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.

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“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.

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 the symptoms 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 compulsive behaviors and problematic patterns related to pornography. 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.

Despite lacking a DSM diagnosis, research suggests it shares many 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 problematic can help you recognize when you need help. The symptoms of porn addiction can affect your mental health, relationships, and daily life in significant ways.

Porn addiction symptoms

Experts have identified several core symptoms that characterize problematic pornography use (PPU).³ These symptoms help distinguish between casual use and use that’s become problematic.

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

The good news is that effective treatments exist for pornography addiction. If you’re wondering how to stop porn addiction symptoms, there are approaches that can help.

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.

Abstinence and “rebooting”

Some people find success with complete abstinence from pornography, informally known as “rebooting.” While this approach is difficult, one study showed it can be achievable with the right strategies:¹⁵

• Cognitive strategies like meditation
• Behavioral strategies like exercise and healthier sleep
• Social support from trusted friends, family, or support groups
• Developing alternative coping strategies
• Setting clear goals and tracking progress

This approach may be a fit for some people, but it doesn’t address the underlying processes that led to the behavior. It also doesn’t offer structured support, which many people need when making meaningful, sustained changes in their lives.

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.

The post Porn addiction symptoms and treatment options 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. 

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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.

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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.

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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.

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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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Autism spectrum disorder (ASD) symptoms tend to start occurring in early childhood, often between six and 18 months of age.¹ It’s a lifelong condition, meaning the signs and symptoms of autism continue throughout a person’s lifetime.

ASD symptoms can present differently from person to person and be affected by their age, gender, and a variety of other factors. If you believe you or someone you know may have autism, it’s important to speak with a licensed mental health professional or doctor to receive an official diagnosis.

Signs of autism in children

The Centers for Disease Control and Prevention (CDC) estimates that one in every 36 children in the United States has ASD.² While it affects people of every demographic, boys are four times more likely to be diagnosed than girls. This doesn’t necessarily mean autism in girls is less common, but rather that it may present differently and go undiagnosed more often.

Signs of autism in babies can also occur. Autism is a developmental condition, so it’s important to watch for any missed milestones as a baby develops.

Early signs of autism in toddlers and young children include: 

• Avoiding eye contact
• Disliking being held or cuddled
• Not responding when spoken to, but still hearing and responding to other noises
• Repeating words, phrases, or actions
• Not playing “pretend”
• Learning skills and then losing them
• Struggling with changes to routine
• Difficulty in social situations

Signs of autism in adults

Some people don’t receive an autism diagnosis until adulthood. They may have received a different or less accurate diagnosis in childhood, or they may have never received a diagnosis of any sort. Factors that could delay diagnosis until adulthood include the high cost and wait times for diagnostic services, as well as a lack of ASD-specific awareness in some healthcare settings.³

Because autism is a developmentally focused, it can be difficult to diagnose in adults. Children with ASD miss developmental milestones or arrive at them later than usual. Adults can’t be assessed in this way because their milestones were reached or missed long ago. 

Additionally, in adulthood autism symptoms can overlap with symptoms of mental health conditions like anxiety or attention-deficit/hyperactivity disorder (ADHD). It’s important not to try and self-diagnose ASD because its adult symptoms can be difficult to separate from other conditions. A doctor or mental health professional can offer a professional diagnosis. 

ASD symptoms in adults include: 

• Missing social cues
• Avoiding eye contact
• Difficulty reading body language
• Misunderstanding figures of speech
• Struggling with changes to routine
• Feeling overstimulated
• Deeply studying one or two topics or skills
• Engaging in repetitive, self-stimulating habits (“stimming”)

What is stimming?

Stimming is engaging in a repetitive, self-stimulating behavior as a way of self-soothing or expressing stressful emotions. We all engage in some form of stimming at some point. You may bite your nails or jiggle your foot during a test, pace around before a presentation, drum your fingers on a table in a meeting, or twirl your hair during a first date.

With ASD, stimming may be more obvious, or it may be harder to control. Common stimming behaviors for people with ASD include rocking, bouncing, rubbing, scratching, staring, snapping fingers, or repeating certain words or phrases. 

If you suspect that you or a loved one may have ASD, it’s important to seek a professional evaluation. A doctor or therapist can assess symptoms and provide an accurate diagnosis, as well as recommend appropriate treatment options.

