropriate discipline, and respect for independence—show only small reductions in behavioral problems in children.¹²
• Some critics argue that gentle parenting may not provide enough structure or clear consequences for serious misbehavior.¹³

Is gentle parenting effective?

Overall, gentle parenting’s effectiveness may depend on the specific situation and behavior being addressed.¹⁴ It could still promote emotional development and well-being in children, but more research is needed to fully understand its impact and limitations.

Is gentle parenting creating a generation of entitled kids?

There’s ongoing debate about whether gentle parenting is creating a generation of entitled children. Critics argue that gentle parenting fails to properly teach children about boundaries and consequences, potentially leading to entitled attitudes.¹⁵

Supporters of gentle parenting, however, argue that when done correctly it shouldn’t create spoiled or entitled children.¹⁶ They point out that gentle parenting is not a lack of discipline or boundaries, but rather leading with empathy while still providing appropriate consequences.

It ultimately comes down to how it’s carried out. When parents maintain clear boundaries while showing empathy, children learn responsibility and respect rather than entitlement.

How to gentle parent effectively

If you want to practice gentle parenting effectively, you can start with these strategies:

Start with small changes in daily interactions.You might begin by practicing active listening during conversations with your child, and acknowledging their feelings before addressing behavior. Focus on one challenging situation at a time, like bedtime or mealtime routines.

Practice self-regulation by staying calm during difficult moments. Model the behaviors you want to see, using phrases like, “I need a moment to calm down,” when frustrated.

Set clear, age-appropriate boundaries while maintaining connection. For example, you might say, “I understand you want to keep playing, but it’s bedtime now. Let’s choose a book to read together.” This approach acknowledges feelings while maintaining structure.

Create opportunities for success by setting realistic expectations. Break tasks into manageable steps and offer specific praise for effort and progress.

Focus on teaching rather than punishing when addressing challenging behaviors. Help children understand the impact of their actions and explore better choices together.

Build a support network of other parents practicing gentle parenting techniques. Share experiences, strategies, and encouragement with others who understand the challenges and rewards of the approach.

Go easy on yourself. You’ll have days when you struggle to be patient or respond perfectly to every situation. When setbacks happen, acknowledge them, reflect on what you could do differently, and move forward with renewed intention. Consider seeking support from a professional if you find yourself struggling with the overwhelming task of parenting. Visit our directory to find a therapist near you

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What is compersion?

Compersion is the feeling of taking joy or happiness in the joy or happiness of others. It’s mostly used in the context of ethically nonmonogamous (ENM) relationships. In ENM relationships, compersion specifically refers to the experience of finding pleasure or satisfaction in your partner’s relationship with someone else. For ENM relationships to flourish, partners must be willing to support each other’s connections with others.

Compersion vs. sympathetic joy

Compersion isn’t technically exclusive to romantic relationships, or to relationships at all. While it’s most commonly discussed in the context of romantic and sexual relationships, it can also apply to any relationship or situation where someone feels joy from seeing another person happy.

When compersion is experienced in non-romantic relationships or situations, a more typical term to describe it is “sympathetic joy.” Sympathetic joy is related to compersion, but broader in scope.¹ It simply involves feeling happiness for others’ successes and positive experiences. The concept has a long history, reaching back to Buddhist philosophy in which it’s considered one of the four sublime states of mind.

Compersion vs. jealousy

When a person shows romantic interest in someone other than their partner, it’s natural to expect to feel jealous due to the perceived threat to the relationship.² But while jealousy can stem from feelings of insecurity, fear, or possessiveness, compersion is rooted in empathy and a genuine desire for your partner’s happiness.

Compersion is often described as the “opposite of jealousy.” Research shows that people can have both positive and negative reactions to their partner’s romantic interests outside the relationship at the same time.³ This suggests that compersion and jealousy, while opposites, can coexist.

Can you experience compersion in a monogamous relationship?

While compersion is most often associated with ENM relationships, it can also be experienced in monogamous partnerships.

In a study of polyamorous and monogamous people, researchers explored how they expected to feel if their partner had romantic interests outside their relationship. People who had experience with a partner having other romantic interests tended to predict more compersion and less jealousy. Interestingly, this was especially true among monogamous partners.⁴

Examples of compersion

In a polyamorous relationship involving three people, one partner feels a sense of genuine happiness and contentment when they see their two partners cuddling on the couch. They appreciate the strong bond forming between the other two. They feel that their connection strengthens the overall dynamic of the three-person unit.

In a friendship, a woman feels excited and proud when her best friend gets a promotion at work. She celebrates her friend’s success without any trace of envy, genuinely happy for her accomplishment.

In an open marriage, a husband experiences joy when his wife returns from a date looking happy and rejuvenated. He’s glad she had a positive experience and feels grateful that his wife has multiple people who bring her joy.

In a monogamous relationship, a man finds it cute that his partner has a crush on a Hollywood celebrity. When a new movie comes out starring that celebrity, he encourages his partner to go see it with friends. He’s genuinely happy that his partner will enjoy the experience.

Compersion psychology

It’s perfectly natural to not feel happy about the idea of your partner having romantic or sexual experiences with others. It doesn’t mean you’re selfish or insecure. It’s a natural response likely rooted in evolutionary psychology.

Humans have developed attachment behaviors to ensure pair bonding and meet other evolutionary needs.⁵ These behaviors laid the framework for how we’ve come to understand and participate in relationships as humans. But compersion challenges these instincts by encouraging a more expansive view of love and relationships.

Recent research suggests three main themes that affect whether you’re likely to experience compersion:⁶

1. Your specific personality traits
2. The nature of your relationship with your partner
3. Your views on your partner’s other partner (their “metamour”)

A person is more likely to feel compersion if they have a strong sense of self-worth, are having their needs met in their relationship, communicate well with their partner, and like the metamour.

These findings align with existing research and suggest that certain psychological theories might explain compersion and how it can strengthen relationships. These include:⁷

• Broaden-and-build, which suggests that experiencing positive emotions can increase a person’s number of possible responses to a given situation.⁸ It also helps them build lasting personal resources, such as resilience.
• Self-expansion, which tells us that people include their relationships with others in how they define and understand themselves. ⁹ Exploring compersion may be a way of expanding one’s sense of self.
• Crossover, which explores how emotions can transfer between people, suggesting that one partner’s happiness can positively influence the other’s emotional state.¹⁰ 

How compersion impacts relationships

Compersion is linked to greater relationship satisfaction, while jealousy and mixed feelings are not.¹¹ It encourages a mindset of abundance rather than scarcity in relationships, which may foster a more supportive and understanding dynamic. This can lead to improved communication and increased trust between partners.

People in polyamorous relationships generally feel less jealousy and more compersion than people in monogamous relationships.¹² Real-life experiences with a partner having other romantic interests can help boost feelings of compersion while combatting feelings of jealousy, even in monogamous relationships.

Challenges with compersion

Compersion can be beneficial for some people, but it’s not always easy to achieve. Some of the biggest obstacles to experiencing it include:

• Personal feelings of insecurity or fear of loss when confronted with a partner’s connections outside the relationship.
• Societal and cultural norms that emphasize exclusivity in romantic relationships.
• Lack of experience with non-traditional relationship structures.
• Comparison and competition with other partners.

How to cultivate compersion

Cultivating compersion takes practice, especially if you’re prone to experiencing emotions like jealousy and insecurity. You’re under no obligation to develop compersion, but if you’re interested in building it, there are some strategies that can help:

Explore the reasoning behind your emotions. Take time to examine your emotions and identify any underlying insecurities or fears. Understanding the root causes of negative feelings can help you address them more effectively.

Practice gratitude for your relationship. Focus on the positive aspects of your partnership and the joy your partner brings to your life. This can help shift your perspective towards abundance rather than scarcity.

Practice empathy and perspective-taking. Try to see situations from your partner’s point of view and understand their feelings and experiences. This can help you connect with their joy and happiness more easily.

Communicate openly with your partner. Share your feelings, both positive and negative, and work together to build trust and understanding. Honest communication can strengthen your bond and make it easier to experience compersion.

Identify and set boundaries about what you are and aren’t comfortable with. It’s important that both you and partner feel safe and respected. Open communication about limits and expectations can help prevent misunderstandings and foster trust.

Commit to a personal development plan. Developing a strong sense of self-worth can help reduce feelings of insecurity and jealousy, making it easier to experience compersion. Engage in activities that boost your self-esteem and reinforce your value.

Challenge negative thoughts. When you notice jealous or insecure thoughts, try to reframe them in a more positive light. For example, instead of thinking “My partner’s happiness with someone else means they love me less,” try “My partner has space to care about more than one person.”

Consider seeking support from a therapist or relationship coach. They can provide guidance and strategies tailored to your specific situation. They can help you work through any underlying issues and determine if a non-traditional relationship structure will work for you. Visit our directory to find a licensed therapist in your area.

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Bipolar disorder is a mental illness involving extreme shifts in mood and energy. Formerly called “manic depression,” this disorder causes you to swing between episodes of two emotional states: mania or hypomania (“high highs”) and depression (“low lows”). The world “bipolar” refers to these two opposite “poles” of emotion.

People with bipolar disorder can have milder moods between manic and depressive episodes. However, in some cases, people have symptoms of mania and depression simultaneously. These “mixed” episodes, which aren’t severe or extensive enough to result in a diagnosis of bipolar disorder, are called “depression with mixed features.”

Symptoms of bipolar disorder

Symptoms of bipolar disorder change depending on what kind of episode a person is experiencing. For example, manic episodes are characterized by abnormally high self-confidence, while depressive episodes are connected to low self-esteem.

Still, some typical signs of bipolar disorder are consistent regardless of whether the person is experiencing mania or depression. These include:

• Extreme mood swings
• Difficulty concentrating or making decisions
• Insomnia, or less need for sleep
• Decreased appetite

Manic symptoms

If you have bipolar disorder and you’re experiencing mania, you feel extremely confident and full of energy. You may act in risky, impulsive ways or have hallucinations. Hypomania, a less extreme form of mania, doesn’t result in delusions or reckless risk-taking.

Symptoms of mania include:

• Feeling overly happy or excited
• High energy
• Speaking very quickly
• Poor decision-making
• Increased sexual desire
• Risky or impulsive behaviors
• Sudden, intense irritability

Depressive symptoms

If you have bipolar disorder and go through a depressive episode, you experience the symptoms of major (or “clinical”) depression. A therapist can help you determine if your symptoms suggest clinical depression or a bipolar depressive episode.

Bipolar depression symptoms include:

• Sadness, emptiness, or hopelessness
• Loss of interest in activities that once brought pleasure or joy
• Low energy
• Slow speech
• Low sexual desire
• Anxiety or restlessness
• Suicidal thoughts (suicidal ideation)

Bipolar disorder in children and teens

It’s often difficult to diagnose children and teens with bipolar disorder. Many bipolar symptoms can also point to other forms of mental illness, such as attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD). It’s also worth keeping in mind that mood swings are also common in children and teens without mental health conditions, especially as they go through puberty.

If your child or teenager is showing signs of bipolar disorder, seek a professional opinion from their doctor and/or a licensed therapist.

Types of bipolar disorder

Bipolar I: Bipolar I is characterized by manic and depressive episodes. Manic episodes last at least a week or result in hospitalization, while depressive episodes last at least two weeks. This form of bipolar disorder typically has the most extreme symptoms. People with bipolar I may also experience depression with mixed features.

Bipolar II: People with bipolar II experience hypomanic and depressive episodes, but they don’t experience full mania.

Cyclothymic disorder: People with cyclothymic disorder have had hypomanic and depressive symptoms for at least two years (or one year for children and teens). These symptoms may not be severe enough to match the specific definitions of hypomania or major depression.

What causes bipolar disorder?

Just like with depression or other mental health conditions, there’s no one exact cause of bipolar disorder. But certain risk factors may increase your likelihood of developing it, including:

• Biochemistry: Some studies have shown ties between bipolar disorder and chemical imbalances in the brain, though this connection is still being explored.¹
• Genetics: You may be at increased risk of bipolar disorder if a relative has been diagnosed with it.²

Certain additional factors can trigger bipolar symptoms in people with a genetic or biological susceptibility for the disorder. These triggers include substance use, physical illness, trauma, and sleep disturbances.

Is bipolar disorder hereditary?

Genetics play a role in who’s diagnosed with bipolar disorder, but they don’t have the final say. Someone can be diagnosed even if they have no family history of mental illness. Your risk may increase if a family member has been diagnosed, but there’s no guarantee you’ll have bipolar disorder if your parent has it.

Strategies for management and treatment

When treating bipolar disorder, therapists typically rely on medication, psychotherapy, or a combination of approaches.

Medical therapy: Mood stabilizers, antidepressants, antipsychotic drugs, and other medications can be effective on their own or in combination with talk therapy. Your psychiatrist may prescribe anti-anxiety pills or sleep medication to help with some symptoms.

Other forms of medical therapy may also help. If you have more serious symptoms, such as severe mania, depression, psychosis, or suicidality, electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) may prove effective. These techniques stimulate the brain using electric or magnetic waves, respectively, to help treat the disorder.

Psychotherapy: Your therapist may choose from a number of methods to help you strengthen your mental health. Cognitive behavioral therapy (CBT) can help you challenge unhelpful thought patterns, while interpersonal and social rhythm therapy (IPSRT) can help you establish stability through a daily routine.

Lifestyle changes: These changes can help alleviate some symptoms of bipolar disorder, but note that they aren’t a cure on their own and shouldn’t be used without some form of professional treatment.

Common lifestyle changes for bipolar disorder include:

• Following a daily routine
• Sleeping, eating, and exercising regularly
• Avoiding alcohol and drugs
• Trying new hobbies
• Keeping a journal of your moods and symptoms
• Investing in healthy relationships

“Am I bipolar?”

If you recognize signs and symptoms of bipolar disorder in yourself, speak with your doctor. No website, friend, or family member can diagnose you with a mental health condition. Only a licensed professional can formally diagnose you.

See your primary care doctor: A good first step is to see your regular physician and share your symptoms and concerns. They can conduct lab tests and a physical to rule out health conditions with similar symptoms.

Speak with a therapist: Your doctor may refer you to a therapist, or you may choose to look for one on your own. Either way, your therapist can evaluate your symptoms and give you a more in-depth view of your diagnosis. Browse our directory to find a licensed mental health professional near you.

Your therapist may diagnose you with bipolar disorder or a different disorder, such as anxiety or depression. Whatever your formal diagnosis may be, your therapist can offer treatment methods to help you start feeling healthier.

Help is available now: If you’re in crisis, support is available 24/7. Call the free, confidential 988 Lifeline at 988 or 1-800-273-TALK (8255), or text HOME to 741741 for the Crisis Text Line.

The post What is bipolar disorder? appeared first on therapist.com.

What is autism?

“Autism” is a shortened way of referring to autism spectrum disorder (ASD). ASD is a group of developmental disorders that involve social and communication challenges and repetitive behaviors. Autism is a lifelong condition. In some cases, it may qualify as a legal disability.

Doctors can diagnose a person with ASD at any age, though they diagnose most cases during childhood. They can reliably diagnose early signs of autism in a child as young as two.¹

What does it mean to be “on the spectrum”?

Because autism encompasses a range of developmental disorders, we sometimes use the term “on the spectrum” to discuss it.

The spectrum encompasses different subtypes of autism with varied symptoms, strengths, and struggles.

Asperger’s syndrome, autistic disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) were previously thought of as distinct conditions. Now, they’re all classified under the single diagnosis of autism spectrum disorder (ASD).²

Terms like “high-functioning ” and “low-functioning ” were once used to refer to the different extremes of the spectrum. However, these aren’t medical terms and many people with autism find them limiting or offensive.

Why is autism so common now?

Experts have used the term “autism” since the early 1900s, but its definition has changed greatly over the past century. Historically, many people who might have had ASD went undiagnosed or misdiagnosed. As awareness increases, rates of diagnosis will also increase.³

This doesn’t necessarily mean there are more people with ASD in the world. It likely means that clinicians are simply getting better at recognizing and diagnosing ASD.

Symptoms of autism

Autism symptoms tend to occur in early childhood, often between six and 18 months of age.⁴ Most children begin to show symptoms within the first year, but some develop typically and then have a period of regression between 18 to 24 months. The average age of diagnosis, however, is four years old.

Some of the most common symptoms include:

• Struggling to communicate
• Difficulty with social interactions and eye contact
• Repetitive behaviors
• Limited, focused interests

Who can diagnose autism?

If you have questions about your child’s development, a pediatrician can answer your questions and conduct some tests to rule out other explanations for your concerns.

If your pediatrician believes an ASD diagnosis may be likely, they’ll refer you and your child to a trained, certified specialist who can offer a professional diagnosis.

If you’re wondering if you may have ASD as an adult, your primary care physician (PCP) can address your concerns and help you rule out other health conditions with similar symptoms. Your PCP can refer you to a psychologist or psychiatrist for a professional evaluation. You can also browse our directory to find a local therapist specializing in treating adults with ASD.

What causes autism?

There’s no known single cause for autism, but certain factors may increase its likelihood:

• Genetics: According to the Centers for Disease Control, you’re more likely to develop ASD if you have an older sibling with ASD.⁵ Certain other genetic or chromosomal syndromes may also increase your likelihood.
• Pregnancy: Research suggests certain drugs taken during pregnancy may result in a higher chance of ASD.⁶ Your child’s likelihood may also increase if your pregnancy happens later in life.⁷

Do vaccines cause autism?

Vaccines do not cause autism. Despite some public misinformation that has circulated over the years, multiple studies have shown that there’s no causal link between vaccines (or their isolated ingredients) and ASD.⁸ In fact, the original study that claimed to find this nonexistent connection was based on fraudulent data and was later retracted.

Treatment for autism

There is no “cure” for autism, but treatment can make a big difference in people’s lives. Treatment may include early intervention, medication, psychotherapy, or some combination of the three.

Early interventions for ASD

Early support can help people with autism thrive. Kids can even receive treatment before age three to help them learn skills like walking, talking, and social interaction.

Common therapies for autism focus on treating symptoms that affect quality of life. A few of these options include:

• Applied behavioral analysis (though it is somewhat controversial)
• Social skills training
• DIRFloortime®⁹
• Pivotal Response Treatment® (PRT)¹⁰
• Occupational therapy
• Speech-language therapy
• Group therapy

If you suspect your child may have ASD, it’s important to ask your pediatrician about it as soon as possible. An early diagnosis can help you access early intervention treatment. 

Medication for ASD

Medication for ASD symptoms is typically only prescribed for older children or adults. Medicine may be used to manage severe symptoms that interfere with daily life. This could include anxiety or hyperactivity.

Psychotherapy for ASD

Psychotherapy can help people with autism cope with mental health issues. In particular, cognitive behavioral therapy (CBT) can be especially helpful. CBT focuses on the relationship between thoughts, behaviors, and emotions. It teaches people to identify unhelpful thoughts so they can make healthy choices.

Early therapy for a child with autism can lead to more positive outcomes. But it can also be a great resource for older children and adults.

An ASD diagnosis in adulthood can affect your sense of who you are. A therapist can help you adjust to the shift in a healthy way. They can help you resolve past issues or traumas that may be easier to understand in light of your new diagnosis.

Autism and identity

When we talk about autism, it’s important to consider the lived experiences and preferences of people with ASD and follow their lead on how they wish to discuss it. Each person with ASD has had different experiences and may view their diagnosis differently.

As Dr. Stephen Shore famously said, “If you’ve met one person with autism, you’ve met one person with autism.” Whether someone considers their ASD to be a mental health condition, a disability, an identity, or a mix of all three, their perspective is the one that matters.

It’s important to use language that respects people with autism and honors their specific preferences. Because autism is not an illness to be overcome, some people with ASD view it as an identity to be embraced. Some people prefer to be called an “autistic person.” Others prefer “person with autism.” Some in the autistic community use the term “neurodivergent,” emphasizing that ASD and certain other developmental and mental health disorders are differences rather than deficits (people without those conditions are called “neurotypical”). When in doubt, ask the person with autism how they prefer to be identified.

If your child has ASD, try not to discuss it in a way that makes it an “enemy” or “illness,” or that implies it comes with a sense of shame. If your child is old enough, ask them about how they view their diagnosis and how they want to talk about it.

Treatment and acceptance

Acceptance and even pride in an ASD diagnosis are not at odds with seeking treatment.

Parents should be encouraged to seek early treatment interventions for their child with ASD in an effort to secure the most positive outcomes. However, it’s equally important to caution parents not to prioritize “curing” their child’s ASD or making them “normal.” People with autism can lead full lives without striving to be “normal.” 

At the same time, it’s okay to feel frustrated with the lived realities of autism, whether you have ASD yourself or are parenting a child with ASD. Remember that people with autism have strengths, weaknesses, opportunities, and challenges, just like people without autism.

If an ASD diagnosis is affecting your mental health, consider speaking with a licensed therapist for support.

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What is relationship OCD?

Relationship obsessive-compulsive disorder (ROCD) is a presentation of OCD characterized by intrusive thoughts and compulsive behaviors related to intimate relationships. Research suggests that ROCD can be just as distressing as other presentations of OCD, and is more likely to lead to both relationship dissatisfaction and depression.¹

Relationship OCD symptoms

Relationship OCD symptoms can be divided into two main categories: relationship-centered or partner-focused.² 

Relationship-centered symptoms involve constantly worrying about the relationship and the emotions surrounding it. Obsessive thoughts might include:

• Doubts about the “rightness” of the relationship
• Questioning if you truly love your partner
• Worrying if your partner truly loves you
• Constantly comparing your relationship to others
• Seeking reassurance about your relationship’s status

Partner-focused symptoms involve fixating on your partner’s specific traits, such as:

• Obsessing over their physical attributes or flaws
• Fixating on their personality traits or quirks
• Constantly analyzing their intelligence or sense of humor
• Worrying about their social skills or career prospects

These obsessions can lead to compulsive checking behaviors like:

• Excessively monitoring how you’re thinking, feeling, and behaving
• Comparing your partner to imaginary “ideal” partners
• Seeking reassurance about your relationship from friends, family, therapists, or even psychics
• Using past positive experiences to try to convince yourself that all is well in your relationship
• Testing your partner to see if they measure up to your expectations
• Trying to fix “mistakes” your partner makes or change certain qualities they have
• Avoiding situations that trigger doubts about your relationship, such as going to see a romantic movie
• Misinterpreting common relationship experiences as signs of incompatibility 

If you’re having doubts or worries about your relationship, a licensed therapist can help you determine if they’re related to ROCD or stem from another source. 

Relationship OCD examples

Nine months into a relationship, a woman constantly wonders if her boyfriend is “the one.” She obsessively analyzes their interactions and compares him to people she sees both in-person and on social media. She frequently seeks reassurance from friends about everything from their chemistry and compatibility to their shared interests and future plans. She finds herself unable to fully enjoy their time together, constantly questioning if she’s truly happy or if there might be someone better out there for her.

Two years into dating, a man obsesses over his girlfriend’s minor physical “flaws.” He compulsively compares her to his exes and other people he finds attractive. Even though he knows looks aren’t the foundation of their relationship, he can’t stop fixating on them. His constant focus on the perceived flaws causes stress and makes it hard for them to be close.

Two years into a marriage, a nonbinary person becomes obsessed with their partner’s intelligence. They begin analyzing conversations and questioning responses, fact-checking their statements online. Although they have a genuine connection and their partner has a successful career, they begin to fear they’ve settled for someone “not smart enough.” Their preoccupation strains the relationship and overshadows their partner’s other qualities.

What causes relationship OCD?

Experts don’t know the exact causes of OCD, but they believe a combination ofgenetics and environmental factors plays a role.³ Personality traits, life events, or attachment issues can all shape how a person thinks about and experiences relationships.

Relationship OCD symptoms often coexist with other OCD symptoms, and are also associated with negative emotions, low self-esteem, dissatisfaction in relationships, and attachment insecurities.⁴ 

One theory suggests relationship OCD may develop and continue when people catastrophize normal thoughts or events.⁵ Events that are typical are misinterpreted as threats, and relationship-related decisions are suspected to have dire consequences. For example, a person might think that staying in a relationship will make them miserable once the “honeymoon” phase is over. Or they may think that if their partner breaks up with them, they’ll never recover from it. 

People in the LGBTQIA+ community may be more prone to experiencing certain symptoms of ROCD. Research shows they tend to have greater doubts about their partner’s love, experience heightened negative emotions, and display more perfectionistic traits compared to those in heterosexual relationships.⁶ It’s possible that this is the result of certain societal factors LGBTQIA+ people are forced to face, such as discrimination, marginalization, and internalized stigma.

How relationship OCD impacts mental health

People with ROCD are more likely than others to feel overly responsible for their thoughts.⁷ They tend to believe thoughts can and should be controlled, making them feel even worse when they have doubts about their relationship. The guilt and self-blame they experience can contribute to stress and negative reactions toward their partner. 

People with relationship OCD also tend to think the negative consequences of being alone are much worse than those without the condition.⁸ They often imagine terrible situations where they’re stuck in unhappy relationships, but also fear being alone.

How does relationship OCD affect relationships?

Relationship OCD symptoms are strong predictors of relationship dissatisfaction and depression.⁹ These symptoms can create a self-fulfilling prophecy, where constant doubting and checking behaviors strain the relationship, eventually leading to problems. 

Partners may feel scrutinized, misunderstood, or emotionally distant due to their partner’s obsessive thoughts and compulsive actions. The person with relationship OCD might struggle to fully engage in the relationship, missing out on genuine moments of connection and intimacy. 

It’s a vicious cycle that can erode trust, communication, and overall relationship satisfaction. If not addressed, relationship OCD can lead to breakups or long periods of distress for both partners.

Relationship OCD treatment

Treating relationship OCD is similar to treating other forms of OCD.¹⁰ Effective forms of treatment include cognitive behavioral therapy (CBT) techniques like cognitive restructuring or exposure and response prevention (ERP).

In cognitive restructuring, therapists work with clients to challenge their obsessive thoughts about their partner or relationship, helping them identify and reframe distorted beliefs. ERP, on the other hand, might involve exposing clients to situations that trigger relationship doubts, then preventing the compulsion that follows.

Research suggests that it can also be helpful to look into how much a person’s self-worth depends on their relationship and to address any attachment issues, like fear of being abandoned.¹¹ Working on certain social skills, such as how to communicate effectively and resolve conflicts, can also be beneficial.

Other helpful forms of therapy include acceptance and commitment therapy (ACT) and couples therapy. ACT can help people with ROCD symptoms embrace uncertainty and experience their thoughts without judgment.¹² Couples therapy, on the other hand, may be needed if ROCD symptoms are significantly impacting both partners in the relationship. 

How to deal with relationship OCD

If you think you might have relationship OCD, it’s important to seek professional help from a therapist experienced in treating OCD. In the meantime, you can:

• Challenge your intrusive thoughts and question their validity 
• Practice mindfulness techniques to help ground you in the moment
• Avoid constantly seeking reassurance, as this can reinforce obsessive thinking
• Journal about positive relationship moments
• Engage in activities as a couple that don’t trigger your doubts
• Remember that certain worries about relationships are normal
• Engage in self-care activities to reduce overall stress and anxiety
• Communicate openly with your partner about your struggles
• Join support groups to connect with others facing similar challenges

Using mobile apps designed for OCD management may also help. Research shows they can reduce symptoms in subclinical levels of relationship OCD.¹³ Couples who use apps together may also improve ROCD symptoms by decreasing negative thoughts and boosting relationship satisfaction.¹⁴

Dating someone with relationship OCD can present its own challenges. If you’re wondering how to help your partner with relationship OCD, consider:

• Approaching them with empathy and understanding 
• Having honest and respectful conversations about their concerns and experiences 
• Creating an open and supportive environment 
• Encouraging them to seek professional help 

Keep in mind that supporting your partner shouldn’t come at the expense of your own mental health. It’s important to set healthy boundaries, maintain your own self-care practices, and seek support if needed. 

Visit our directory to find a qualified therapist specializing in OCD treatment, relationships, or couples therapy.

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What is hypervigilance?

Hypervigilance is a state of heightened awareness that involves constantly watching for potential danger, even when the risk is low.¹ Think of it as your brain’s alarm system being stuck in the “on” position.

While being alert can help keep us out of harm’s way, hypervigilance goes far beyond normal caution. It can cause real problems when it continues in safe, everyday situations.

Hypervigilance symptoms and signs

Behavioral signs of hypervigilance include:²

• Constantly feeling “on guard”
• Persistent visual scanning or searching even when safe
• Difficulty concentrating on tasks or regulating emotions

Your body responds to hypervigilance with heightened physical responses and nervous system activation.³ These physical reactions happen automatically, even when there’s no real danger present.

Common physical reactions include:

• Elevated heart rate and blood pressure
• Larger pupil sizes (indicating increased arousal)

Real-world hypervigilance examples include:

• Always sitting with your back to the wall, noting where exits are located
• Having trouble focusing on TV shows because you’re listening for sounds outside
• Simple activities like reading or watching TV becoming more challenging to engage in as part of your mind is preoccupied with scanning your environment

Hypervigilance vs. paranoia

Hypervigilance can be confused with paranoia, but the two conditions are actually quite different. As discussed earlier, hypervigilance involves constantly watching your surroundings to look for potential dangers.

Paranoia, on the other hand, involves incorrectly thinking that others are deliberately trying to harm you.⁴ It focuses on specific beliefs about being targeted by particular people or groups, rather than general environmental scanning.

If you recognize any troubling signs in yourself or a loved one, don’t wait to seek help. A mental health professional can provide support, teach effective coping strategies, and guide you toward treatments that reduce anxiety and improve your overall well-being.

Hypervigilance causes and risk factors

Many types of trauma can lead to hypervigilance, but some of the most common include:

Childhood trauma, such as psychological abuse, neglect, or witnessing violence can increase sensitivity to future stress.⁵ These early experiences may make individuals more vulnerable to developing heightened alert responses when faced with future threatening situations.

Community violence exposure, especially traumatic police encounters, can increase hypervigilance scores by up to 20%.⁶ Living in areas with high crime rates or experiencing violence in your community can trigger this response.

Combat exposure creates adaptive hypervigilance for survival that becomes maladaptive in civilian environments.⁷ Military training and combat experience can make it difficult to “turn off” the alert response when returning to safe environments.

How hypervigilance impacts daily life

Hypervigilance can affect nearly every aspect of your life, from social interactions to mental and physical well-being.

Relationships

Experiencing hypervigilance in relationships can make it more difficult to connect genuinely with others. Research shows that people with social anxiety disorder (SAD) may struggle with certain forms of hypervigilance, especially when threatened or anxious.⁸

This heightened state of alertness can make it hard to focus on conversations and build meaningful connections, as their attention is pulled away by perceived threats. Importantly, this tends to occur mainly under stressful conditions, meaning that people with social anxiety may appear more attentive in calm situations but struggle when anxiety rises.

Cognitive function

Hypervigilance creates feedback loops where increased anxiety leads to more vigilant scanning, which detects more potential threats and increases anxiety further.⁹ This means the more hypervigilant you become, the worse symptoms may become.

The condition also disrupts your “attentional balance,” making you focus too much on watching for external threats and not enough on internal information, reducing ability to concentrate on tasks.¹⁰ This explains why hypervigilance examples often include difficulty with work, school, or hobbies that require sustained attention.

Physical health

Hypervigilance to pain can make it feel worse and is the strongest predictor of whether it will become chronic and long-lasting.¹¹ When you’re constantly alert to bodily sensations, experiences of pain can feel much worse.

Continued, intense hypervigilance can cause significant physical health impacts including higher blood pressure.¹² Chronic activation of your body’s stress response could lead to serious health problems over time.

Research shows hypervigilance may affect sleep quality in individuals with chronic pain conditions.¹³ When your brain won’t “turn off” its alert mode, getting restful sleep becomes nearly impossible.

How to manage hypervigilance

Depending on what’s causing your hypervigilance, there are several effective treatments and strategies that can help you feel more relaxed and safe.

Psychological interventions

Cognitive behavioral therapy (CBT), especially exposure-based CBT, can be effective in reducing hypervigilance and related symptoms. It’s been used to treat concerns that involve hypervigilance such as posttraumatic stress disorder (PTSD), panic disorder, and medical symptom preoccupation.^14,15,16

Prolonged exposure therapy and imagery rescripting are commonly used in the treatment of PTSD. Research surrounding exposure therapy suggests reducing hypervigilance may be especially important to symptom improvement.¹⁷

Self-help strategies

You can practice attention-training exercises that help you learn to shift your focus away from threats and toward safe, positive things around you:

• Practice mindfulness. Start by spending a few minutes each day deliberately noticing safe, pleasant things around you, or focusing on your breath.
• Limit exposure to triggers. Identify situations, media, or environments that increase your hypervigilance and try to reduce or manage your exposure to them. This can help lower overall stress and give your mind a chance to relax.
• Use grounding techniques to help interrupt hypervigilant scanning patterns and reduce arousal responses. Simple exercises like the “5-4-3-2-1” technique (naming 5 things you see, 4 you hear, 3 you feel, 2 you smell, 1 you taste) can quickly ground you in the present moment.

When to seek help

It’s important to recognize when hypervigilance requires professional intervention. Seek help when hypervigilance interferes with daily functioning, relationships, or work performance and causes significant distress or impairment. If you’re avoiding activities you once enjoyed or struggling to maintain relationships, it’s time to reach out.

Visit our directory to find licensed mental health professionals who can help you manage hypervigilance and support your journey toward healing.

The post Hypervigilance: Definition, signs, causes, and how to cope appeared first on therapist.com.

Attachment theory helps us understand how children develop emotional bonds with their caregivers. Many children form secure attachments, meaning they trust their caregivers to meet their needs and provide comfort. Some children develop insecure attachments, where they learn to be anxious or avoidant in relationships.

In rare cases, children who experience severe neglect or trauma may develop reactive attachment disorder (RAD)—a serious condition that affects their ability to form secure, meaningful attachments.

What is reactive attachment disorder?

Reactive attachment disorder is a trauma- and stressor-related condition caused by neglect or mistreatment.¹ Children with RAD have significant difficulty forming emotional attachments to others, struggling to seek or accept comfort.

RAD is different from disinhibited social engagement disorder (DSED), though they do have certain similarities. Both disorders stem from early neglect, but RAD centers on a child’s inability to form attachments while DSED involves indiscriminately seeking comfort or attention from any available adult, including strangers.² Though they were once viewed as two subtypes of the same disorder, they are now considered two separate conditions.

Reactive attachment disorder symptoms

Recognizing the signs and symptoms of RAD is crucial for early intervention. The core symptoms include:³

Inability to seek or respond to comfort. Children with RAD don’t turn to caregivers when they’re upset, scared, or hurt. Even when comfort is offered, they may reject it or show no response.

Emotional withdrawal. These children often appear detached or unaffected. They show minimal social and emotional responsiveness to others, even their primary caregivers.

Limited positive emotions. Children with RAD have difficulty expressing joy. They may seem emotionally flat or disconnected from their surroundings.

Unexplained emotional outbursts. They may have episodes of irritability, sadness, or fearfulness during everyday interactions with caregivers, even when there’s no apparent threat.

“Flight, fight, or freeze” mode. Many children with RAD have unpredictable moods, and they may react unexpectedly, or not react at all, when someone tries to comfort or hold them.

Additional symptoms can include difficulties being affectionate, contradictory responses to caregivers (approaching and then pulling away), and negative reactions when reuniting with caregivers after separations.⁴

If these symptoms sound familiar, help is available. Browse our therapist directory to find mental health professionals who specialize in trauma and attachment that can provide the support you and your family need.

Causes and risk factors for RAD

Reactive attachment disorder in children develops from severe early life experiences. The primary causes and risk factors include the following.

Extremes of insufficient care is a diagnostic requirement for RAD. This may look like:⁵

• Social neglect and emotional deprivation by caregivers
• Absence of adequate caregiving during critical developmental periods
• Institutionalized care with high caregiver-to-child ratios
• Limited opportunity to form stable attachments to consistent caregivers

Parental mental health issues can increase the risk of RAD. When both parents have psychiatric disorders, the risk increases significantly.⁶ Having both parents diagnosed with substance abuse, depression, or some combination of the two can also be a particularly strong risk factor.⁷

Other risk factors include:

• Multiple placement moves in foster care
• Longer exposure to environments of mistreatment
• Higher numbers of adverse childhood experiences (ACE)

How RAD impacts daily life and well-being

The effects of RAD extend far beyond attachment difficulties. Children with this disorder can face challenges in many areas of their lives.

School and social life: Children with RAD show significantly more behavioral problems and psychosocial difficulties than children without RAD. These challenges can negatively impact their education, peer relationships, and ability to maintain friendships.⁸

Mental health: RAD frequently appears alongside other mental health conditions or concerns, including:⁹

• Attention-deficit/hyperactivity disorder (ADHD)
• Posttraumatic stress disorder (PTSD)
• Autism spectrum disorder (ASD)

Children with RAD may have an increased likelihood of experiencing anxiety disorders, conduct disorders, or learning differences.

Family strain: In the families of children with persistent RAD, the disorder can severely impact family functioning. Even when children have been placed into families able to provide nurturing care, the families may experience high levels of emotional strain, difficulties connecting with the child, or resulting marital problems.¹⁰

High-risk behaviors in adolescence: As children with RAD approach adolescence and adulthood, they are more likely than their peers to engage in high-risk sexual behavior or substance abuse, become involved with the legal system, or experience incarceration.¹¹

Reactive attachment disorder in adults

While RAD is typically diagnosed in early childhood, its effects can persist into adolescence and adulthood. Reactive attachment disorder in teens and adults can look different than in younger children, but the struggles remain significant.