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When you think about therapy, you might picture quiet offices and formal talks. But in reality, every client-therapist relationship is unique, and not all types of therapy look the same. Finding the right therapist, and the right style of therapy, may be the most important step you can take towards mental health.

Mental health professionals use different approaches to meet specific needs. Some methods may be more effective than others in treating certain conditions. Here are some common types of therapy to begin your search.

Evidence-based behavioral therapies

• Cognitive behavioral therapy (CBT) focuses on modifying thought patterns and behaviors
• Dialectical behavioral therapy (DBT) teaches skills for emotion regulation and distress tolerance
• Exposure therapy helps clients overcome specific fears and phobias
• Rational emotive behavior therapy (REBT) focuses on changing “irrational” beliefs

Trauma-focused therapies

• Eye movement desensitization and reprocessing (EMDR) helps people process trauma through guided eye movements
• Racial trauma specialists help heal from race-based traumatic stress (RBTS)
• Brainspotting therapists process trauma through fixed eye positions
• Internal Family Systems (IFS) therapy focuses on the different parts of the personality, including those shaped by trauma

Mind-body approaches

• Somatic therapists help explore the connection between mind and body and how one’s health affects the other
• Biofeedback practitioners use technology to help clients control their physical responses to stress, anxiety, and other challenges
• Mindfulness-based stress reduction (MBSR) is a program that teaches meditation and awareness practices
• Certified hypnotherapists use guided relaxation techniques to address problems and work toward goals

Creative and expressive therapies

• Art therapists use visual arts to help clients process emotions and experiences
• Music therapists facilitate healing through musical expression and rhythm work
• Dance/movement therapists guide emotional healing through body movement
• Drama therapists use role-play and storytelling for personal growth
• Play therapists work with children through structured play activities

Cultural and identity-focused approaches

• Multicultural therapy specialists address mental health through cultural perspectives
• LGBTQIA+ affirming therapists provide identity-affirming care
• Liberation psychologists work with marginalized communities to address systemic impacts on mental health

Specialized population therapies

• Geriatric specialists focus on mental health concerns of older adults
• Addiction specialists work with substance use and behavioral addictions
• Eating disorder specialists treat various types of disordered eating

When choosing a specialized therapist, be sure to check their credentials and confirm that your insurance will cover them. During your first meeting, discuss their experience and whether they coordinate with other providers if needed.

Visit our directory to find qualified mental health professionals in your area. You can filter results by therapist specialties, services offered, therapeutic approaches, insurance acceptance, and more.

Visit the following pages to learn more about different approaches to therapy:

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In the 1950s, psychologist John Bowlby began developing attachment theory—the theory that our bonds with our primary caregivers shape our lifelong emotional and social development.¹ As humans evolved, he suggested, we developed an instinctive need to seek out our caregivers in times of danger or stress. Bowlby called the actions we use to look for this connection, such as crying out for or clinging to a caregiver, “attachment behaviors.”

Psychologist Mary Ainsworth expanded on attachment theory in the 1970s with a famous experiment called the strange situation procedure.² In this experiment, babies were separated from their caregivers for short periods of time, then reunited. Ainsworth and her team observed the infants’ reactions and noticed some distinct differences. From the study results, Ainsworth proposed that infants develop one of several styles of attachment based on their experiences with their primary caregivers.

What are the four styles of attachment?

When a baby’s attachment behaviors get a consistent, competent response—meaning a primary caregiver meets their needs with physical care, communication, or affection—the child begins to think of their caregiver as a safe base for exploring the world. This stable relationship results in a secure attachment style. However, if the child’s needs are met inconsistently or unpredictably, they may develop one of several insecure attachment styles: anxious, avoidant, or disorganized.

As we grow up, our attachment styles can affect how we behave in other close relationships, such as friendships or romantic partnerships. While it’s possible for attachment styles to change as we age, research shows that our early attachment experiences can contribute to emotional or psychological challenges later in life.^{3, 4}

It’s important to note that it’s not your fault if you don’t have a secure attachment style. It can also help to remember that most parents don’t set out to fail their kids, and there’s no such thing as a perfectly understanding and responsive caregiver. Parents usually don’t know that they’re modeling their own insecure attachment styles for their children. If you’d like to explore your own attachment style with the help of a therapist, browse our directory to find a licensed provider near you.

Secure attachment

Secure attachment develops when an infant knows their primary caregiver will provide comfort, understanding, and safety consistently in times of stress. Kids with secure attachment turn to their caregivers when something frightening happens. They’re also able to separate from their caregivers without much anxiety—they feel confident that the people they’re attached to will come back.

Securely attached young people tend to form close relationships with others and experience less loneliness.⁵ As adults, they generally form positive relationships based on trust and vulnerability. Because of the consistency they were shown when they first began forming attachments, they continue to expect their efforts in relationships will be returned.

Anxious attachment

Anxious attachment, also known as ambivalent attachment, develops when children form worried, insecure patterns of interacting after getting inconsistent care from their primary caregivers. As with all attachment styles, these patterns can carry over to other relationships.

Anxiously attached kids are more likely to be nervous about going to school and getting to know their classmates.⁶ Adults with an anxious attachment style may come across as clingy and as spending too much time and energy worrying about their relationships. For instance, they might overanalyze conversations or a partner’s expressions, looking for problems even when there aren’t any.⁷

Avoidant attachment

Children with avoidant attachment have learned that their primary caregiver can’t meet their needs reliably, so they rely on themselves instead.

Adults with avoidant attachment styles may seem like they don’t care about their relationships. They dislike depending on others and don’t want others to depend on them. They may struggle to be vulnerable or intimate in relationships, which can lead to less satisfaction, less connection, and a general lack of support.⁸

Disorganized attachment

Disorganized attachment was recognized as an attachment style several years after the original strange situation study. Researchers noticed that some children responded to reunions with their caregivers in unpredictable ways that combined elements of anxious and avoidant attachment.⁹ Some kids acted as though they wanted to punish their caregivers for abandoning them, while others seemed fearful or conflicted. Some even took on the caregiver role themselves, comforting their parents.

As they grow, children with disorganized attachment may struggle with hostile or oppositional behavior. Adults with disorganized attachment can find relationships confusing, scary, or unpredictable. While they may crave intimacy, they’re not confident their partners will return their efforts.

Attachment disorders and difficulties

Insecure attachment styles and other problems with attachment are often grouped together as “attachment difficulties.” Attachment difficulties are common, and they can be treated with attachment-based therapy—where a therapist creates a secure, trusting bond with a client and addresses patterns that stem from the client’s early attachment experiences.

Separate from attachment difficulties are attachment disorders, two specific and rare conditions recognized by the American Psychiatric Association’s diagnostic manual, the DSM-5.¹⁰

• Reactive attachment disorder (RAD): Children with RAD avoid adults because of past negative experiences such as abuse, neglect, or trauma. They rely on themselves for comfort when they’re under stress, even as they struggle to regulate their emotions. They have difficulty expressing positive feelings like joy.¹¹ They struggle to accept comfort and may react violently when held.
• Disinhibited social engagement disorder (DSED): Children with DSED have usually experienced neglect. As a result, they seek care and affection from all adults, even total strangers.¹² They show little to no preference for their caregivers and will willingly leave them—but they’re overly friendly with strangers, often putting themselves in vulnerable or risky situations. 

Attachment disorders don’t appear often and can improve over time. Family therapy, attachment-based therapy, or individual therapy for both children and caregivers can help.

It’s important to remember that attachment issues aren’t the only source of problems with intimacy and connection. If you’re struggling with anxiety around your relationships, talking to a therapist can help you uncover the root of the problem. Browse our directory to find a licensed mental health professional near you today.

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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 the grey rock method?

The grey rock method (or “grey rocking”) is a technique to manage interactions with narcissists and other difficult people. The idea is to intentionally become unresponsive, bland, and uninteresting—like a grey rock. The goal is to make interacting with you feel dull and unsatisfying so that the difficult person loses interest.

The grey rock method has gained popularity in self-help communities as a practical strategy for dealing with toxic relationships. However, it’s not an official term used in clinical psychology.

Benefits of grey rocking

The grey rock method is essentially a tool for setting boundaries. It can help you:

• Regain control by depriving someone of the emotional reactions they seek
• Protect your emotional well-being by limiting exposure to manipulative behavior, drama, and conflict
• Reduce stress and anxiety when dealing with difficult people

How the grey rock method works

The grey rock method isn’t an official therapeutic technique, so there’s no official procedure for using it. Generally, though, it involves a few key communication strategies. Here are several grey rock method examples:

• Keeping interactions brief and to the point
• Using a neutral tone of voice and facial expression
• Avoiding eye contact
• Giving short, non-descriptive responses
• Keeping calm and emotionally detached
• Not explaining or defending yourself

A person could exhibit any of these behaviors for many reasons. But if they do it with the intention of keeping a narcissistic, unpleasant, or even abusive person at bay, it could be considered grey rocking.