One study exploring adults who had RAD as children found many of them faced serious challenges including a high prevalence of:¹²

• Psychiatric diagnoses
• Substance use
• Attempted suicide
• Hospitalization for psychiatric care

There were also impacts in their psychosocial outcomes. Nearly 35% of the study participants never graduated high school and only 2% went on to complete a college degree.

These outcomes suggest that RAD’s impact can extend well beyond childhood, deeply affecting a person’s life trajectory.

Reactive attachment disorder treatment options

Treatment for RAD requires patience and a comprehensive approach. Effective treatment includes:¹³

Parent education and support: Caregivers learn positive, non-punitive strategies for responding to and managing behaviors. Understanding the root causes of a child’s behavior can help parents manage their frustration and respond with consistency.

Trauma-focused therapy: Because RAD stems from early trauma and neglect, therapy designed to address trauma can help heal some of the underlying concerns.

Parent-child psychotherapy: This approach helps facilitate bonding and healthy attachment. Building a strong, trusting parent-child bond is essential for overcoming the damage done by neglect and abuse.

Behavior management training (BMT): This approach has shown promise for children ages 6-11.¹⁴ It helps caregivers understand childhood misbehavior and teaches effective parenting skills.

Long-term outcomes and prevention

The good news is that early identification and treatment can significantly improve outcomes.¹⁵ Research provides encouraging evidence about RAD’s course when children receive proper care.¹⁶

Additionally, prevention is possible. Because RAD stems from extremes of neglect and inadequate care, ensuring that all children receive adequate support can prevent this disorder. Routine screening in high-risk populations—including children in foster care, institutionalized children, and those with a documented history of abuse or neglect—is critical for early identification when treatment is most effective.

If you are concerned about a situation involving a child, there are resources available. You can contact the Childhelp National Child Abuse Hotline online or by calling or texting 800-422-4453. Professional crisis counselors are available to talk through child abuse situations, provide support, and help you find additional resources.

Moving forward with hope

If you know or care for a child who’s showing signs of RAD or other mental health issues, it’s important to seek professional help as soon as possible.

As a parent or guardian, be sure to ask your pediatrician or family doctor for a referral to a child psychiatrist or psychologist who specializes in attachment issues. Don’t wait for symptoms to worsen; trust your instincts if something feels wrong.

As a family friend, educator, or other concerned adult, you can play a vital role by gently sharing your observations with the child’s parents, guardians, or other trusted figures.

If you’re looking for support, you can visit our therapist directory to connect with mental health professionals who specialize in attachment disorders and childhood trauma.

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What is orthorexia?

Orthorexia nervosa, usually referred to as orthorexia, is an unhealthy obsession with healthy eating. It involves compulsively pursuing a diet you believe will maximize your well-being, even when it seriously disrupts your life.

The diet can vary and might mean eliminating entire food groups, tracking every nutrient and ingredient you put in your body, or doing “detoxifying” fasts and cleanses. Some people may be trying to reach personal health-related goals, while others may be looking to manage specific food allergies or intolerances.

It’s hard to estimate how common orthorexia is because we don’t have standardized diagnostic criteria for it. Estimates of the percentage of people affected by this disorder range substantially depending on the research methods used and the location of the people studied.

Is orthorexia an eating disorder?

Orthorexia isn’t formally classified as an eating disorder, but it is a form of disordered eating. So far research shows that orthorexia shares symptoms with several disorders, including obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), illness anxiety disorder (often informally called “hypochondria”), and even psychosis.¹

When does healthy eating become unhealthy?

One of the challenges of orthorexia is being able to recognize when healthy eating has turned into an unhealthy obsession. That line can be blurry, especially since there’s no such thing as a “perfect” diet—what’s healthy for one person may not be healthy for another.

Generally speaking, problems can start when your food choices and eating habits start to harm your mental and physical health. This could look as simple as not enjoying daily meals because they lack variety, or it could be as serious as developing social isolation, food-related anxiety, or nutrient deficiencies.

Signs of orthorexia are even harder to spot if your eating habits are motivated by health-related goals and you’re seeing results you want. For instance, if your appearance has changed, your energy has improved, or other people have taken positive notice of your efforts, you may be more likely to focus on those upsides and downplay any problems.

Signs and symptoms

The following may be warning signs of orthorexia:²

• Obsessive thoughts about the quality of your diet
• Preoccupation with nutritional value, ingredients, and how they affect you
• Rigid, restrictive meal plans
• Anxiety when faced with the prospect of eating certain foods
• Perfectionism in how you eat, such as always trying to get the “right” balance of nutrients
• Avoidance of foods, ingredients, and food groups you feel aren’t healthy or “pure”
• Frequent fasting, cleansing, or detoxing
• Extreme worry about illness
• Social isolation due to food restrictions
• Feelings of guilt or shame after eating particular foods
• Concerns about body image
• Focusing on how healthfully others are eating

These common beliefs about food and eating may contribute to orthorexia:

• Food is good or bad, right or wrong, clean or unclean.
• Planning and tracking everything I eat is necessary for success.
• Nutritional value and purity is more important than taste, satisfaction, or pleasure.
• “Cheat meals” or indulgences in certain foods are rewards for healthy eating.
• Straying from my diet should result in punishment or tighter restrictions.
• Failure to stick to my diet reflects a lack of willpower, self-control, or motivation.
• I should avoid situations where “healthy” food isn’t available or “unhealthy” food is too tempting.
• Someone I admire eats in a restrictive way, so I should too.

Causes and risk factors

The causes of orthorexia aren’t yet known, but several factors may contribute. Some of the biggest risks include preexisting mental health issues such as obsessive-compulsive traits, a history of disordered eating or eating disorders, and negative body image.³ Having a family member with an eating disorder may also be a risk factor. Low self-esteem doesn’t seem to be associated with orthorexia, but preoccupation with weight and appearance are.⁴

Personality traits—especially perfectionism—may also make someone more likely to develop orthorexia.⁵ A strong need for control can also lead to an obsession with food choices.

Age may play a role, but we don’t yet know for certain. Some research indicates that adolescents and young adults are especially vulnerable, while other studies show no significant difference in susceptibility between adolescents and adults, suggesting that the disorder can happen at any age.^{6, 7}

Social factors in orthorexia

Commonly held beliefs about health or body image can sometimes cause us to take our habits too far. Orthorexia seems to occur most often in people who are:

Well educated and high earners: People with a higher socioeconomic status can access and afford healthy foods more easily, which may lead to a greater focus on diet as a source of health or wellness.⁸

Studying or working in health- or fitness-centered fields: In a study of more than 600 dieticians who completed a survey about their eating habits, more than half were at risk of having or developing orthorexia.⁹ Other professionals who may have higher risk include nutritionists, health care students, fitness and yoga instructors, gymnasts, trainers, and dancers.¹⁰

Athletic: People who exercise regularly tend to have higher rates of orthorexia, especially endurance athletes and participants in fitness trends like CrossFit.^{11, 12, 13}

Following special diets: People who adhere to vegetarian, vegan, paleo, gluten-free, all-organic, and other exclusionary diets may be more likely to develop orthorexia.¹⁴ The results on this are mixed, though—other research concludes that following a special diet isn’t a risk factor.¹⁵

Reading health-related media: Health-focused blogs, magazines, podcasts, books, and social media are full of advice, sometimes contradictory, on what people should and shouldn’t eat. Wellness and health commentators who promote rigid or restrictive diets can give followers a false impression that certain eating habits are necessary for physical and mental well-being.¹⁶ The healthy-eating community on Instagram, in particular, is associated with higher rates of orthorexia.¹⁷

Using diet and fitness tracking apps: Many people who struggle with disordered eating and use fitness and diet tracking apps feel those apps contribute to unhealthy eating behaviors.¹⁸ Tracking apps tend to encourage obsession, dependency, fixation on numbers, and rigid dieting.¹⁹

How orthorexia affects your mental and physical health

Mild symptoms of orthorexia may look like feeling a bit sluggish or low. More severe cases can cause serious distress or a decline in mental health. The disorder is associated with:²⁰

• Lack of interest in everyday activities
• Anxiety
• Depression
• Chronic fatigue
• Insomnia
• Strained relationships and social isolation
• Other eating disorders, including anorexia nervosa and bulimia nervosa

If orthorexia is severe enough to lead to malnutrition, it can cause physical health problems like hormone issues, menstrual irregularities, low bone mass, vitamin D deficiency, and unstable blood sugar levels.²¹ Some people with physical health conditions may also focus too much on healthy eating to help combat their symptoms naturally, only to wind up making their health worse.

Diagnosis and treatment

Even though orthorexia isn’t officially classified as an eating disorder, mental health professionals may be able to detect and diagnose it using tools such as the Eating Habits Questionnaire or the Dusseldorf Orthorexia Scale, among others.²² Note that while these tools can be helpful, they’re not always reliable, and they may falsely identify people as having orthorexia.

For a more thorough diagnosis, mental health professionals should also consider a client’s history of disordered eating or eating disorders, links to other mental health concerns (such as anxiety), changes in their social life, malnutrition, and weight loss.

Orthorexia tends to be treated similarly to other eating disorders. This may include a combination of therapy, psychoeducation, medication, and, in severe cases, hospitalization.²³ More research is needed into how effective these treatments are for orthorexia.

Therapeutic approaches for orthorexia include cognitive behavioral therapy (CBT), which may be especially helpful for perfectionists, and exposure and response prevention (ERP), which may help with obsessive-compulsive habits. Holistic therapeutic methods that promote relaxation, such as mindfulness and meditation, can also help people reduce their food-related anxiety.

How to get help

If you or someone you know is struggling with orthorexia, disordered eating, or an eating disorder, seek help as soon as possible. Start by contacting your primary care doctor or a mental health professional who specializes in eating disorders.

If you’re in crisis and need immediate help, call the 988 Lifeline at 988 or text HOME to the Crisis Text Line at 741741. Both of these free, confidential resources are available 24/7.

Another option is to build a support network. Organizations focused on helping people recover from eating disorders and disordered eating include:

• National Eating Disorders Association, a comprehensive support resource for individuals and families.
• National Association of Anorexia Nervosa and Associated Disorders (ANAD), which offers virtual support groups, one-on-one mentors, and resource guides for recovery.
• Project Heal, which helps people who can’t afford eating disorder treatment get the help they need.
• The Alliance for Eating Disorders Awareness, which offers support group and a daytime helpline where you can speak to a licensed professional.
• Eating Disorder Hope, which has a directory of eating disorder treatment centers, programs, and other resources.

It is possible to live a healthy lifestyle free from obsession. Browse our directory to find a therapist who can help you learn to maintain healthy habits without harming your mental or physical health.

The post Orthorexia: Signs, risk factors, and treatment appeared first on therapist.com.

What is the dark triad?

The dark triad refers to a group of three personality traits: Machiavellianism, narcissism, and psychopathy. Though these traits are seen in normal behavior, they’re generally considered negative and socially undesirable.

Machiavellianism is marked by manipulation, deception, and emotional detachment. People high in Machiavellianism, known as “High Machs,” are skilled at exploiting others for personal gain and tend to have a cynical worldview.

Narcissism is an inflated sense of self-importance, but it’s more complex than normal arrogance. While “grandiose” narcissists openly demand attention and admiration, “covert” narcissists might appear shy or self-deprecating while still harboring deep feelings of superiority. Both types share a common thread: They see others as sources of validation.

Psychopathy is marked by manipulative and harmful behaviors, and a lack of concern or guilt. Primary psychopaths act with calculated precision while secondary psychopaths behave impulsively and show emotional instability. Both types can cause harm to others, whether through deliberate planning or emotional reactivity.

All of the traits are associated with a lack of empathy.¹ People high in these traits may be able to recognize others’ emotions, but struggle to share or connect with those emotions on a deeper level.

The contrasting “light” triad

In contrast to the dark triad, the light triad encompasses a set of positive personality traits that foster well-being and personal growth. While the dark triad is associated with traits that often prove detrimental to relationships, the light triad is characterized by benevolence, compassion, and a genuine concern for others.

The light triad is measured using the Light Triad Scale (LTS), a validated 12-item assessment that consists of three core aspects:²

1. Kantianism: Committing to live authentically and morally
2. Humanism: Valuing the dignity and worth of each person
3. Faith in humanity: Believing in the fundamental goodness of people

The dark tetrad vs. dark triad

The dark triad became the dark tetrad when a fourth trait—subclinical sadism—was added. Sadism is closely related to the dark triad personality traits but is a separate construct.³

What is sadism?

Sadism is a personality trait that involves taking pleasure in seeing others suffer or feel pain. We know sadism leads to cruel acts, but researchers still disagree on exactly how to define and measure it.⁴ This makes it hard to tell which harmful behaviors count as truly sadistic.

Many people think sadists can’t feel empathy at all, but research shows it’s more complicated than that.⁵ Sadists might be able to understand how others feel (cognitive empathy) while not sharing those feelings themselves (emotional empathy). This combination can be dangerous because they can recognize when they’re hurting someone, but don’t feel bad about it.

There’s a specific type of sadism, called sexual sadism, where people gain sexual pleasure from causing physical or mental pain. While sadism shows up in many areas of life, most studies have focused on sexual sadism. Research suggests about 2% to 5% of people experience sexual pleasure from hurting others.⁶

If you or someone you know have experienced uncomfortable or unsafe sexual behavior, help is available. You can contact the National Sexual Assault Hotline for free at 1-800-656-HOPE (4673), available 24/7 for support.

Why some people have dark personality traits

Dark personality traits stem from a combination of biological, psychological, and social factors. At their core, these traits are strongly linked to low levels of certain personality traits.⁷ These traits are:

• Honesty-humility: The tendency to be sincere, fair, and modest versus manipulative, entitled, and greedy
• Emotionality: How deeply someone experiences and expresses feelings, particularly empathy and attachment to others
• Agreeableness: The tendency to be forgiving, less judgemental, cooperative, and considerate of others versus antagonistic and hostile
• Conscientiousness: The degree of self-discipline, organization, and concern for following rules and obligations

Of these traits, honesty-humility appears to be most significant in predicting dark personality traits. People who score low on honesty-humility and agreeableness consistently show higher levels of dark triad and dark tetrad personality traits.

Dark personality traits exist on a spectrum. People can display these traits to varying degrees, with differences observed across:⁸

• Gender: Men typically score higher on dark traits compared to women.⁹ Traits like psychopathy and Machiavellianism are associated more strongly with masculine than feminine gender roles.
• Culture: The expression of dark personality traits varies across different global regions and cultural contexts.¹⁰
• Social environments: One evolutionary theory suggests that dark triad traits developed as adaptive strategies to provided advantages in certain social competitions.¹¹ Certain characters in popular culture show that dark triad traits may actually be respected and desired in certain environments today.¹²

The impact of dark personality traits

Research comparing the dark triad and light triad traits revealed distinct patterns in life outcomes.¹³

The dark triad was linked to:

• Lower life satisfaction
• Less personal growth
• More aggressive and selfish behaviors

In contrast, the light triad was associated with:

• Greater life satisfaction
• More personal growth
• Concern for others

Unsurprisingly, these findings suggest that cultivating light triad traits are more likely to create well-being and personal development than dark triad characteristics.

How dark personality traits are assessed

The dark triad and tetrad traits aren’t formal mental health diagnoses. However, they can be associated with several personality disorders, which are diagnosable conditions. These include:¹⁴

• Narcissistic personality disorder (NPD)
• Antisocial personality disorder (ASPD)
• Borderline personality disorder (BPD)
• Histrionic personality disorder (HPD)

Dark personality traits can be assessed using self-report questionnaires. These might include:

• The Short Dark Triad (SD3)¹⁵
• The Short Dark Tetrad (SD4)¹⁶
• The Dark Triad Dirty Dozen (DTDD)¹⁷
• The Comprehensive Assessment of Sadistic Tendencies (CAST)¹⁸

Additional tests for sadism include the Short Sadistic Impulse Scale (SSIS), Varieties of Sadistic Tendencies (VAST), and the Assessment of Sadistic Personality (ASP).¹⁹

While high scores on these tests may indicate that the traits are present or strong, they can’t confirm or diagnose personality disorders. If you’ve noticed patterns in yourself that you’re concerned about, consult a mental health professional. They can help you address harmful patterns and determine if a mental health disorder may be making things harder.

Treatment options for dark personality traits

Dark personality traits can be challenging to treat because people with these traits may be less motivated to change. But there’s always hope for overcoming them. A 16-week study with 467 participants revealed two important findings:²⁰

1. When people did want to change their dark triad traits, they were able to make measurable progress.
2. Interventions focused on increasing agreeableness (being more kind, cooperative, and considerate of others) led to reductions in all three dark triad traits.

This suggests that treatment approaches focused on developing positive traits like agreeableness may be successful. Types of therapy that may help include:

• Cognitive behavioral therapy (CBT), which helps people identify and change harmful thought patterns and behaviors. It may be particularly useful for addressing narcissistic tendencies.²¹
• Dialectical behavior therapy (DBT), which teaches emotional regulation and interpersonal effectiveness skills that can help reduce impulsive or harmful behaviors.
• Schema therapy, which targets deep-rooted emotional patterns and beliefs that may contribute to manipulative or exploitative behaviors.
• Mentalization-based treatment (MBT), which improves your ability to understand others’ mental states and develop empathy.

Mental health professionals can use these approaches to help clients gradually develop healthier patterns of thinking and relating to others. This focus on building positive traits, rather than targeting dark ones, may lead to sustainable change. Visit our directory to find qualified therapists near you who specialize in personality disorders and trait-based therapy. Remember that change is possible with commitment and professional support.

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Have you ever felt a lingering sense of anger or bitterness toward someone who hurt you? Does that feeling keep coming back whenever you think about what happened? That’s resentment, and it affects more than just your mood—it can impact your entire well-being.

What is resentment?

Resentment is a complex emotion that happens when you feel that you’ve been treated unfairly and are unable to do anything about it.¹

When you resent someone, you’re reliving an offense that injured you in the past.² The word comes from the roots “re” (again) and “sentir” (to feel). It describes the act of feeling something painful again and again.

Resentment vs. other emotions

While resentment shares qualities with other negative emotions, it stands apart in important ways. It’s distinct from depression, hopelessness, or anger, though they may well occur alongside it.³

Depression includes a general sense of hopelessness or sadness, while resentment specifically centers on perceived injustice. Unlike anger which flares up and subsides, resentment can build up inside you and eventually turn into hatred or even a desire to get back at someone.⁴ It’s like carrying around a backpack filled with past hurts that gets heavier the longer you carry it.

It also contains elements of helplessness that distinguish it from pure anger. It often stems from situations where you feel wronged but unable to repair the situation.

Interestingly, resentment and gratitude are opposites of each other. Analysis suggests that the more grateful someone is, the less resentful they tend to be.⁵ This helps explain why resentful people might struggle to experience the benefits of gratitude.

Signs of resentment

How do you know if you’re harboring resentment? The signs appear in your emotions, behaviors, and even physical health.