Setting yourself up for success

The grey rock method is simple enough to understand. But employing it consistently can be challenging, especially if the difficult person is persistent. It requires self-discipline and emotional control to maintain the grey rock persona, especially in high-stress situations.

With time and practice, these responses can become more natural. It may become easier to navigate interactions without getting pulled into conflict or emotional turmoil.

Here are some practical tips to help you effectively implement the grey rock method:

• Practice mindfulness. Stay aware of your emotional reactions and maintain control over them.
• Get clear on what your boundaries are. Ask yourself what is acceptable and what isn’t in your interactions.
• Prepare responses in advance. Think about common scenarios and plan neutral responses.
• Seek support. Talk to a trusted friend or therapist about your experiences.
• Take breaks. Give yourself time away from the difficult person to recharge.

Using the grey rock method may help you avoid unpleasant interactions with difficult people. But if someone’s treatment of you crosses the line into abuse, it’s important to seek professional help. You can get free, confidential help 24/7 by calling the National Domestic Violence Hotline at 1-800-799-SAFE (7233).

When to use the grey rock method

The grey rock method is a fairly new concept, and so it has not been widely tested. But in theory, this approach could be useful when:

• Dealing with narcissists or anyone exhibiting manipulative or attention-seeking behaviors
• Avoiding the person altogether is not possible, such as with coworkers or family members
• A person tries to continuously pry into your personal life and you want to maintain your boundaries
• You want to minimize the possibility of conflict or escalation

How effective is the grey rock method?

Currently, no scientific research specifically supports the grey rock method. However, grey rocking could be viewed as a form of emotional detachment. Emotional detachment has been more widely researched and show to have certain benefits. For instance, research shows that in certain contexts, practicing emotional detachment can reduce emotional exhaustion, lessening depressive symptoms.¹

In general, the grey rock method may be an effective short-term strategy for casual or infrequent relationships. Coworkers, acquaintances, or distant family members may respond well. It may be less effective when used in close or long-term relationships.

When shouldn’t you use the grey rock method?

In long-term relationships, using the grey rock method can be emotionally draining and may not be sustainable. It could provide temporary relief while you explore other strategies and support systems. But it isn’t a long-term solution or a healthy form of communication for partners.

It can be hard to deter people with severe narcissistic or manipulative tendencies. When confronted with the grey rock method, they might escalate their behavior to regain control. In cases like these, it’s best to seek external help.

If someone’s treatment of you crosses the line into abuse, seek immediate help. You can get free, confidential support 24/7 by calling the National Domestic Violence Hotline at 1-800-799-SAFE (7233).

Alternatives to the grey rock method

There are many strategies for dealing with manipulative people. A handful of other methods include:

Assertive communication: Use clear, direct language to express your needs and set boundaries without aggression. This form of conflict can be difficult for some people, but may be better in the long term.

No contact: In some cases, it may make sense tocompletely cut off communication with a manipulative person in order to protect your mental health.

Mediation: In situations where ongoing interaction is necessary involving a neutral third party to mediate can help the relationship.

Therapy: Consider speaking with a mental health professional to develop personalized strategies and gain additional support. Visit our directory to find a provider in your area.

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Posttraumatic stress disorder (PTSD) is a mental health disorder that can develop after you witness or experience trauma. Trauma is an emotional response to a terrifying or disturbing event, relationship, or circumstance that threatens or harms your physical, mental, or emotional health and safety. Traumatic events are surprisingly common: In a global survey of nearly 70,000 adults, more than 70% of respondents reported having experienced one.¹

Trauma has existed throughout history, but it wasn’t until 1980 that the American Psychological Association (APA) added the term “PTSD” to the third edition of its diagnostic manual, known as the DSM. The APA made this change partly in response to veterans returning from the Vietnam War with a history of trauma—but the new diagnosis covered trauma of all kinds, not just the kind experienced on the battlefield.

Anyone who has experienced trauma can be diagnosed with PTSD, even if they’ve never served in the military or experienced warfare. Research suggests that approximately 6% of people in the US will have PTSD at some point—but not everyone who experiences or witnesses trauma will develop it.²

What causes PTSD?