Emotional signs

Emotionally, resentment shows up as sadness, anger, deception, and feelings of inferiority.⁶ You might experience emotions like:

• A persistent sense of being wronged
• Feelings of bitterness when thinking about certain people
• A sense that life or others have treated you unfairly
• Anger that doesn’t seem to fade with time

Behavioral signs

Resentment changes how you act. Common behaviors include rumination (constantly thinking about the offense), withdrawal, isolation, and avoidance.⁷ You might notice yourself:

• Replaying past hurts over and over in your mind
• Pulling away from relationships
• Having trouble moving forward from past events

Psychologists note that resentful people hold on to grievances “like a bargaining chip” that only grows their need for revenge.⁸ This can create a cycle that’s hard to break.

If you’re struggling with feelings of resentment that are affecting your mental health and daily life, you may want to speak with a therapist. They can help you identify the root causes of your emotions and guide you toward healthier ways to cope and move forward.

Physical signs

Your body feels resentment too. Physical presentations include cardiac activation (like a racing heart), increased stress, sleep difficulties, and exhaustion.⁹

Long-term resentment may contribute to serious health problems including gastrointestinal issues, cardiovascular problems, and chronic pain.¹⁰ Research suggests that chronic stress related to not forgiving others can accelerate aging and impact your immune system.

The impact of resentment on physical health is also often reflected in everyday language. People commonly describe feeling it “in the pit of our stomach,” or that someone left them feeling “broken-hearted.”

Common causes and triggers of resentment

What makes people resent someone? Many situations can trigger these feelings.

Workplace experiences can spark resentment and lead to bitterness.¹¹ In romantic relationships, irritation and disappointment can lead to feelings of resentment.¹²

Experiencing injustice that can’t be adequately addressed is another major trigger.¹³ When you can’t right a wrong, the feelings of helplessness can transform into resentment.

Major life events can also leave lasting resentment. Negative experiences such as unemployment, divorce, death of relatives, or workplace conflicts often create deep wounds.¹⁴ Early life injuries, including childhood abuse, are particularly powerful sources of resentment that can affect people throughout their lives.¹⁵

On a broader scale, social factors contribute to resentment too. Cultural alienation combined with public contempt creates fertile ground for resentful feelings. This happens in societies where inequality exists—where equal rights compete with unequal opportunities. When people feel powerless because societal promises benefit only a few, resentment grows.

At its core, resentment often springs from frustrated hopes, misguided self-assessments, and failed aspirations. When life doesn’t turn out as expected, the gap between reality and expectations can breed lasting resentment.

The impact of resentment

The effects of resentment reach far beyond momentary discomfort.

Effects on relationships

Resentment creates distance in relationships and leads to isolation. As one research participant expressed, its weight “makes me slower, heavier, further removed from myself and others.”¹⁶

Ironically, by holding onto resentment, people believe they’re punishing others but actually end up hurting themselves.¹⁷ Many people refuse to give up what they see as “justified resentment,” thinking this somehow holds the other person accountable. Instead, they remain trapped in their own pain.

Effects on overall well-being

Research shows that resentment contributes to anxiety, depression, and embitterment.¹⁸ The emotional burden takes a toll on mental health over time.

Philosophers and psychologists describe resentment as causing a “self-poisoning of the mind.”¹⁹ This vivid description captures how resentment in relationships can become toxic to the person carrying it.

Why we hold onto resentment

Despite its harmful effects, many people find themselves holding onto resentment for reasons they might not fully recognize:²⁰

• It can create an illusion of control when we feel powerless in a situation
• It sometimes provides energy and motivation to take action
• It offers an alternative to difficult conversations we’d rather avoid
• It can be emotional armor against vulnerability
• It allows us to maintain a sense of moral righteousness
• Some unconsciously use it to evoke guilt in others
• It can serve as a shield against deeper, more painful emotions like grief or shame
• In some cases, it can maintain a relationship that might otherwise end
• It enables staying in a victim role, avoiding responsibility for change

It’s clear that resentment can be a logical reaction to certain situations—but it’s not always the healthiest one. Understanding these causes can help you identify when you’re holding onto resentment and examine whether it’s necessary.

How to let go of resentment

If you recognize resentment in yourself, there are ways to address it.

Forgiveness is one of the most powerful ways to address resentment. Here are some strategies you can use to work toward forgiveness, which creates space for more positive emotions:

1. Start by acknowledging your resentment without shame. Naming what you feel is the first step toward healing.
2. Try focusing on being gratefulfor past positive aspects of your relationship with the person you resent. This doesn’t mean excusing harmful behavior, but rather remembering that relationships are complex and multifaceted.
3. Do more of what boosts your confidence and sense of control. Empowerment helps overcome feelings of inferiority that feed resentment.²¹ When you build your sense of personal power, you’re less vulnerable to feeling like a victim.

Other helpful strategies include maintaining physical distance and letting time pass.²² Focus on other problems, learn new things, notice changes in the source of your frustrations, and make personal efforts to move forward and make decisions about what needs to be left behind.

Preventing feelings of resentment in others

Sometimes we do or say things that can trigger resentment in others without realizing it. While it isn’t always possible to prevent others from feeling resentful, there are steps we can take to make it less likely.

Creating environments where people feel valued and appreciated can reduce or ward off the development of resentment.²³ This applies to both families and workplaces.

One simple practice is greeting others with gratitude, which can help them feel connected and create a sense of belonging. This small act builds relationships that are more resistant to resentment.

Seeking professional help

For deep-seated resentment that doesn’t resolve over time or with your own efforts, professional help may be necessary. Therapeutic approaches that promote forgiveness show positive results. These include structured approaches like the REACH Forgiveness model and emotionally focused therapy (EFT).²⁴

Visit our therapist directory to connect with a professional who can support you in understanding your experiences and working through emotions related to resentment.

The post Resentment: Meaning, signs, impact, and how to let it go appeared first on therapist.com.

“Sex addiction” and “porn addiction” are terms people use to describe compulsive behaviors related to sex and pornography. But are they actual diagnoses? There’s still much to learn about how these compulsive behaviors develop and work—and researchers are still figuring out how to talk about and treat them.

Many people enjoy sex and porn in healthy ways. Some mental health professionals find the ideas of sex and porn addiction to be sex-negative, shaming people whose behavior doesn’t fit certain cultural or religious ideals. Other experts point out that some of the actions “sex addiction” and “porn addiction” describe can be harmful.

Regardless of your perspective or what terminology you use, understanding what unhealthy sexual behavior looks like can make it easier to recognize when you or a loved one need help.

How do sex and porn affect the brain?

Having sex and viewing porn both release hormones in your brain that have positive effects on cognitive function, mood, and pain. Dopamine is mainly responsible for these effects. Your brain also produces dopamine during other enjoyable activities, like eating good food or listening to music.

What is sex addiction?

Sex addiction (also called “compulsive sexual behavior” or “hypersexuality”) was previously treated as a mental health disorder. However, the American Psychiatric Association (APA) has stopped listing “sex addiction” as a mental health disorder or diagnosis in its diagnostic manual.

Experts instead describe sex addiction as a compulsive, problematic sexual behavior that causes serious negative consequences and can’t be controlled or stopped, even if someone wants to.¹

Compulsive sexual behaviors can include:

• Repeatedly cheating on a partner
• Constantly thinking about or pursuing sex while neglecting other interests and activities
• Spending too much money to access sex
• Putting yourself and your partners at risk for pregnancy or sexually transmitted infections (STIs)

Is the term “sex addiction” accurate?

While many experts argue that compulsive sexual behavior shouldn’t be considered an addiction, the media and the public have embraced “sex addiction” as an informal term, so it’s generally accepted regardless of whether it’s clinically accurate.² Many people, though, have pivoted to describing sex addiction as a compulsive behavior disorder rather than an addiction.

Sex addiction in society and culture

The idea of sex addiction is widespread and familiar. But some of the ways we use the term can be harmful or misleading.

Communicating disapproval

Instead of describing physical or mental health concerns around sex, the term “sex addiction” sometimes gets applied to sexual behavior that particular communities disapprove of, such as:

• Frequent sex
• Multiple sexual partners
• Non-heteronormative sex
• Sex outside of marriage

It’s important to note that health professionals don’t embrace this use of the term. If your sex life doesn’t fit the moral standards of a specific community, that doesn’t mean you have an inherently unhealthy relationship with sex.

Downplaying sexual misconduct

People sometimes use a sex addiction diagnosis as a means of self-preservation. Public figures, for example, have claimed the diagnosis while revealing their struggles with infidelity or sexual misconduct. In other cases, people who’ve committed sexual assault, harassment, or other crimes have tried to use a sex addiction diagnosis to suggest they weren’t fully responsible for the damage they caused.

Although these attempts don’t always work, they show how the diagnosis can be misused to avoid consequences of harming others.

What is porn addiction?

“Porn addiction” describes compulsive behaviors related to pornography. These may include:

• Watching porn so much that it interferes with other parts of your life
• Consuming porn in inappropriate settings
• Pressuring your partner to look at or act out porn even if they aren’t interested
• Needing to watch porn before having sex

Similar to sex addiction, “porn addiction” is a term accepted by the media and the public to describe compulsive behaviors. And as with sex addiction, more research is needed to explain what drives (and how to treat) compulsive porn use.

Porn addiction in society and culture

The internet has expanded access to porn significantly. Now free porn is at the fingertips of anyone who can go online.

Since porn is taboo in many cultures, people often hide their use, especially if it’s frequent—and the label “porn addict” is often used to stigmatize and shame someone who watches any amount of pornography.

According to a variety of international studies, some 50% to 99% of men and 30% to 86% of women consume porn, and a Kinsey Institute study found that 80% of porn users felt “fine” about their amount of use.³ One study found that “recreational” porn users (who made up most of the people in the study) averaged about 24 minutes each week and felt satisfied with their sex lives, while “compulsive” users rearranged their schedules around their consumption and felt isolated, ashamed, and unable to stop.⁴

How to get help

If you’re worried that your sexual behaviors may be compulsive, unhealthy, or otherwise out of control, working with a sex therapist can help. To find a licensed mental health professional near you, browse our therapist directory.

The post Are sex addiction and porn addiction real disorders? appeared first on therapist.com.

Picture this: You’re a couple of months into the kind of whirlwind romance you’ve only dreamed about. Your heart skips a beat every time your phone buzzes. You’ve shared laughs, dreams, and slices of your favorite pizza.

Before you know it, a few more weeks have zipped by. You realize you’re almost at the three-month mark—the moment, some say, when you should either commit or cut your losses.

Suddenly it feels like you’re a contestant on a game show where the host suddenly announces, “Time’s up! Make your choice.” You feel a knot in your stomach, a weight on your shoulders. Is this love or just infatuation? Are your date’s quirks charming or irritating? Is this what true happiness feels like, or have you just gotten comfortable?

Whether you realize it or not, your partner might be feeling the same pressure to define where the relationship stands. What is it about three months?

Why the early months are critical

Healthy relationships take time to develop. New relationships tend to pass through a few different stages, each with its own set of challenges.

1. Attraction: Also known as the “infatuation” or “honeymoon” stage, this is when you feel like you’re in a euphoric state thanks to a cocktail of hormones from your brain. You’re at high risk of being swept away by the passion of the moment—meaning you might overlook potential issues that could disrupt your relationship down the line.
2. Uncertainty: This stage is filled with questions. You’ve had some time to learn about each other, and you may be starting to question your compatibility, how you feel, and whether your feelings are mutual. Rumination and anxiety can sneak in, leading to doubts.
3. Commitment or breakup: If your relationship survives the uncertainty phase and seems worth continuing, you agree to stay together. If not, you end the romance. Note that if this stage is either rushed or delayed for too long, it can cause problems and distress.

These early stages can unfold over a longer (or shorter) period than three months. But the three-month rule offers people a way to do several important things: prevent feelings from being hurt, minimize wasted time and energy, and move things to the next phase—either relationship growth or the freedom to explore other options.

The three-month rule and the “feelings gap”

In 2022, dating app Inner Circle reported that 68% of its users had a relationship end after three months because one partner wasn’t ready to commit.¹ Around half of men and 38% of women reported acting impulsively in the early days, then reflecting on their actions later. They generally did this reflecting at—you guessed it—the three-month mark. If things didn’t feel right, they ended the relationship.

The “feelings gap” refers to the difference in time it takes for each partner to decide whether or not they want to stay together long-term. Given these findings, the three-month rule may help reveal the gap if it’s there.

Is three months a useful make-or-break timeline?

Not necessarily. Everyone experiences relationships differently, and it’s hard to find research on how long people take to decide if a romance has potential.

However, researchers have looked at the timing of other relationship milestones. Here are a few examples.

Doing the deed

In a YouGov survey of over 1,300 Americans, 19% thought it was appropriate for couples to start having sex between one and three months into the relationship—tied with 19% who thought it would be fine after the first week but before one month had passed.² Among respondents who were currently married or in a serious relationship, 21% said they’d waited one to three months.

Saying those three little words

In the same poll cited above, 19% of respondents thought between one and three months into dating was the right time to say “I love you,” but 18% thought it should take longer—around four to six months.³

Other research shows that men tend to start thinking about expressing love at just over two months (70 days) on average, but they don’t actually do it until about three and a half months (108 days) into dating.⁴ Women weren’t far off, having thought about saying it by day 77 on average and actually saying it by day 123.

Meeting the family

In the YouGov survey, 22% of respondents said it’s appropriate to meet a partner’s family after one to three months, tied with 22% who think it should happen between four and six.⁵ These stats are on par with what some mental health professionals recommend: waiting around three months to introduce a partner to your family.⁶

Going exclusive

Having sex may or may not be a sign of commitment, but saying “I love you” and meeting the parents are pretty clear signs that you’re serious. Another way to mark an official transition to coupledom is to stop seeing other people.

In another poll of more than 1,000 Americans, 39% said that three months was the most acceptable time to talk with a partner about dating each other exclusively.⁷ A related survey showed that dating app users tend to move a bit faster: They felt exclusivity should be discussed after one to three months of dating.⁸ People who weren’t on the apps said three to six months was the most acceptable timeline for that conversation.

It’s worth being skeptical of the three-month rule

Three months may sound like a sweet spot for defining your relationship, but there are reasons to take it with a grain of salt.

The biggest problem with the three-month rule is its one-size-fits-all approach. The rule assumes all couples progress at a similar rate, when in reality every relationship is different and moves at its own pace.

By relying too much on a three-month timeline to reveal the fate of your relationship, you could mistakenly:

• Fail to address red flags
• Downplay any gut feelings until the three-month probation period is over
• Hold back on sharing your true emotions
• Invest too much in the relationship too early
• Rush to make a decision when you need more than three months to feel sure

Your romantic relationships are influenced by complex factors like your early childhood, your attachment style, your relationship history, your personality traits, your emotional needs, and your values. Beyond these, the growth and development of a relationship depend hugely on practical factors like physical distance, how well you communicate, and how much time you can spend building a connection.

Your true feelings may or may not rise to the surface around the three-month mark. Instead of worrying about a timeline, it’s best to be fully present and honest with yourself, your partner, and your relationship as it evolves.

How about a three-month guideline instead?

It’s absolutely fine to set a timeline if it helps you think about how your relationship is progressing. You just don’t want to be so devoted to that timeline that you suppress your authentic feelings or make rash decisions. Here’s how you can use three months as a helpful guideline rather than a mandate.

Practice self-reflection. Check in with yourself throughout the first few months and note any changes in your feelings or outlook. This can help you stay aware of your inner world and how it affects the relationship—as well as the effect of the relationship on you.

Be mindful of red flags. Don’t ignore warning signs that tell you there’s an issue. If something doesn’t feel right, trust your intuition and address it head-on rather than waiting until three months are up.

Stay present. Don’t get too far ahead of yourself by worrying about what will happen next or whether you’ll still be together in the future. Instead, focus on building a strong foundation and enjoy the process of getting to know each other.

Talk openly and authentically. You don’t have to dive into serious topics until you feel ready, but it’s important to be honest about what matters most to you. For example, if you have or want kids, that’s worth mentioning ahead of the three-month mark.

Be flexible. It’s reasonable to put a reminder in your calendar to talk about where you both stand at three months. Just remember that this timeline isn’t set in stone—it can change as you learn more about each other or if unexpected life events come up.

Pay attention to your gut feelings. You may want your dating experience to go a certain way, but your mind or body might sense when something is off. They may be trying to show you something about yourself, your partner, or the relationship that you can’t consciously see yet.

Get support. If you’re feeling overwhelmed or anxious, consider talking to a therapist or a relationship coach. They can offer personalized advice and strategies to improve your dating life and overall well-being.

The goal of dating is to find a partner who complements your strengths and contributes to your happiness. This shouldn’t come at the expense of your self-worth or emotional security. Enjoy the relationship journey as it unfolds, and trust yourself to make the right decisions along the way.

The post Is the three-month rule for real? appeared first on therapist.com.

What Is OCD?

Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by recurring, unwanted thoughts (obsessions) that trigger the urge to engage in repetitive, ritualistic behaviors (compulsions). OCD follows a four-step cycle:

1. Obsession
2. Mental distress
3. Compulsion
4. Temporary relief

What Is an Obsession?

The cycle of OCD starts with an obsession. Obsessions are unwanted thoughts, images, ideas, or impulses that enter a person’s mind without their consent or control.

These repetitive thoughts cause severe mental distress and are often accompanied by feelings of fear, disgust, or anxiety. They cannot be wished away, reasoned with, or ignored. Common obsessions include:

• • Cleanliness
  • Order (symmetry/perfection)
  • Words or numbers
  • Perfection
  • Religion
  • Losing control
  • Harming yourself or others
  • Sexual violence

People with OCD usually know that their obsessions are not logical and wish they would stop having them. Obsessions are unwanted, unwelcome thoughts that often feel like an intrusion into a person’s psyche.

What Is a Compulsion?

Compulsive behavior starts as a way of relieving the distressing emotions caused by unwanted obsessions. A compulsion may be directly related to the obsession (e.g., excessive handwashing due to a fear of contamination), or it may be expressed through an unrelated behavior. Common compulsions include:

• • Counting to a specific number
  • Excessive cleaning
  • Putting objects in a specific order
  • Checking locks or appliances
  • Repeating a specific word or phrase
  • Hoarding

Keep in mind that compulsions may offer temporary relief, but they are not a long-term solution. Instead, compulsions usually strengthen obsessions by reinforcing the (illogical) idea that performing the compulsion is the only way to find relief from the obsession, resulting in more frequent and more intense cycles of OCD.