As the term “posttraumatic” indicates, PTSD develops after someone experiences or witnesses trauma. This sets the disorder apart from other mental health conditions that don’t need an identifiable cause for a diagnosis.

Symptoms of PTSD

To be diagnosed with PTSD following trauma, you must have the following four symptoms for at least a month, and they must affect your ability to function.

1. Intrusive memories: With PTSD, you unwillingly remember or reexperience your trauma in distressing memories, flashbacks, or nightmares.
2. Avoidance: With PTSD, you try hard to avoid “triggers”—situations, people, places, thoughts, or memories associated with your trauma.
3. Cognition/mood changes: PTSD changes the way you think and feel. You may struggle to remember things, even information that isn’t related to your trauma. And you may experience feelings of hopelessness, numbness, or detachment.
4. Arousal/reactivity: With PTSD, you often feel constantly on guard. This state is called “hypervigilance,” and it can cause insomnia, irritability, anxiety, rapid heartbeat, and muscle tension. You may also respond to stress with irritability, intense guilt and shame, or angry outbursts.

How do PTSD triggers work?

If you have PTSD, certain triggers—sights, smells, sounds, or situations—may remind you of your trauma and cause overwhelming physical or emotional responses (like rapid heartbeat, difficulty breathing, or flashbacks). Your triggers will depend on the trauma you experienced; for example, if you were seriously injured in a car accident, driving may trigger PTSD symptoms.

PTSD triggers don’t have to last forever. Many people learn how to overcome their triggers with professional treatment. Types of therapy that have proven effective for treating PTSD include cognitive behavioral therapy (CBT), exposure therapy, and eye movement desensitization and reprocessing (EMDR). Learn more under “PTSD treatment,” below.

How do you know if you have PTSD?

The only way to be certain you have PTSD is to receive a diagnosis from a mental health professional.

Reactions to trauma

We don’t all respond in the same way after experiencing trauma. Different reactions include:

• Normal stress response: After an isolated stressor or traumatic event, you may experience symptoms related to the body’s “fight-or-flight” response—like anxiety, increased heart rate, or muscle tension. These effects typically fade shortly after the situation resolves.
• Acute stress disorder: The symptoms of acute stress disorder (ASD) are similar to PTSD’s—but unlike PTSD, ASD symptoms last for less than a month. If your symptoms continue, your diagnosis may be changed to posttraumatic stress disorder. While some people with ASD develop PTSD, many cases of ASD resolve on their own. (Note that ASD isn’t a type of PTSD, but a separate disorder.)
• Uncomplicated PTSD: With uncomplicated PTSD, you don’t struggle with additional mental health disorders at the same time. Because of this, your treatment focuses only on addressing your trauma-related symptoms.
• Comorbid PTSD: Some people with PTSD already struggle with a preexisting mental health disorder, such as anxiety or depression. Others develop a co-occurring mental health condition after they experience trauma. Some of the mental health disorders that happen most frequently alongside PTSD are major depression, anxiety, and substance use disorders.
• Complex PTSD: Some traumas are single events that affect us dramatically, like a car accident or a natural disaster. Other traumas take place over time, like an abusive relationship or a yearlong deployment to a war zone. If you’ve been through long-term trauma or multiple traumas, you may be diagnosed with complex PTSD.

“Big-T” trauma and “little-t” trauma

Many people wonder, “What counts as trauma?” We often reserve the word for extreme danger or acts of violence. But trauma is all about our response, not the specific events or circumstances themselves. More ordinary situations can still “count” as trauma.

It may be helpful to think about this wider definition in terms of “big-T” and “little-t” trauma. Big-T trauma covers extreme, terrifying, life-altering events and circumstances we already associate with the word “trauma,” such as:

• Sexual violence
• Physical abuse
• War
• Mass shootings
• Natural disasters
• Severe car accidents

“Little-t” trauma refers to distressing circumstances that are not life-threatening but can still produce a trauma response, like:

• Divorce and breakups
• Bullying
• Getting fired
• Unresolved relational conflict
• Financial or legal trouble

Multiple “little-t” traumas can end up affecting our mental health as much as one “big-T” trauma—and multiple “little-t” traumas over the course of a lifetime may result in PTSD.

Experiencing vs. witnessing trauma

It makes sense that if you directly experience trauma, you may develop PTSD. But even simply witnessing trauma can cause PTSD.

Trauma is our response to danger and threats, real or perceived. Even if you were completely safe from the trauma you witnessed, your body may still have reacted to a perceived threat.

First responders, who are tasked with responding to catastrophic events involving severe injury or death, may develop PTSD after witnessing trauma. Children who witness a parent’s violence toward another family member may develop PTSD, even if those children weren’t subject to physical abuse themselves. Even televised national disasters, such as 9/11 or a school shooting, can trigger a trauma response.

What if I don’t remember my trauma?

Trauma affects our cognition, which means you may struggle with memory problems after a traumatic event. You may block your memory of the trauma itself, or you may not even remember having gone through a trauma in the first place.

It’s okay if your memories of a traumatic event are fuzzy or unclear, or if you don’t remember the trauma at all. A therapist can help you unlock those memories safely so you can process them and integrate them into your sense of self.

PTSD treatment

PTSD is treatable, and many people with PTSD benefit greatly from treatment. Below are some of the many options for treating PTSD:

• Cognitive behavioral therapy (CBT) can help you identify and replace unhelpful thought patterns that fuel your emotions and behaviors. For example, people with PTSD often overestimate the likelihood of bad events happening, and CBT can help counter and address these patterns of thinking.
• Prolonged exposure therapy allows trauma survivors to relive their trauma in a safe, controlled environment. By confronting your memories and emotions head-on, you can gradually separate fear and anxiety from your traumatic experience and learn how to move forward.
• Eye movement desensitization and reprocessing (EMDR) therapy allows you to process traumatic memories you may have been blocking. It engages your eyes in a similar way to REM sleep, allowing you to access traumatic memories in a way that helps you make new connections. It can be particularly helpful in recovering memories after trauma.
• Medication may be prescribed, typically alongside other forms of treatment. Certain antidepressants may help ease some PTSD symptoms.
• Group therapy with people who’ve survived the same kind of trauma can be a source of support.
• Animal assistance from a service animal, therapy animal, or emotional support animal may help ease PTSD symptoms.

When should you seek professional help?

Therapy is a great treatment option for PTSD—and you can start going to therapy whenever you want, for whatever reason. It’s a good idea to look for help if you’re struggling with symptoms in the weeks or months after a traumatic event.

If you’re wondering if you have PTSD, you don’t have to figure out whether you meet a certain threshold of trauma or stress on your own. Instead, you can find a therapist with the skills and experience to help you process your memories and emotions—no matter what diagnosis you may or may not receive.

Find a local trauma-informed therapist near you in our provider directory.

Get help now

If you’re in crisis, help is available immediately:

• 988 Lifeline: Call or text 988
• Crisis Text Line: Text HOME to 741741
• Veterans Crisis Line: 1-800-273-8255, press 1, or send a text to 838255

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What is trauma?

Trauma is an emotional response to a horrifying, stressful, or dangerous event, relationship, or circumstance that threatens or harms a person’s health and safety. Most people will experience at least one form of trauma in their lifetime.

There are four types of trauma:

• Acute trauma develops in response to a single event (like a car accident, sexual assault, or natural disaster).
• Complex trauma develops in response to prolonged and repeated traumatic events (such as child abuse or neglect, domestic violence, or civil unrest).
• Secondary/vicarious trauma develops in response to witnessing someone else’s trauma (typical among therapists, first responders, health care providers, and so on).
• Generational trauma is passed down from one generation to the next, particularly when it’s experienced by a collective group (as in slavery or genocide).

Our trauma response usually occurs in three stages:

1. Emergency response
Right after a traumatic event, you may experience psychological shock, also called an “acute stress response.” In psychological shock, your body is overwhelmed with emotion, which can show up in a variety of physical symptoms. A rush of adrenaline may result in shakiness, a rapid heartbeat, difficulty breathing, nausea, and chest tightness. These symptoms represent your body’s fight-or-flight response—it’s getting ready for immediate action in order to survive.

More recently, researchers have expanded the idea of “fighting” (becoming aggressive or screaming) or “fleeing” (running away) to include two additional emergency responses: “freezing” (staying still, avoiding decisions, or feeling numb or disconnected) and “fawning”(trying to please others to avoid conflict).

2. Short-term processing
In the days and weeks following your trauma, you return to some sense of normalcy or routine. During this adjustment period, you may experience grief, stress, or flashbacks. You may also develop a trauma or stressor-related disorder that keeps you from recovering fully.