Five Types of OCD

Not everyone with OCD has the same obsessions, compulsions, or experiences. In general, however, most forms of OCD fall into one of five categories:

1. Checking (Doubt): Checking can manifest in a number of ways. You may have to check that the stove is turned off before you leave the house, or you may feel the urge to call your parents and make sure they’re still healthy. You may be obsessed with your own health, constantly checking for signs of disease or illness.
2. Contamination: There are many forms of OCD that revolve around the idea of contamination. You may excessively clean your house or even yourself through handwashing, extra showers, and other hygiene rituals. You may obsess over the possibility of food poisoning or contracting some sort of fatal foodborne disease.
3. Order (Symmetry/Perfection): If your OCD centers on order, you need everything just so. This may result in an excessively organized or clean environment, or it may manifest in doing something a certain number of times. You may be obsessed with doing everything “just right.”
4. Rumination: People who experience ruminative thinking dwell on unanswerable questions regarding philosophy, metaphysics, or religion that have not been definitively proven, such the issue of whether there is life after death or the meaning of morality. This type of ruminative thinking is undirected and unproductive, as the person may spend hours going over arguments in their head while invariably nevering reaching a satisfactory conclusion.
5. Intrusive Thoughts: Unlike rumination, intrusive thoughts involve unwelcome, disturbing, and even horrific thought patterns that result in fear, disgust, or panic. These thoughts may involve the obsessive fear of carrying out violence against others, committing unwanted sexual acts, violating certain religious beliefs, or engaging in some other form of taboo behavior.

Signs and Symptoms of OCD

Symptoms of OCD differ depending on the type of obsessive-compulsive disorder you have. However, some symptoms may apply to more than one type of OCD. For example, excessively cleaning your home could be due to an obsession with contamination or order.

Common symptoms that apply to one or more types of OCD include:

• • Ritualistic counting or checking
  • Excessive cleaning of the environment, objects, or yourself
  • Repeating certain words, numbers, or phrases
  • Worry, anxiety, or paranoia
  • Unwanted thoughts that seem to spiral out of control
  • Inability to break from routine without experiencing deep distress
  • Feeling like you have to perform certain behaviors in order to get on with your day

What Warrants an OCD Diagnosis?

Have you ever heard someone say, “I clean all the time—I’m so OCD”? The term “OCD” has unfortunately entered the general vocabulary of our culture. It’s often used to describe thoughts and behaviors that do not match a true medical diagnosis of a mental health disorder.

There’s a big difference between a person who prefers a clean house and a person who suffers from OCD. Generally speaking, getting diagnosed with OCD means you meet the following criteria:

• • You experience unwanted or troubling thoughts that you attempt to get rid of by engaging in some kind of ritual.
  • You cannot control or stop your obsessions or compulsions.
  • You spend an excessive amount of time performing compulsions, even though they bring you no pleasure.
  • Your symptoms regularly interfere with your ability to function at home, at work, at school, or in relationships.

Keep in mind that no article, quiz, or opinion of a friend or family member can actually diagnose you with OCD. Only a trained mental health professional can offer a true diagnosis. If you think you may have OCD, click here to find a therapist near you.

What Causes OCD?

• • Genetics: If someone in your family has been diagnosed with OCD, you are at a greater risk for developing OCD, even if you develop a different obsession and/or compulsion.
  • Biochemistry: Chemical imbalances in the brain may increase your likelihood for OCD.
  • Learned behavior: You may learn to develop OCD by watching a parent or sibling practice certain behaviors. For example, if your parent expresses their OCD through cleanliness, you may grow up thinking excessive cleaning is normal and expected.
  • Personality: Certain personalities may be more likely to develop OCD than others. For example, personalities that are prone to perfectionism may develop obsessions and compulsions regarding “just right” behaviors.

Related Disorders

OCD may also occur alongside of other mental health disorders, such as:

• • Anxiety
  • Depression
  • Eating disorders
  • Addiction
  • Tic disorders
  • Trichotillomania (hair-pulling disorder) and excoriation (skin-picking disorder)

Seeking Treatment for OCD

Most successful treatments for OCD are based on psychotherapy, medication, or some combination of both. You can also practice stress management to incorporate healthier habits at home.

Common OCD Treatments

• • Cognitive behavioral therapy (CBT): CBT is a form of psychotherapy that helps people identify unhelpful or negative thought patterns that affect their emotions and behaviors. Your therapist may use CBT to help you identify your obsession and explore healthier responses to those thoughts other than your compulsion.
  • Exposure and Response Prevention (ERP): ERP is a form of CBT that re-enacts the four-step OCD cycle in a safe environment under the supervision of your therapist. It involves purposely exposing yourself to situations that trigger your obsession and then engaging in response prevention to avoid carrying out the associated compulsion. ERP is considered the gold standard in the treatment of OCD.
  • Medications (SSRIs): Selective serotonin reuptake inhibitors (SSRIs) are a form of antidepressant commonly used to treat people with OCD.
  • Stress management: Stress may trigger OCD behaviors. By practicing stress management (while still receiving professional treatment), you may be able to interrupt the OCD cycle the next time you encounter a stressful situation.

Frequently Asked Questions (FAQs)

“Do I Have OCD?”

The only way to receive an OCD diagnosis is to seek professional help. Click here to find an OCD therapist near you.

Is OCD a Mental Illness?

Yes, OCD is a mental health disorder. This means that people with OCD likely will need professional help in order to overcome their symptoms. The good news is that OCD is treatable. Many people with OCD experience great improvement with therapy, medication, or both.

The post Obsessive-compulsive disorder (OCD): Symptoms and treatments appeared first on therapist.com.

What is mindfulness?

Mindfulness is the practice of being present in the moment without judgment or interpretation. As a type of meditation, it’s grounded in feeling and sensing the moment, as opposed to being focused on the past or future. With mindfulness, you may notice your breathing, become more intimately aware of what’s nearby, or observe what’s happening within your body.

Mindfulness has roots in religions like Hinduism and Buddhism, as well as secular forms of meditation, and it’s often incorporated in practices like yoga. Many early Western mindfulness practitioners learned about the concept in the Far East and brought it to the West. 

Mindfulness practices have been combined with other therapeutic techniques to form both mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR). In more recent years, mindfulness has been combined with positive psychology to promote well-being and self-awareness.

Benefits of mindfulness

Mindfulness can help keep you from reacting to your environment out of impulse or instinct. It encourages you to stay calm down and respond to stress in more productive ways. It can help ease stress, anxiety, depression, relationship issues, and chronic pain.

It can also help you achieve goals, reduce symptoms of burnout, and improve your attention and focus. Studies have also found mindfulness is useful in addressing insomnia, high blood pressure, and diabetes management.^1,2,3

Mindfulness for anxiety

Research suggests mindfulness-based interventions can be effective in reducing anxiety.⁴ In some cases, mindfulness helps people feel more in control of their own actions and outcomes, which in turn reduces anxiety and other mental health concerns.⁵  

Mindfulness practices can also increase self-awareness, helping you recognize signs of anxiety in your body and mind. Noticing these symptoms while they’re mild can give you a better chance at stopping their escalation. Mindfulness may also help some people who experience panic attacks.⁶ 

Mindfulness for depression

Mindfulness-based interventions have been shown to mildly reduce depressive symptoms, especially when used in combination with other treatments.⁷ In addition, mindfulness-based cognitive therapy has been shown to help prevent depressive relapses in patients with recurring depression.⁸

Mindfulness helps people become aware of the negative thought patterns common in depression and change the way they relate to them. It also helps lessen negative emotional reactions to events and unproductive, anxious rumination.

Mindfulness techniques

Different mindfulness techniques, including the ones listed below, can be used in therapy or as self-care:

• Meditation involves focusing on a single object, activity, or thought to heighten awareness and increase attention.
• Mindful eating involves being fully present while you eat. You might appreciate food by deliberately focusing on how it tastes, smells, and feels while you slowly chew.
• Mindful breathing focuses your attention on your breath. One simple way to do this is to concentrate on your chest and stomach’s rise and fall as you inhale and exhale.
• Walking meditation involves attending to the process of walking. Being conscious of each part of a step can help bring you out of autopilot and into the present moment.
• Mindful seeing involves consciously noticing what’s in your field of vision. You can start by focusing on one object and noticing all of its details, colors, and textures.
• Mindful listening involves giving your full attention to what’s being said, and turning off your own internal judgments or anxious thoughts to focus on the message being conveyed.

Many other mindfulness techniques—such as specific breathwork, use of your five senses, or focusing on feelings or physical sensations—can also be employed.

Mindfulness vs. meditation: What’s the difference?

Mindfulness and meditation are interconnected practices, but they aren’t the same thing. Mindfulness is an ongoing, non-judgmental awareness of the present moment, which can be integrated into daily life.

Meditation, on the other hand, is a deliberate and structured practice that includes techniques like mindfulness to cultivate a focused mental state. While mindfulness can be a part of meditation, meditation encompasses a wider range of practices beyond just mindfulness.

Mindfulness in therapy

A therapist may use mindfulness techniques to help you manage symptoms and become more aware of your thoughts and feelings. In both MBCT and MBSR, mindfulness techniques are a core part of therapy. 

In MBCT, for example, participants learn various mindfulness exercises during an eight-week program and practice using them in their daily lives. The techniques are combined with traditional cognitive behavioral therapy (CBT). 

Mindfulness is also used in other therapies, including:

• Acceptance and commitment therapy (ACT): Encouraging psychological flexibility, ACT helps people accept what they can’t change and take action on what they can. Mindfulness techniques are used to help people accept reality without labels or judgment.
• Dialectical behavior therapy (DBT): DBT incorporates mindfulness techniques to help teach emotional regulation and impulse control.
• The Hakomi method: This therapy combines somatic therapy with mindfulness to help people gain awareness of their core thoughts, feelings, and beliefs.

How to practice mindfulness

Mindfulness can be a helpful daily practice for managing mental health issues or reducing stress. Here are some simple mindfulness techniques you can use in everyday life: 

• Slow down and pay attention: Focus on using your five senses to experience the present moment. When eating, take time to focus on the smell of the food, what it looks like, and how it tastes. When lying in bed, focus on the textures you feel, the sounds you can hear, or the sensations in different parts of your body.
• Focus on your breath: Bring your attention to the rise and fall of your chest. Concentrate on your breathing as the air moves into and out of your body.  Close your eyes and take deep breaths that fully expand your lungs.
• Acknowledge your thoughts and emotions: When you find yourself in difficult situations, acknowledge how you’re truly feeling in the moment. Allow the thoughts and emotions to be present without judging them.
• Return to the present: When your mind wanders from the technique you’re practicing, simply return your attention to the present without judgment.

If you’re interested in learning how mindfulness techniques can help you manage mental health issues or reduce stress, consider making an appointment with a therapist who uses mindfulness techniques.

A licensed therapist can help you identify which techniques might be best for you and teach you to use them to manage symptoms of depression, anxiety, or other mental health issues.

The post Mindfulness and mental health: Techniques and therapies appeared first on therapist.com.

Harm reduction. Symptom management. Lowering “subjective units of distress.” Many of us have trained for years to achieve identifiable goals such as these, which fit nicely into case notes and satisfy insurance companies’ thirst for payment-validating change.

Imagine, however, what therapy would look like if the focus were on liberating a client from their pain, rather than simply diluting their symptoms. Can clients ever truly be free of their suffering? Of their trauma? Of the confines of their selves?

Reverend angel Kyodo williams certainly thinks so.

A writer, activist, and ordained Zen Buddhist teacher, Rev. angel is the author of Being Black: Zen and the Art of Living with Fearlessness and Grace, and the coauthor of Radical Dharma: Talking Race, Love, and Liberation. The Library Journal called her “the most vocal and most intriguing African-American Buddhist in America.”

Ryan Howes: Were you seeking a spiritual path, or did it find you?

Rev. angel: It definitely found me. Growing up, I was decidedly agnostic, although I had a number of religious influences. One was a babysitter who came from a very religious family. She took me to church, and all the expectations around getting dressed up in the Black Baptist tradition really turned me off. I remember sweating in the summertime with little white socks on and patent leather shoes. My father is a nonpracticing Catholic. My mom is quite spiritual, though definitely not religious. And I had a stepmother who took me to Sunday school in an Episcopalian church.

RH: What drew you to Zen Buddhism?

Rev. angel: I was looking for something that moved me, and I stumbled across Zen art. That led me to Zen meditation. The thing that I was most attracted to in Zen, and what I was imagining about Buddhism, was that it’s so practiceable that it doesn’t require that funny little word “faith.” I often help people distinguish between Buddhists and philosophical Buddhists. I was a decidedly philosophical one, even though I became a priest.

RH: You talk a lot about teaching liberation and the path to liberation.

Rev. angel: The Buddha taught “only suffering and the causes of suffering.” But if you say that, a lot of Westerners are turned off. They’re gone. So, because I’m practical and I know how much words matter, I teach liberation—it’s simply the other side of suffering, nothing else.

I want to be able to speak to people. I don’t want to be bound by trauma when I talk. Given the lineage of my people and the inequitable social structures that persist, our suffering is a given. Let’s talk about how we address it: liberation.

RH: Many people who are suffering seek out therapy, religion, or some form of spirituality. What do you think they’re hoping to find? Relief? Meaning?

Rev. angel: I think people are looking for liberation from their suffering. That’s the equation of the Buddha. But there’s a distinction between freedom from suffering and liberation from it. In each, there’s a release, but the former entails a freeing from and the latter a freeing into. With liberation, we’re freed into the fullness of who we are, and empowered to live that way.

Conventional wisdom teaches that the nature of suffering is a result of attachment to a substantiated self. Zen and Buddhism posit that there’s no such thing as self—which is interesting inside the world of psychotherapy. People are navigating how we deal with this thing called a self.

RH: Yes, self is central to many therapeutic approaches.

Rev. angel: Zen Buddhism is the notion of the dissolution of a self in a way that’s effervescent. It’s not to say that we don’t have a body or a being, but that it rises and falls, and when we fixate on any singular moment of it or expression of it, that’s what our suffering comes from.

The self says, “I was happy yesterday. I want to be happy today.” We cling to the past or yearn for something that’s going to come in the future, and we suffer as a result of it. That’s not to say that we can’t enjoy life or that we don’t have sadness, but that the suffering is a looping of pain beyond the time-space of pain itself.

We have emotional pain, physical pain, physiological pain. We have bodies and nervous systems, and we’re frail creatures. We have ancestral pain, generational pain, socially induced pain. But when we loop on it and cast ourselves into the future or fret about a past that we can’t change, we get anxious and depressed.

RH: In therapy, we’d call that rumination.

Rev. angel: These things, these sufferings that we think of in psychotherapeutic terms, are the results of not being present. In the now, we experience pain, but when we carry the pain into the next moment, then we’re suffering. We’re bringing our pain along, adding insult to injury, and overidentifying with a particular experience.

Zen suggests that you distinguish the moment of pain from who you are. You are not your pain. You are not that singular experience. You may be informed by it, shaped by it, but you’re not that moment of pain.

RH: It sounds like the modern idea of mindfulness, which is about being in the present moment, as opposed to living in your past trauma or your worries about the future.

Rev. angel: I’d say that the modern mindfulness stuff is a distillation of the pithiest concepts of a rich, complex body of thought and experience to come out of Buddhist understanding.

RH: You once said, “Without inner change, there could be no outer change, and without collective change, no change matters.” So inner change comes first, but if we’re going to make any difference, we have to have collective change. Right?

Rev. angel: That’s right. It’s like if you save the ship, but everybody’s been tossed off, then it doesn’t really matter if you’re the only one who survives, because you’ve lost your loved ones, your connections, your community. We’re social creatures, and our sense of relationship and joy, vigor, and appreciation of life comes as a result of our connections.

So the Western inflections of Buddhism aren’t sufficient: it isn’t sufficient just to have your own solo liberation if the world around you is burning. While you may experience yourself as somehow unscathed, the truth is that we’re interdependent. If the pandemic has shown us nothing else, it’s that we impact each other. We touch each other. We share breaths; therefore we have a responsibility to be accountable to how we are and how things are for others. We can’t just sit here and ignore the fact that Africa doesn’t have access to much vaccine.

RH: You’re only the second Black woman Zen teacher. I know a part of your journey has been inviting other people of color to become aware of Zen philosophy. How has that been for you?

Rev. angel: Lonely! It took maybe 10 years before I heard about the only other Black Zen teacher when I was coming up. There were only white people around me, who thought they were being Zen but were actually embodying garden-variety racism. There was no one to help me navigate that racism and tell me, “No, you’re not crazy. What you’re experiencing is real.”

Of course, it makes sense that there aren’t a lot of Black people in a Japanese tradition that comes from China, and India before that—and has been in the United States for only 50 years. Black people come with their own history. They’re largely Christian or Muslim, with their own spiritualities.

RH: Have more Black people begun to convert to Zen?

Rev. angel: As I’ve come to connect with other Black folks who’ve studied Zen or Buddhism, a lot of them co-hold it with their existing spirituality in ways that white people don’t; they haven’t left Christianity to enter Zen. So the more curious-minded question is around why the European-descended, white-bodied people in America want to run off and become quasi-Japanese.

I’m not saying that it’s bad—just weird. And it’s not just within Zen. Many people who are accustomed to having their practices and spirituality and music appropriated aren’t so quick to go appropriate someone else’s. It’s the same for indigenous practices and yoga.

There’s a sense of entitlement to access other people’s things. But now that we’re in a global society, it makes sense that it’s happening more and more. The global connectivity allows us to find aspects of ourselves that we didn’t know existed in another culture and that we find resonance with so much more than what we grew up with. I think that that’s where we’re heading as a people and a planet: to greater complexity and not just being situated according to what we were born into and of, which has led to an incredible clash that we’re having as a society.

Where does belonging come from? How do we know what belonging is? Is it about saying, “I was born in coal mine country, and so all I know how to do is take the tops off of mountains. If I don’t have that, I can’t be whole anymore”? Or are we coming into a place in which we know ourselves more wholly by difference?

RH: Is there something that you wish therapists knew about spirituality?

Rev. angel: Without inner work, there can be no outer work. It’s a therapist’s own work that’s going to be their greatest gift to their clients and the people that they support; their own wholeness.

What we have most to offer to our clients, to the people and things we care about and love, it doesn’t exist in a book. It can’t be trained. It’s someplace out there, and we have to move into it. We have to find it within ourselves and offer it to ourselves to be able to offer it to others.

Ryan Howes, PhD, ABPP, is a psychologist, writer, musician, and clinical professor at Fuller Graduate School of Psychology in Pasadena, California. 

The post Total liberation: A Buddhist approach to healing appeared first on therapist.com.

What is limerence?

Limerence is an intense emotional state that stems from an overwhelming romantic obsession with another person. The person receiving the attention is often referred to as the “limerent object” (LO). The person experiencing limerence typically feels an intense longing for the LO, characterized by intrusive thoughts, heightened emotional reactivity, and a strong desire for mutual affection.

Limerence vs. having a crush: While crushes are typically mild and fleeting, limerence is more intense and long-lasting. Limerence involves a deeper emotional investment and often leads to obsessive thoughts and behaviors.

Limerence vs. infatuation: Limerence can involve infatuation, but infatuation alone is often short-lived and based on superficial attraction. Limerence, on the other hand, is more intense and can persist for months or even years.

Limerence vs. love: Limerence is often one-sided and involves intense emotional highs and lows. Love, on the other hand, tends to be more stable and enduring—especially in a healthy relationship where feelings are reciprocated.

Limerence stages

Limerence often unfolds in a series of stages, each with its own unique characteristics and emotional triggers. Several different models have been used to describe the stages of limerence, typically ranging from three to seven stages. One widely accepted model divides it into five distinct phases:¹

1. Pre-limerence: Initially, you may find yourself longing for love without having focused your attention on a specific person. This stage is marked by a readiness for connection but doesn’t yet involve a designated LO. Your desire to feel intensely loved fuels this state.
2. Pre-reciprocity: As your interest sharpens towards the LO, you enter a stage of intense focus. You may not feel immediate sexual attraction, but there’s a strong desire for emotional and physical intimacy. Nonverbal cues of interest are common in this phase. If these signals are ignored, you may feel despair for a time, but eventually resume your pursuit.
3. Reciprocity: If the LO responds positively to the advances, or has feelings of love or interest themselves, this triggers a period of intense emotion and obsession. This stage can vary in length, often shortened by increasing levels of mutual affection. Both uncertainty and the emotional extremes that come with it are reduced during this phase.
4. Gradual dissolution: With time, the intensity of your feelings may diminish. This can lead to anxiety or attempts to rekindle the initial excitement. Responses during this stage can range from feelings of betrayal to efforts to restore previous emotional highs.
5. Post-limerence: In this phase limerence subsides entirely, hopefully making room for a more stable and communicative relationship. Achieving this stage is rare due to the emotional turmoil that often accompanies limerence.

Limerence symptoms

Signs of limerence can be seen in various behaviors, including:²

• Obsessive attachment to a specific person
• Overwhelming longing for the person’s attention
• Persistent, intense feelings for the person that lasts for months or years
• Addictive and obsessive rumination about the person
• Involuntary and all-consuming thoughts about the person
• Intrusive thoughts about the person that interfere with daily life
• Imagining your feelings are reciprocated
• Idealization of the person
• Physical symptoms (such as sweating or heart palpitations)

Who is prone to limerence?

Anyone can experience limerence, no matter their age, gender identity, background, or current relationship status. Women, however, may be slightly more prone to experiencing it than men.³

What causes limerence?

The exact causes of limerence aren’t fully understood and is likely influenced by a mix of psychological and environmental factors. It shares some characteristics with the following mental health conditions:⁴

• Anxious attachment style
• Obsessive-compulsive disorder (OCD)
• Attention-deficit hyperactivity disorder (ADHD)

People with an anxious attachment style may be more prone to experiencing limerence due to their heightened need for emotional validation and fear of abandonment. Similarly, those with OCD may find their repetitive thought patterns align with the intrusive thoughts common in limerent experiences. People with ADHD often have impulsivity and hyperfocus, which could also fuel the obsessive qualities typical in limerence.

Some research suggests that the obsessive behavior behind limerence may be triggered by a combination of hormones and neurotransmitters, similar to the brain chemistry involved in addiction.⁵ Like people with behavioral addictions, people experiencing limerence may spend a lot of time thinking about and pursuing their LO even when they know it comes with a risk of extreme emotional highs and lows.

Despite sharing similarities with these conditions, limerence isn’t considered a mental health disorder but rather a distinct cognitive state. These conditions don’t necessarily cause limerence, but they may increase the likelihood of experiencing it or intensify its effects.

The intensity of limerence may also be influenced by personal circumstances, such as loneliness, low self-esteem, or a desire for emotional connection. It’s possible some people may even be more susceptible to limerence due to their personality traits, such as a tendency towards idealization or a strong need for validation from others.

Modern technology, such as social media, can further enable limerence. These platforms provide constant access to information about the LO, fueling obsessive thoughts and behaviors.

Living with limerence and its impact

Limerence can significantly impact daily life, affecting personal relationships, work performance, and overall well-being.⁶ Those who experience it may find themselves constantly distracted, unable to focus on tasks or engage meaningfully with others. In severe cases, limerence may lead to:⁷

• Symptoms similar to posttraumatic stress disorder (PTSD)
• Depression
• Attachment anxiety
• Self-harm tendencies
• Stalking behaviors
• Breakdown of existing relationships
• Intense emotional highs and lows
• Difficulty in maintaining daily routines or focus

How does limerence usually end?

Limerence tends to end in one of the following ways:⁸

• The intense feelings gradually fade over time as they run their course.
• The limerent person is rejected by the LO, which helps break the obsession. It can also result in a renewed state of limerence—for the same person or for someone else.
• The limerent person’s feelings are reciprocated by the LO, causing an intense period of mutual limerence. In rare cases, this may lead to a stable relationship. If it doesn’t, limerence fades or is redirected to a new LO.  
• The limerent person consciously decides to stop the limerence and learns to end it through effort and practice.

How long does limerence last?

Early research suggested that limerence typically lasts between 18 months to three years.⁹ More recent research indicates that the duration can vary greatly depending on individual circumstances and personality traits. Some people may experience limerence for only a few weeks, while others may struggle with it for decades. Factors influencing the duration include:

• The level of reciprocation from the LO
• Personal resilience and coping mechanisms
• External life events and stressors
• Availability of support systems
• Presence of underlying mental health conditions

How to get over limerence

Learning how to beat limerence can be challenging, but there are several strategies that may help:

Practice mindfulness and self-awareness. Mindfulness techniques can help you recognize and manage intrusive thoughts about the LO.

Limit contact with the LO. Reducing exposure to the object of your affections can help break the cycle of obsessive thoughts and behaviors. This may include unfollowing them on social media or avoiding places where you’re likely to encounter them.

Challenge idealized thoughts about the LO. Recognize that your perception of the LO may be distorted. Try to see them as a real person with flaws and imperfections. This can help break the idealized image you’ve created.

Engage in self-care and personal growth. Focus on your own interests, hobbies, and goals. This can help boost self-esteem and reduce the need for external validation.

Seek professional help. A therapist can provide guidance and support in managing limerent feelings and addressing any underlying issues. Exposure and response prevention (ERP), a form of cognitive behavioral therapy (CBT) used to treat OCD, has been shown to be effective in treating limerence.¹⁰ Visit our directory to find a therapist near you who specializes in these types of therapy.

The post Limerence: Meaning, signs, causes, and how to overcome it appeared first on therapist.com.

What is prolonged grief disorder?

Prolonged grief disorder (PGD) is a condition where someone experiences intense grief that doesn’t ease with time after losing a loved one. It involves strong yearning for the deceased and being preoccupied with thoughts or memories of them.¹

Grief itself is not a disorder or illness—it’s a natural, necessary response to loss.² While painful, grief tends to gradually change in character and intensity, allowing people to cope and adapt.

With prolonged grief, this natural healing process gets stuck. About 10% of bereaved people will develop this condition, where their grief remains intense and debilitating.³

How long does prolonged grief last?

Prolonged grief is defined as intense grief that lasts a year or more for adults or more than six months for children and adolescents. ⁴ Typically, people begin to adapt to a loss within this timeframe. The pain doesn’t disappear, but it becomes more manageable and doesn’t severely impact daily functioning.

When people experience PGD, painful thoughts and memories continue much longer. Because everyone grieves differently, there’s no rule of thumb for how long prolonged grief can continue. Grief doesn’t follow a strict timeline.

Some people may experience brief periods of intense grief years after a loss, especially during anniversaries, birthdays, or significant life events. These temporary surges of grief are normal and distinct from PGD.

Prolonged grief disorder vs. complicated grief

The term “complicated grief” was previously used to describe grief that doesn’t resolve naturally over time.⁵ While it isn’t an official diagnosis, it may still be used informally to describe symptoms consistent with prolonged grief disorder (PGD). The official diagnosis for this condition is now PGD, as recognized in recent diagnostic updates.

The change in terminology reflects the formal recognition of PGD in updated diagnostic manuals. These manuals include the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) and the “International Classification of Diseases” (ICD-11). Both provide standardized criteria for diagnosing the condition.

The term “persistent complex bereavement disorder” (PCBD) was also a proposed description for this state at one time. It was mentioned as a condition requiring further study in the DSM-5 before PGD was ultimately included in the DSM-5-TR update.

Prolonged grief disorder symptoms

People with prolonged grief disorder experience several distinctive symptoms.⁶ To be diagnosed with PGD, a person must experience a combination of the following:

Separation distress:

• Feeling a strong longing for the deceased
• Constantly thinking about the deceased and your memories of them

Additional symptoms:

• Feeling like you’ve lost a part of yourself
• Having a hard time believing the person is gone
• Avoiding reminders that the person has passed
• Deep emotional pain related to the death (such as anger, bitterness, or sorrow)
• Difficulty engaging with relationships and activities after the loss
• Feeling emotionally numb or less able to feel things
• Feeling that life is meaningless without the deceased
• Intense loneliness as a result of the death

Time criteria:

• For adults: Symptoms continue for at least 12 months after the death
• For children and adolescents: Symptoms continue for at least six months after the death
• Reaction to the loss goes beyond cultural and social expectations

In one research study, difficulty accepting the loss was found to be the most common symptom. It was estimated to affect between 14% to 25% of bereaved people.⁷ Grief-related impairment was the second most common symptom at 10% to 16%.

While not part of the official diagnostic criteria, physical symptoms sometimes accompany prolonged grief, including:⁸

• Chest tightness or choking sensations
• Shortness of breath
• Stomach issues
• Lowered energy
• Physical weakness
• Lasting fatigue

If you believe you’re experiencing PGD, or are struggling with a loss in any form, help is available. Visit our directory to find a therapist who specializes in grief counseling.

Prolonged grief disorder risk factors

Several factors may increase the risk of developing PGD:⁹

Unhelpful thought patterns, such as excessive self-blame, rumination, or catastrophizing. These cognitive patterns can trap people in cycles of painful thinking, making it difficult to process and integrate grief in healthy ways.

Avoidance behaviors, like steering clear of reminders of the deceased or not talking about the loss. While these behaviors may help a person temporarily avoid pain, it prevents the emotional processing necessary in healthy grief.

Difficulty managing painful emotions. When someone struggles to tolerate or regulate intense emotions, they might suppress them or become overwhelmed by them. Both of these actions can complicate healing.

Lack of social support. Grieving in isolation can significantly increase risk for prolonged grief. Grief becomes more manageable when there are other people around to validate you and provide comfort.

Previous mental health challenges. Grief can interact with and worsen conditions like depression or anxiety. It may make symptoms more intense and complicate recovery.

Compounded grief. When a loved one passes, it can create additional losses that complicate grief further. For example, if an elderly person loses their spouse, it may also mean losing the person who helped them compensate for mobility challenges. So, in addition to the grief of losing their partner, they may also lose their ability to live independently.

Other significant risk factors include:¹⁰

Traumatic circumstances surrounding the loss, such as sudden, violent, or unexpected deaths. These situations can create added layers that complicate the grieving process.

Closeness of the relationship. People may be at a higher risk for PGD when they lose someone very close to them. This may be a child, spouse, sibling, or parent (especially if the parent passes while their children are still young).  The more closely the person was tied to your everyday life and sense of self, the harder it will likely be to adjust to their loss.

Personal vulnerabilities. Certain qualities may make people more vulnerable to developing PGD. These traits include low self-esteem, a history of depression or anxiety, or previous struggles with suicidal thoughts. These factors can reduce resiliency when facing the weight of grief.

Nature of the relationship. If you had a complicated relationship with the deceased, it can affect the way you grieve. If the relationship involved ambivalence or dependency, processing grief can be more challenging because of unresolved feelings or the way it disrupts your identity.

How grief impacts well-being

Prolonged grief disorder can seriously affect both mental and physical health in the following ways:

• Physical health problems: In some cases, high levels of traumatic grief may increase risk of cancer, heart issues, and other chronic conditions.¹²
• Substance use: People with complicated grief may be more likely to use alcohol or drugs to cope. Interestingly, the relationship seems to go in both directions: People who misused substances before a loss were also more likely ultimately develop complicated grief.¹³
• Suicidal thoughts and behaviors: Complicated grief is a strong independent risk factor for suicidality, even when controlling for other mental health concerns like depression and posttraumatic stress disorder (PTSD).¹⁴

If you or someone you know is having thoughts of self-harm or suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

Grief’s impacts can also be more subtle and appear in the long-term.¹⁵ People with prolonged grief may:

• Neglect their healthcare needs
• Eat poorly or irregularly
• Exercise less often
• Experience sleep disturbances
• Withdraw from relationships

All of these changes can further harm both mental and physical well-being.

Impact on relationships

Prolonged grief can strain relationships in several ways:

• Friends and family may not understand why a person isn’t “getting better”
• The bereaved person might withdraw from social activities
• Conversations can become uncomfortable when others don’t know how to respond to ongoing grief
• The person may have difficulty forming new relationships due to fear of future loss

These impacts can create a concerning cycle in which a person becomes more and more isolated just when they need social support the most.

Prolonged grief disorder assessment

PGD is a fairly new diagnosis. But healthcare providers have been trained to recognize troubling patterns and distinguish between PGD and other similar conditions.

Clinicians may use specialized tools to evaluate grief symptoms, such as:¹⁶

• The Yearning in Situations of Loss Scale–Bereaved (YSL)
• Typical Beliefs Questionnaire (TBQ)
• Grief-Related Avoidance Questionnaire (GRAQ)

While these tools can be helpful for clinicians, they’re not intended for self-diagnosis. If you have concerns about your mental health, it’s important that you speak with a mental health professional as soon as possible. They can help you recognize and address unhelpful thought patterns and painful emotions.  

Prolonged grief disorder treatment

For those whose grief doesn’t lessen naturally with time, several effective treatments exist:¹⁷

• Complicated grief treatment (CGT), a specialized 16-session therapy that balances processing the loss with rebuilding life after it. CGT is highly effective for reducing prolonged grief symptoms.
• Cognitive behavioral therapy (CBT), which helps identify and change unhelpful thought patterns and behaviors related to grief. Techniques include exposure therapy and cognitive restructuring, with specific protocols for grief-related sleep problems.
• Support groups, which provide social connection and peer support, are valuable in the early stages of grief and may help lower the risk of developing PGD.
• Medication, specifically antidepressants, may help treat co-occurring concerns like depression. It may have limited effects on grief symptoms when used alone, but it can be a helpful part of a well-rounded treatment plan.

When to seek help for grief

A therapist can be a good source of support regardless of how well you feel you’re processing a loss. There’s no length of time or volume of emotion that you need to feel to “justify” seeking help.

Professional guidance may be especially useful if:

• Intense grief hasn’t begun to ease after 6 to 12 months
• You’re having trouble functioning in daily life
• Grief is interfering with your ability to work, maintain relationships, or care for yourself
• You’re experiencing thoughts of suicide or feeling that life isn’t worth living
• You’re using alcohol or drugs to cope with your feelings
• You feel stuck in your grief with no improvement over time

Remember that seeking help for grief is a sign of strength and self-awareness. Find a therapist who specializes in grief and loss near you.

The post Prolonged grief disorder (PGD): Symptoms and treatment options appeared first on therapist.com.

The following is an excerpt from “Stop Overthinking Your Relationship” (New Harbinger Publications, Inc.). Copyright ©2022 by Alicia Muñoz.

Have you ever observed a colorful little beach ball pop up on your computer screen, usually when something has gone wrong? Macintosh users refer to it as the Spinning Beach Ball of Death—or sometimes the Marble of Doom. If you’ve witnessed this endlessly spinning rainbow pinwheel in action, you know it’s a sign of trouble. You may have to force-quit your software program and lose some of your recent work. You could end up spending hours on the phone with tech support. The Spinning Beach Ball of Death is a nifty metaphor for overthinking.

When overthinking interrupts the natural flow of your life, it’s also a sign of trouble. Unlike a beach ball, rumination cycles aren’t colorful. They’re dreary and predictable, made up of repetitive negative thoughts instead of rainbow colors. The more they spin, the more space they take up in your mind. They can spin so fast and take up so much space that it gets hard to see past them. It’s easy to fall into the trap of assuming their anxiety-provoking content is true.

When overthinking combines with the emotionally charged needs and fears in an intimate adult bond, you can end up reliving the same conflict with your partner over the course of many years—though it may disguise itself in novel forms. You may even hear some couples talk about having the same fight they had on their first date a decade later. Awareness of your repetitive negative thinking can reduce the intensity of conflicts—or even defuse them completely. The differences between partners don’t make or break a relationship. What does is how partners think about these differences.

Rumination cycles

Like the Spinning Beachball of Death or a snowball rolling downhill and gathering momentum, ruminative thoughts turn in a seemingly endless loop around the same painful themes. I’ve identified five distinct rumination cycles centered on the themes of blame, control, doubt, worry, and self-pity.

All of us are capable of spinning all the rumination cycles, and it’s not unusual to spin a hybrid of two or even three of them at once. But most of us have a dominant cycle: the one we spin most often. We may spin it so much that it colors our identity and personality. As you investigate your own dominant rumination cycle, you’ll probably discover you have a secondary one too. This is the cycle you spin when your dominant cycle fails to bring resolution, relief, or closure.

As you identify your dominant and secondary cycles, get curious about what triggers them. Draw on practices that can help you counteract your cycle’s reality-distorting power by cultivating the missing “nutrient” of acceptance, being present in your body, trust, letting go of perfectionism and control, and taking responsibility for your contribution to problems.

Blame cycle

Antidote: Practice acceptance

This is my fault. I’m such an idiot. How could I let this happen? It’s unacceptable, intolerable, horrible, awful. My partner is selfish. They’re wrong. They should pay for this. They should apologize. Don’t they realize how much pain they’re causing me?

Thoughts, memories, and images in the blame cycle revolve around painful past events. A conversation escalated into a fight. You’re sure you’ve been unfairly treated, taken advantage of, and misunderstood. You had good intentions, and your partner misinterpreted what you said or did. You planned a special trip, and your partner ruined it with their irritability. The dinner ended awkwardly for you and your dinner guests. You recall the past selectively. Events confirming your own (or your partner’s) flaws are magnified.

Has your partner ever sincerely praised you for something you reflexively denied or minimized? Maybe they said, “You look great,” and you responded, “No, I don’t,” or “I’m tired.” Maybe they said, “It was so thoughtful of you to pick me up from the airport,” and you said, “Well, of course, why wouldn’t I?” When you spin blame cycles, you’re too busy blaming your partner—or yourself—to take love in.

When blame is directed at your partner, it’s fueled by aggression and resentment. As long as you focus on what’s wrong with your partner, you don’t have to look at your contribution to problems. You can cry, “I’m innocent!” A false sense of superiority protects you from the truth of your own human imperfections and flaws. When you direct it at yourself, it’s sustained by guilt, shame, and regret. You’re self-critical. You should have known better.

If blame cycles are your go-to form of overthinking, you suffer from an acceptance shortage. Practice accepting what you normally blame yourself or your partner for. If you blame your partner for regularly taking the last sheet of toilet paper on the roll without putting in a replacement roll, accept the fact that they do this (you may as well, since they’re doing it whether you accept it or not). If you blame your partner for their current stress level, try accepting it instead. They are under stress right now. It is happening. If you blame yourself for being angry, accept your anger. How does it help you or anyone else for you to reject what you already are?

You don’t have to like something to accept it. You don’t have to give up on expressing your needs and wishes either or on improving your life and your relationship. You can accept your partner taking the last sheet of toilet paper without putting in a new roll, and at the same time, you can let your partner know how you feel and what you want when you’re calm and they’re more likely to hear your feedback. You can say, “When you take the last sheet of toilet paper without putting in a new roll, I get mad. It puts me in a tough position. Can you replace the roll next time?”

Doing this with acceptance increases the chances of your partner listening and altering their behavior since the negative charge of blame isn’t leaking into the relationship field, raising their defenses, and making it harder for them to relate to you.

Control cycle

Antidote: Release perfectionism and what you can’t control

I know best. I’m rational. I’m in touch with my emotions. My views should hold sway. I’m more genuine. I’m kinder, wiser, healthier, superior, younger, older. Because I’m the extrovert, I’m more suited to organize our social life. I’m the one who keeps us healthy, safe, and happy. I’m justified in pursuing and enforcing my agenda. I’m the one who knows how to handle this.

These thoughts orbit a desired future outcome and the best way to achieve it. Your partner must sit down at the table immediately. They must talk to someone—a therapist, parent, boss, or real estate agent—ASAP. It’s time for an emergency meeting with your attorney because you know what the next step is. You’re curious about consensual nonmonogamy, and so they should be too. It’s time to go to Hawaii. You’re done with long-distance relationships. You’re showing up on your partner’s doorstep with a suitcase, a toothbrush, and an espresso machine.

If you’re in the control cycle a lot, get grounded in one breath often. Remind yourself that absolute certainty and invulnerability are pipe dreams. You can trust yourself, others, and life wisely and gradually. You can entertain a more complex, nuanced worldview. Practice trusting and enjoying the process instead of striving for a predetermined outcome.

What if events can unfold in everyone’s best interests, even when you don’t micromanage them? Ask yourself, “Is this person, event or situation mine to control? Will control get me what I truly want here?”

Doubt cycle

Antidote: Cultivate trust

Can I be sure of my own perceptions? Maybe I’m imagining things. Did what I think took place really happen? Why is every other couple doing better than we are? Why did I choose my partner? Is there someone smarter, kinder, more attractive, or richer out there for me? Why did my partner choose me? Am I a fraud? Can I trust my own choices? My intuition has misled me in the past. What if I keep making poor choices?

Gaslighting refers to a form of psychological manipulation done by one person to another where the gaslighter disorients the gaslightee by denying, minimizing, questioning, and undermining their perceptions of reality. In this cycle, your own overthinking gaslights you. You selectively recall, minimize, and deny what you know. Or else you overdramatize embarrassing, shameful, or negative aspects of things you’ve done and choices you’ve made. Like a fisherman casting a line into a stagnant pond, these kinds of thoughts fly and land with a plop. They don’t hook what they’re trying to catch. There’s never enough certainty. There are never absolute guarantees. No evidence is ever ironclad enough to support your choices, decisions, or actions. Good times seem insubstantial and fleeting. Searching for evidence only reinforces doubts.

Painful insecurity and self-judgment are the hallmarks of chronic doubt cycles. The more you overthink, the less you trust your own recollections and intuition. You risk giving others’ negative perceptions of you—real or imagined—more importance than they deserve. When your overthinking regularly gaslights you, caring feedback from a supportive partner can open your eyes to a broader perspective. It can reduce the imbalance created by your constant second-guessing of yourself and your choices. If the thoughts in your doubt cycles undermine your own or your partner’s assessment of your strengths, accomplishments, and positive qualities, recognize it. Remind yourself, “Here’s doubt, gaslighting me again.”

Invest yourself fully in the process of living your life, even when your choices don’t deliver the outcomes you expect on your timeline. Make decisions and choices to the best of your ability, even when the outcome can’t be known in advance. Be gentle with yourself and cultivate realistic expectations. When things don’t work out the way you want them to, be with the vulnerability you feel instead of thinking about how you shouldn’t have trusted yourself. Remind yourself, “I’m doing the best I can with the knowledge and abilities I have. Missing the mark and learning is part of being human and relating authentically to other people.”

Worry cycle

Antidote: Connect with your body in the here and now

What will happen if he gets hurt on the job? What if we divorce and I don’t see our children as much as I do now? What if they stop loving me? She might cancel our next date if she finds out I’m a type-1 diabetic. One of us might catch COVID and give it to my father. This could be the last time we’re happy together as a couple.

Ruminative worry is an attempt to generate knowledge through forecasting and prediction. But nobody can truly know what will happen in advance. In this cycle, positive outcomes are dismissed or ignored. Worst-case scenarios rule. Fear keeps this cycle going.

You convince yourself you’ll be safe as long as you prepare for the worst. Your mind does this by thinking of everything that could go wrong. Instead of helping you feel safer, this strategy heightens your sensitivity to danger. Like a game of psychological Whac-A-Mole, for every worst-case scenario you think of and imagine fixing, another worst-case scenario pops up. There’s no way you can prepare for every potential catastrophe or possible negative outcome.

If you spin worry cycles regularly, the antidote is connecting with your body in the here and now. Worry commandeers awareness, siphoning it away from the present moment and wasting it on a nonexistent future. Tuning into your body can bring your awareness back to what does exist: you. Now. Like oil and water, worry and the present moment don’t mix.

When you find yourself worrying about an event or situation, insight meditation teacher and founder of Mindful Shenandoah Valley Shell Fischer has a mantra she offers retreatants. She suggests settling in, getting grounded in your body, and then saying these words to yourself as often as you need to: “If this thing I fear transpires the way I would like it to, that would be great. If it doesn’t, that will be okay, too, because either way, I am and will be okay.”

Self-pity cycle

Antidote: Take responsibility for your part

Why me? There’s nothing I can do. Life is unfair. I don’t deserve this. How come bad things always happen to me? I’ve tried everything. My situation is hopeless. We don’t stand a chance as a couple. Nothing makes a difference. The universe is against me. Suffering is my destiny. There’s no solution. Giving up is my only option. Nothing will ever change.

The self-pity cycle kicks in when the other cycles don’t bring resolution or relief. If you convince yourself you’re never the problem or are always wrongly treated, you can ignore your own irresponsibility, selfishness, immaturity, or passivity. Self-pity distracts you from your part in creating or sustaining hurtful situations. Life looks simple through a fairy-tale lens of good and bad, right and wrong, particularly if you’re always on the “right” side of the lens. Often, the unacknowledged expectation is that by embracing the role of a victim, you’ll inspire your partner to rescue you. But when you make your partner responsible for your well-being or behave as though you’re completely helpless when you’re not, they end up feeling controlled.

Even if your partner bends over backward to help you feel better, sooner or later they will get annoyed with you. They may complain of feeling manipulated. When you use self-pity to extract care or concern, you take advantage of other people’s goodness.

Often, the self-pity cycle is a reaction to unacknowledged shame, self-judgment, and self-hatred. It’s a weak substitute for the self-acceptance and self-love a person caught in self-pity truly longs for. People who find themselves spinning self-pity cycles can work on grieving losses, changing or accepting a difficult situation, and taking responsibility for their part in creating relationship problems. Forgive yourself for things you’ve said or done reactively or defensively. Allow yourself to feel remorse and make amends for what you’ve done. If you face your flaws, it brings you closer to self-acceptance than denying them or blaming them on your partner or other people. Ask yourself, “What can I take more responsibility for here?”

I’m not saying you should blame yourself for things you haven’t done, ignore your own hurt when people mistreat you, or deny injustice. Becoming a masochist isn’t the answer—it’s another facet of self-pity. If you find yourself on the receiving end of insults or aggression, this must be addressed when it’s safe for you to do so. Enabling partners to behave in devaluing ways isn’t good for you or them. You can recognize your needs and assert yourself while also facing your contribution to problems. Be humble without needless self-sacrifice. Tell the whole truth.

When you recognize your rumination cycles, you empower yourself. You’re no longer at the mercy of anxious overthinking that’s hidden and hard to spot. Identifying cycles deflates them, like bubbles you pop with a prick of needle-sharp awareness.

The post Stop overthinking your relationship appeared first on therapist.com.

What is posttraumatic growth?

Posttraumatic growth (PTG) is a term for the positive psychological changes you might go through after facing a traumatic event or life crisis.¹

Experiencing PTG doesn’t mean a trauma was “good” or that it didn’t cause damage. It’s an acknowledgement that you can adapt and find new meaning alongside the pain.

It’s important to remember that everyone processes experiences differently and that the path of growth can vary greatly from one person to the next.

Posttraumatic growth vs. resilience

Resilience is the ability to return to your usual way of living after stress, trauma, or setbacks.² Posttraumatic growth is different—it’s about moving beyond where you started.

While resilience focuses on stability and coping, PTG involves transformation and discovering new strengths, perspectives, or purpose. Resilience is about getting back to baseline—growth is about going beyond it. You might experience both resilience and growth at the same time.

PTG happens through deliberate reflection and meaning-making, not just by managing stress. These mental processes help you spot opportunities for positive change, even during painful experiences.

What posttraumatic growth looks like

PTG can show up as changes in different parts of your life. Therapists and researchers use tools like the Posttraumatic Growth Inventory (PTGI) to measure these changes in roughly five areas: relationships, new possibilities, personal strength, spirituality, and appreciation of life.³

1. Deeper relationships

Your relationships might feel deeper or more meaningful. Some people become more open, compassionate, or connected after going through something hard. This shift can show up in stronger bonds with family, friends, or your community.

2. New possibilities

You might start exploring different paths, setting new goals, or noticing opportunities you hadn’t thought of before. This sense of openness can make the future seem less limited.

3. Personal strength

You may feel more able to handle stress or challenges than you did before. Even when life feels difficult, you might feel more capable of handling it and accepting the way things work out.

4. Spiritual development

For some people, spiritual or religious beliefs get stronger. Trauma can cause people to seek meaning, sometimes resulting in a stronger religious faith or a deeper understanding of their spiritual beliefs.

5. Greater appreciation of life

Finally, you may find a bigger appreciation of life. Simple moments, daily routines, or time with loved ones might feel more valuable. Even small joys can seem more important, helping you focus on what really matters.

Not everyone experiences PTG, and those who do won’t all experience it the same way. Growth can also show up alongside pain. Some people might continue to deal with fallout from traumatic or difficult experiences, including posttraumatic stress disorder (PTSD), even as they notice positive changes at the same time.

If you’ve experienced trauma, a mental health professional can help you navigate the complex process of healing.

The psychology of posttraumatic growth

After trauma, your mind often tries to make sense of what happened. Some thoughts just pop up and feel intrusive, but it’s deliberate reflection—the times when you purposefully stop and process—that tends to support growth the most.⁴

Purposeful rumination helps you rebuild your sense of who you are and how the world works. You might notice that changing how you see your trauma changes how you carry it.

As you spot new strengths, see things from a different angle, or find value in your struggle, you start to turn distress into growth. This process isn’t about pretending the pain isn’t there—it’s about weaving it into your story in a meaningful way.

Who is most likely to experience posttraumatic growth?

Surprisingly, PTG isn’t rare. One review found that about half of people report at least moderate growth after trauma.⁶

The rate of PTG varies a lot—from about 10% to 77%. It depends on factors like your age, the kind of trauma you experience, and other personal details.

You’re more likely to experience posttraumatic growth if you’re under 60, especially if the trauma happened recently. Younger adults often report higher rates of growth than older adults, but more research is needed to determine why.

Groups like veterans, firefighters, and healthcare workers also report higher levels of growth. Their jobs expose them to intense stress, which can push them toward reflection and change.

Debates and limitations in research

If you dig into posttraumatic growth research, you’ll find that experts don’t always agree on what PTG really is.

The debate runs much deeper than most people realize. While many people who experience trauma report various levels of posttraumatic growth, mounting evidence suggests these self-reports aren’t accurate.

It’s been proposed that there are actually three types of PTG:⁷

1. Perceived PTG: What people believe about their own growth
2. Genuine PTG: Actual, measurable growth following adversity
3. Illusory PTG: Unfounded claims of growth

Some argue that illusory PTG is common, while genuine PTG is rare. The disconnect between how people believe they’ve changed and how they’ve actually changed may be much larger than previously understood.

What might create these illusions of growth? Researchers point to several factors:

• Design flaws in current measurement tools
• Emotional biases that favor positive interpretations
• The inherent appeal of the concept
• Cultural expectations that encourage growth narratives
• Problems of definition, including exactly what counts as growth

Measuring PTG is tricky, too. The most used tool, the PTGI, splits growth into five areas. But research shows these areas often overlap, and the supposed differences might not be all that clear.

One study found the five factors of the PTGI are highly interrelated, which raises the question of if they’re really measuring separate things.⁸ Self-reports are another problem. There’s no real way to know if someone has changed after a trauma, or if it’s just a belief that helps them cope.

This measurement problem is central to the controversy. The argument is that if most self-reports are inaccurate, then the foundations of PTG research need serious reconsideration.

Social context matters, too. Sharing your struggles can strengthen relationships for some people. But, as one case study explored, opening up can sometimes backfire. Instead of support, some people might react with discomfort, pressuring the person who’s gone through trauma to demonstrate growth.⁹

Therapy to support posttraumatic growth

Given how hard it can be to tell the difference between genuine growth and perceived or illusory growth, professional support becomes particularly valuable.

Understanding these concepts—the difference between resilience and growth, the various areas where change might occur, and the mental processes involved—can help both you and your therapist recognize and nurture authentic, positive change.

When you go through trauma, therapy can help you heal—and sometimes, you even find new strengths along the way. Posttraumatic growth often pops up during the recovery process, and there are a few different ways to support it.

Mindfulness-based therapy helps you stay present and manage difficult emotions through breathing, guided awareness, and supportive conversation. Studies with cancer patients showed these practices boosted resilience, self-compassion, and growth over time.¹⁰

Psychosocial interventions such as counseling, support groups, or skills-based therapies that provide coping tools and emotional support. They may modestly increase PTG even when not specifically designed to promote it.¹¹

Trauma-focused therapies like eye movement desensitization and reprocessing (EMDR) and brief eclectic psychotherapy (BEP) not only reduce PTSD symptoms—they may also help you feel closer to others, appreciate life more, and recognize your own strength.¹²

Therapy doesn’t have to focus specifically on growth to help it happen. Research shows that different types of treatment can boost PTG even when that’s not their main goal.¹³ This suggests that working on trauma symptoms may naturally lead to positive changes.

These approaches give you tools to cope and reflect, and they help you build meaning after tough times. Sometimes, that’s all it takes to nudge the door open to growth.

Supporting your own posttraumatic growth

While professional support is often helpful, there are simple ways to nurture growth in your daily life:

Practice deliberate reflection. Set aside time to think about what you’ve learned from your experience. This is different from ruminating—it’s purposeful thinking about how you might be changing or what new strengths you’re discovering.

Connect with others. Share your story with trusted friends or family members. Meaningful connections often deepen during difficult times and can help you see positive changes you might miss on your own.

Stay open to new possibilities. Trauma can shake up your assumptions about life. While this feels unsettling, it can also create space for new goals, interests, or ways of living you hadn’t considered before.

Be patient with yourself. Growth doesn’t happen on a timeline. Some people notice changes soon after trauma, while others see them years later. There’s no “right” pace.

Measure progress for yourself. Remember that genuine growth is different from proving to others that you’ve grown. Talking with a professional can provide valuable perspectives on which forms of growth you want to pursue.

If you’re struggling with the aftermath of trauma, or want support exploring potential growth, consider reaching out to a mental health professional. Search our directory to find a therapist who specializes in trauma and posttraumatic growth.

The post Posttraumatic growth (PTG): Supporting positive change after trauma appeared first on therapist.com.

What is anxiety?

Anxiety is a state of worry or apprehension. In small doses, it can be a healthy response to stress by giving us an extra push to study for an exam or make a great impression on a first date. It’s our body’s way of helping us think about and prepare for the future.

Too much anxiety, though, can harm us. Anxiety disorders develop when anxious feelings grow too strong or last too long. Instead of giving us a temporary boost, these disorders can drag us into overwhelming worry and fear, making it hard for us to function.

Fear vs. anxiety

We often use the words “fear” and “anxiety” interchangeably, but they refer to slightly different emotional experiences. We feel fear in response to something specific that we can see in the present moment, whether it’s an object, situation, or circumstance. With fear, the threat is immediate and known.

We feel anxiety in response to something we’re anticipating: a future threat that’s unknown or vague, such as worries about our health, family, or future.

Stress vs. anxiety

We all experience stress about exciting and challenging aspects of our lives. Stress is our body’s response to a specific challenge or struggle, and it usually goes away after the event or situation is over. However, anxiety may or may not be tied to something specific—and unlike stress, it sticks around.

While they’re different experiences, stress and anxiety often go hand in hand, and stressful situations can trigger anxiety.

Depression vs. anxiety

Our awareness and understanding of anxiety and depression have increased dramatically in recent years. These two terms also aren’t interchangeable. Anxiety disorders and depression are different mental health conditions. They share some symptoms—and you can be diagnosed with both at once—but it’s important to understand how they diverge.

Both types of disorder involve overwhelming feelings that can seem permanent. But their emotional foundations are different. Fear and worry are at the heart of anxiety disorders, while hopelessness and sadness are at the heart of depression.

Anxiety symptoms

Physical symptoms

• Rapid heart rate and/or heart palpitations
• Difficulty breathing
• Dry mouth
• Shakiness or dizziness
• Muscle tension
• Sweating
• Nausea or gastrointestinal problems
• Insomnia
• Restlessness

Mental symptoms

• Rumination
• Feelings of dread or doom
• Difficulty concentrating
• Irritability
• Avoidance of triggers (people, places, things, or situations) that worsen your anxiety symptoms

Types of anxiety

Generalized anxiety disorder (GAD)

If you have GAD, you struggle with constant worry for at least half the year, mainly about ordinary parts of life. Instead of having a specific focus for your anxiety, you feel anxious about many things at once—work, school, relationships, money, health. Anxiety may seem to seep into every aspect of your life.

Panic disorder

If you have panic disorder, you have panic attacks: short episodes of excessive anxiety and fear that come and go quickly but are often hard to shake. You may have additional anxiety about when the next panic attack will strike.

Symptoms of a panic attack include:

• Difficulty breathing
• Rapid heart rate
• Heart palpitations
• Sweating
• Shaking
• Lightheadedness
• Dread
• Feeling a loss of control

Phobias

A phobia is a kind of anxiety disorder that causes specific, persistent anxiety. With a phobia, you have excessive or irrational fears about a specific person, place, thing, or situation. You’ll often go out of your way to avoid the cause of your fear in ways that disrupt your daily life.

Common phobias include:

• Agoraphobia: Fear of leaving your home, often centered around being trapped in crowds or public places
• Social anxiety (or “social phobia”): Fear of embarrassment or judgment in social situations
• Separation anxiety: Fear of being separated from a parent or parental figure
• Health anxiety: Fear of illness or poor health (formerly called “hypochondria”)
• Selective mutism: A child’s fear of speaking, even when they have the skills to do so
• Specific phobia: Intense fear about a specific object or situation (like heights, animals, or flying)

What causes anxiety?

The causes of anxiety can be divided into two categories: “risk factors” and “triggers.” Risk factors increase your likelihood of developing an anxiety disorder, and triggers contribute to specific episodes of anxiety or panic.

Risk factors for anxiety

• Genetics: If a relative has been diagnosed with anxiety, you’re more likely to develop an anxiety disorder as well.
• Trauma: Trauma can affect us physically and psychologically. You may suffer from panic attacks or other forms of anxiety after experiencing trauma.
• Substance abuse: The relationship between anxiety and substance abuse is a cycle. Increased substance abuse can cause anxiety, and anxiety disorder symptoms may push people toward substance abuse as a coping mechanism.
• Other health conditions: Medical conditions like hyperthyroidism and asthma can have similar symptoms as anxiety and panic. This may increase your likelihood for an anxiety disorder. In addition, dealing with a serious health condition can be stressful or even traumatic, creating a greater risk for anxiety.

Triggers for anxiety

1. Stress: You may develop an anxiety disorder in response to ongoing high levels of stress in any area of your life: financial, professional, or relational.
2. Caffeine: Because it’s a stimulant, caffeine can speed up your heart rate and cause shakiness, insomnia, and gastrointestinal problems. This may worsen anxiety symptoms and trigger anxiety or panic.
3. Not eating regularly or not eating enough: Skipping meals or restricting your food intake can cause lightheadedness, shakiness, and gastrointestinal problems, contributing to anxiety symptoms.
4. Social events: If you suffer from social anxiety or agoraphobia, social situations may trigger a panic attack.
5. Lack of sleep or trouble sleeping (insomnia): Not getting enough sleep can increase your stress levels and worsen anxiety symptoms like irritability, difficulty concentrating, and muscle tension.
6. Life transitions: Even happy transitions like having a baby, starting a new job, or starting a new relationship can bring stress and trigger your anxiety.
7. Health problems: Health issues can cause a great deal of stress, which can trigger anxiety. If a loved one suffers from a health problem, your anxiety may increase as well.

How do I know if I have anxiety?

Everyone experiences anxiety at some point in their life. If you think you may have an anxiety disorder, there are steps you can take to know for certain:

• Keep track of your symptoms: When you feel anxious, write down what you’re experiencing. Try to pinpoint the cause of your feelings—even if that cause is something ordinary, it’s helpful to write it down. By keeping track of your symptoms and triggers, you can capture crucial information that will help a medical professional give you a more accurate diagnosis.
• Ask your doctor: An online anxiety quiz won’t provide an accurate assessment of your mental health. Only a medical professional can give you a diagnosis. Schedule an appointment with your primary care doctor and share your concerns with them.
• See a therapist: Your doctor can give you a referral to a therapist, or you can look for one on your own. A therapist can give you a professional diagnosis and offer treatment for your anxiety disorder.

Related disorders

It’s fairly common to be diagnosed with another disorder alongside anxiety, and you may develop anxiety in response to trauma or other mental health disorders.

Disorders related to anxiety include:

• Depression
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Addiction

How to treat anxiety

Most long-term anxiety treatment plans include psychotherapy (also called “talk therapy”), medication, or a combination of both. There are also steps you can take in the moment to treat acute anxiety symptoms or even a panic attack.

Psychotherapy

These types of psychotherapy can help treat anxiety disorders:

Cognitive behavioral therapy (CBT)

CBT is the most common and successful kind of talk therapy for anxiety disorders. It helps you identify and challenge unhelpful thoughts or beliefs that feed your anxious behavior, so you can develop healthier patterns of thinking. This change in thinking (“cognition”) ultimately leads to a change in how you live your life (“behavior”).

Exposure therapy

Exposure therapy is another method of treating phobias and other anxiety disorders. In this type of treatment, you confront your fear in one of four ways:

• Direct, physical exposure
• Imaginary exposure
• Virtual reality exposure
• Sensation-based exposure

The key to exposure therapy is that it’s a safe experience guided by your therapist. Many people mistakenly think exposure therapy relies on tricks or deceit to put someone in situations they’re afraid of. This isn’t the case.

The goal of exposure therapy isn’t to force you into a situation so you can “get over it” quickly, but to gradually expose you to your fears so you can learn that those fears are misplaced. With time and repeated exposure, you learn to stop avoiding your fears and can improve your quality of life.

Mindfulness

Your therapist may teach you mindfulness techniques alongside other forms of talk therapy to help reduce anxiety symptoms. Mindfulness teaches you to focus without judgment on the current moment instead of thinking deeply about the past or worrying about the future. In mindfulness, you also focus on any of your physical senses—sight, smell, touch, sound, or taste—to help calm your mind.

If professional help isn’t available to you at this time, mindfulness apps like Calm can be a good short-term option.

Anxiety disorder medications

If you have an anxiety disorder, your doctor may prescribe medication. These medications can reduce the intensity and frequency of your symptoms.

Your anxiety medication will likely be for one of two things:

• Short-term relief of current symptoms (medications include benzodiazepines, sedatives, beta blockers, etc.)
• Long-term symptom management (medications include antidepressants, buspirone, etc.)

Self-care steps for anxiety and panic

In addition to getting help from a health care professional, you can take these steps on your own to try to decrease anxiety or panic in the moment:

• Breathe deeply: Take a deep breath in. Slowly let it out. You may find it helpful to count—for instance, breathing in for four seconds, holding your breath for four seconds, and breathing out for eight seconds.
• Limit stimuli: Close your eyes. Find a quiet place.
• Practice mindfulness: Check in with your five senses. Clear your mind and allow yourself to notice what you’re feeling without judging it. Meditate. Introduce soothing sensations, such as relaxing smells or soft candlelight.
• Go for a walk: Our bodies respond positively to exercise and motion, as well as being in nature. If you can, take a walk outside.
• Tell a friend: Panic attacks often leave us feeling scared and alone. Talking with a friend or family member can help you remember this truth: You are not alone, and you are loved.

Get help now

If you’re struggling with anxiety, browse our directory to find a specialist in your area—or learn how to choose a therapist who’s right for you.

If you’re in crisis, help is available now. For free, confidential 24/7 support, call or text the 988 Lifeline at 988.

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What is rumination?

Rumination is more than just overthinking. It’s a specific pattern where you repeatedly focus on distress or negative events, dwelling on their causes and consequences.¹

Rumination is challenging because it has the power to keep you stuck. This happens because you’re repeatedly reprocessing negative information, magnifying negative emotions instead of creating actionable plans. For example, instead of thinking “I’ll apologize to my friend tomorrow,” you might get stuck on the thought “I’m a terrible person for how I behaved.”

Brooding vs. reflection

While rumination can be harmful, research shows this isn’t always the case. It’s considered a “multidimensional construct” with both helpful and unhelpful parts.² When rumination is discussed as problematic, it’s likely the “brooding” aspect that people are referring to.

Brooding is the unhelpful component of rumination. It involves “a passive comparison of one’s current situation with some unachieved standard.” Brooding involves asking questions like “Why did this happen to me and not others?” Studies show brooding is a significant predictor of worse treatment outcomes for depression, especially among women.³

Reflection, on the other hand, is described as “a purposeful turning inward to engage in problem-solving.”⁴ Rather than passively dwelling on problems, it involves actively thinking about what you can learn from an experience. Studies on trauma survivors found that deliberate, reflective rumination was associated with posttraumatic growth rather than distress.⁵ This type of thinking helps you process experiences and move forward.

The key difference: Brooding keeps you stuck in passive comparison and self-blame (“why me?”) while reflection involves active problem-solving (“what can I learn?”). Unfortunately, people often believe they’re engaging in reflection when they’re actually brooding. Learning to accurately recognize and change which type you’re engaging in can help you shift toward more helpful thinking patterns.

Rumination vs. worry

While rumination and worry might seem similar, they have a key difference. Worry focuses on future uncertainty and anticipated threats, while rumination focuses on past and present negative events.⁶

Thinking “What if I fail my exam next week?” is a form of worrying. Thinking “Why did I embarrass myself at that party last month?” is a form of rumination.

Both can be problematic, but understanding which pattern you’re experiencing can help you address it more effectively.

Signs of rumination

Like other forms of repetitive negative thinking (RNT), ruminative thinking is typically:⁷

• Intrusive
• Difficult to disengage from
• Feels unproductive
• Captures your mental capacity

People who ruminate report being likely to do so late at night or in bed, which can seriously disrupt sleep.⁸ This quiet time without distraction can be a tempting time to replay and unpack the events of the day, but it’s easy for thoughts to get out of hand.

If you’re struggling with rumination and are having trouble managing it on your own, you might benefit from professional help. A licensed therapist can help you identify these patterns and develop healthier ways of thinking.

What causes rumination?

Certain situations and experiences are more likely to be the subject of rumination. Research on people experiencing rumination found they most commonly think about:⁹

• Personal relationships
• Past mistakes
• Past negative experiences
• Past conversations

Some people are more vulnerable to developing rumination patterns. Risk factors include early adversity like childhood abuse, interpersonal stress, and unsupportive or overly controlling parenting styles.¹⁰ It’s unclear exactly what mechanisms make this the case, but it may be that certain experiences lead people to respond more passively, and internally, to problems.

The good news is rumination is a learned pattern, which means it can be unlearned with the right support and strategies.

How rumination affects the brain and body

Effects on mental health

Research shows that rumination can worsen mental health problems by magnifying negative moods, interfering with problem-solving, lowering confidence in plans, and affecting concentration.¹¹

If someone is prone to ruminating, it increases the likelihood that they’ll experience future depressive episodes.¹² There’s also a strong relationship between rumination and depression severity, meaning the more someone ruminates, the more severe their depression tends to be.¹³

Though much of the research on rumination focuses on its relationship with depression, several other mental conditions are linked to it. Rumination is what researchers call a “transdiagnostic feature.”¹⁴ This means it appears across many different mental health conditions, including:

• Generalized anxiety disorder
• Social anxiety disorder
• Eating disorders
• Posttraumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Rumination also affects sleep. In students with symptoms of generalized anxiety disorder, rumination significantly correlated with sleep difficulties. Over half the students experienced sleep problems, with rumination playing a large mediating role in the relationship between metacognition and sleep quality.¹⁵

Effects on physical health

The effects of rumination aren’t just mental; they’re physical too. When people ruminate habitually, it predicts decreased physical health and well-being.¹⁶

Rumination is associated with elevated cortisol responses and harmful effects on blood pressure.¹⁷ Essentially, ruminating on a stressor you experienced in the past may extend your body’s cortisol stress response. This suggests that chronic rumination can trigger your body’s stress response repeatedly, potentially contributing to long-term health problems.

Rumination also affects how you experience pain. Studies show that people who ruminate more tend to report greater pain and distress.¹⁸ In fact, one study found that rumination was the only psychological factor that significantly predicted pain immediately following surgery. It’s also been linked to higher pain levels in chronic conditions like back pain and fibromyalgia, as well as greater likelihood of disability in chronic pain patients.

Strategies to reduce and manage rumination

Cognitive behavioral therapy (CBT)

Rumination-focused cognitive behavioral therapy (RFCBT) uses functional analysis to identify what triggers your rumination and teaches you to respond differently. Clients are taught to think of rumination as a habit that can be identified and changed. In the course of treatment, they’re given the tools they need to develop more effective styles of processing and responding.

One small study exploring RFCBT suggests it can be very effective in resolving depressive symptoms.¹⁹ It also significantly reduced both rumination and worry during and following treatment.

Mindfulness-based cognitive therapy (MBCT) helps reduce rigid, repetitive thinking by redirecting attention from thoughts to conscious bodily experiences.²⁰ Instead of getting caught up in questioning the past, mindfulness helps you focus on the present moment.

Research shows that when people practice mindfulness, rumination becomes less associated with increased negative emotions.²¹ This means mindfulness likely acts as a buffer, protecting you from harmful effects even when ruminative thoughts appear.

Lifestyle changes

Simple changes in your daily life can make a big difference. Consider trying the following:

Distract yourself. One study showed distraction was the most common coping strategy that people found helpful.²² Almost half of the participants found intentionally distracting themselves, especially by doing activities such as exercise, was effective for them.

Spend time in nature. Getting outside in green spaces can genuinely help quiet your mind. In one study, a 90-minute nature walk was shown to decrease self-reported rumination compared to a walk of the same length in an urban area.²³

Connect with friends and family. When you’re ruminating, reaching out to a friend might be more helpful than you realize. In one study, 83% of participants reported less rumination when around others, suggesting that social support offers real protection against negative thinking patterns.²⁴

Working with a mental health professional

If rumination is interfering with your daily life, professional help can make a significant difference. Remember that you don’t need to reach a certain threshold of inconvenience or pain to justify involving a professional in your care.

A qualified mental health professional can help you understand your unique patterns and develop personalized strategies to break the cycle. Visit our therapist directory to find one online or in your area.

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ARFID stands for “avoidant/restrictive food intake disorder.” It’s a feeding and eating disorder in which a person avoids certain foods or has extreme limits on what they eat. Typically, this avoidance is not part of an effort to lose weight or change their body shape, but because they lack interest in food or are very sensitive to its taste, texture, or smell.

There are four ARFID types, which include:¹

1. Fearful: Characterized by a fear of negative food-related consequences such as choking, vomiting, or allergic reactions, leading to food avoidance.
2. Sensory: Avoiding foods based on texture, taste, or smell, often leading to a very limited diet.
3. Lack of interest: Showing little to no interest in eating or food.
4. Combination: The most common subtype, featuring some mixture of fearful, sensory, or lack-of-interest motivations.

ARFID in children vs. adults

ARFID is much more commonly diagnosed in children. Studies have shown that the prevalence of ARFID in children and adolescents can be as high as 18%, compared to the 0.3% to 2% occurrence rate of ARFID in adults.²

ARFID vs. picky eating

While “picky eating” might be considered a normal phase that most children pass through, ARFID is much more severe and persistent. Picky eaters might gradually expand their diet over time, but individuals with ARFID often have a very limited range of accepted foods, severely impacting their nutritional intake.

Additionally, “picky eaters” may choose to avoid certain foods because they don’t enjoy them. But people with ARFID avoid food to an extreme degree and may do so out of fear, sensory issues, a complete disinterest in food, or any combination of these reasons.

How is ARFID different from other eating disorders?

When it comes to ARFID, the motivations behind food avoidance are distinctly different from those of other eating disorders. While anorexia and bulimia are typically driven by body image concerns, ARFID is not. Instead, ARFID patients often fear either the physical act of eating or food itself.

Some people who struggle with eating disorders or disordered eating habits also engage in compensatory behaviors such as excessive exercising or laxative use. Those with ARFID, however, typically don’t. They often experience anxiety or stress around food in a different way.

ARFID symptoms

ARFID can be tricky to identify because its symptoms often overlap with those of other conditions and can be mistaken for simple picky eating.

Common symptoms of ARFID include:³

• Dramatic weight loss, or a lack of normal weight gain in children
• Notable levels of malnutrition
• Needing nutritional supplements or even tube feeding to meet dietary requirements
• Digestive issues, such as stomach pain or constipation
• Distorted or absent hunger cues
• Avoidance of social situations involving food, like family meals or birthday parties
• Significant interference with normal daily functioning and development
• Extreme sensitivity to food textures, tastes, or smells

ARFID causes

Researchers don’t know exactly what causes ARFID, but it’s believed that biology plays a big role. Some suggest that ARFID has three main causes:⁴

1. Heightened sensitivity to the taste, texture, smell, or appearance of certain foods.
2. Issues with natural appetite.
3. Increased fear responsiveness, in which the idea of choking or vomiting leads to a fear of eating certain foods.

Mental health conditions like anxiety, obsessive-compulsive disorder (OCD), attention/deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) often cooccur with ARFID.⁵ Likewise, certain physical health conditions or allergies could contribute to the development of ARFID.⁶

A health care professional can provide a thorough assessment to determine if a person has an underlying condition that may be contributing to ARFID symptoms. A mental health professional can help determine is other mental health conditions are playing a role or worsening symptoms.

The impact of ARFID on well-being

ARFID can cause significant weight loss, nutritional deficiencies, and impaired growth and development, including delays in puberty and stunted growth.⁷ People with ARFID often suffer from weaker bones and conditions like iron deficiency anemia, leading to fatigue. Many are dependent on tube feeding or nutritional supplement drinks.

The health impacts of ARFID can be as severe as other eating disorders, sometimes requiring hospitalization. In fact, a study found that nearly one-third of ARFID patients needed hospitalization for medical reasons.⁸

In addition to the severe physical health consequences, ARFID can also have profound effects on a person’s mental health. Individuals with ARFID often experience intense anxiety around food and eating situations, which can lead to social isolation and negatively impact their quality of life. The stress associated with managing the disorder can also result in emotional distress and depression.

ARFID diagnosis and treatment options

ARFID is a relatively new diagnosis that was introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Many people, including some healthcare providers, might not be fully familiar with it. There are four main ARFID diagnostic criteria that must be met:⁹

1. There’s a noticeable problem with eating or feeding, which leads to at least one of the following:

• Significant weight loss
• Major nutritional deficiencies
• Dependence on tube feeding or nutritional supplements
• Significant impact on social functioning

2. The eating issues are not due to religious or cultural practices or a lack of available food.

3. The eating problem is not a result of another eating disorder, indicated by there being no concerns about body image or weight.

4. The eating problem is not better explained by another medical or psychiatric condition.

Children and teens with ARFID can show one or more of these features. They might be of normal weight, overweight, or underweight.

Treatment for ARFID may include a combination of medications and therapies to address the various aspects of the disorder.

Medication for ARFID

There isn’t much research on using medication for ARFID treatment. However, one small study suggests that low doses of an antipsychotic drug could help when combined with other treatments.¹⁰ Medications may be an effective part of a treatment plan for ARFID someday, but more time and research is needed.

Therapy for ARFID

Therapy has been used as a form of treatment for eating disorders for decades. In particular, cognitive behavioral therapy (CBT) and family-based therapy are known to help children and teens with eating disorders improve.^11,12

A new type of CBT specifically for ARFID (CBT-AR) is currently being studied, which lasts six to 12 months and includes family or individual sessions.¹³ It focuses on improving nutrition and slowly exposing patients to different foods.

Visit our directory to connect with a licensed mental health professional in your area who can help you develop a treatment plan. If you suspect that you or someone you know could have a feeding or eating disorder, immediate help is available. Call the National Alliance for Eating Disorders helpline at 866-662-1235 to speak with a licensed therapist (available Monday through Friday, 9 a.m. to 7 p.m. EST).

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