3. Long-term recovery
In this later stage, you learn to make meaning from your trauma and integrate what you’ve experienced into your life story. You’re able to accept what’s happened without reliving your trauma endlessly.

Trauma and perception

Trauma relies on our own perception of danger and safety. This means different people can go through the same stressful experience and have different trauma responses.

For example, let’s say three roommates are home when a minor earthquake hits. The first person may develop trauma symptoms that resolve in a few days or weeks. The second person’s symptoms may linger for months, eventually developing into posttraumatic stress disorder (PTSD). The third person may not be traumatized at all, having lived in an earthquake-prone area their entire life.

The third roommate had experience with and context for what was happening and remained calm. The second roommate, however, didn’t realize the earthquake was minor and thought they were going to die. Even though they weren’t technically in danger, their perception of danger still caused a serious trauma response.

Big-T trauma and little-t trauma

Because trauma depends on an individual’s emotional response, many different circumstances can count as trauma. Therapists often use the ideas of “big-T” trauma and “little-t” trauma to help us understand how seemingly small things can traumatize us.

Big-T trauma refers to the clearly dangerous and extreme events we already associate with the word “trauma.” Examples include:

• War
• Natural disasters
• Sexual violence
• Physical abuse
• Mass shootings
• Terrorist attacks
• Severe car accidents

Little-t trauma refers to events and circumstances that are life-altering but not life-threatening. These situations may seem ordinary, but they can still produce a trauma response and damage our mental health. Examples include:

• Divorce
• Bullying
• Getting fired
• Unresolved relational conflicts
• Financial or legal trouble

It’s important to expand our definition of trauma beyond just big-T trauma. Multiple little-t traumas can build up over time and cause the kinds of severe symptoms that usually come from big-T traumas.

Effects of trauma

Trauma harms or threatens to harm our physical, mental, or emotional well-being. Different kinds of traumatic events can jeopardize different areas of our health, and most forms of trauma affect us in more than one way.

Let’s say you get in a car accident and break your leg. While the physical trauma of your broken leg is visible, the emotional trauma of the experience may be less obvious. Unresolved emotions may affect you psychologically, showing up as fear and panic any time you get in a car.

Emotional or psychological trauma can also express itself physically. For example, if you’re struggling with the psychological trauma of a divorce or breakup, you might develop physical symptoms like insomnia, appetite changes, or muscle tension.

Common trauma disorders

Sometimes our trauma responses develop into mental health disorders known as “trauma and stressor-related disorders.” Common ones include:

• Posttraumatic stress disorder (PTSD) occurs when trauma symptoms last for more than a month after the trauma happened. PTSD symptoms include intrusive memories, avoidance, cognition and mood changes, and heightened reactivity.
• Acute stress disorder (ASD) occurs when trauma symptoms last for less than a month after the trauma happened.
• Adjustment disorders involve difficulty adjusting to a stressful event; these disorders persist for up to six months after the event has ended.
• Complex PTSD is a more severe form of PTSD that can follow long-term trauma or multiple traumas, such as an abusive relationship or a lengthy deployment to a war zone.

How childhood trauma affects development

Experiencing or witnessing trauma in childhood can have lasting effects on a person’s development. Certain mental health disorders and developmental disorders may develop in response to trauma, especially if a child can’t access treatment, resources, and support and can’t process the trauma in a healthy way.

Childhood trauma can affect development in these common ways:

• Developmental trauma disorder (DTD): Bessel van der Kolk, MD, has proposed this potential diagnosis for children with complex trauma histories.¹ It’s not currently included in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), but experts are weighing its usefulness.
• Oppositional defiant disorder (ODD): ODD is a childhood behavior disorder involving anger, defiance, and spite. Children may develop ODD in response to trauma, abuse, or other family issues.
• Dissociation: Many children dissociate as a way to cope with trauma. Dissociation means detaching from yourself or from reality in order to protect yourself. Depersonalization/derealization disorder is one type of dissociative disorder commonly triggered by trauma.
• Cognitive struggles: If you experience or witness trauma as a child, you may struggle cognitively. For example, if you’re repressing memories of childhood trauma, you might struggle to remember not just those traumatic memories, but also unrelated details and information.

Associated mental health challenges

Trauma can interact with, trigger, or worsen mental health disorders such as:

• Anxiety
• Depression 
• Addiction
• Eating disorders 
• Obsessive-compulsive disorder (OCD)

Trauma treatment options

The following reliable, evidence-based therapies can help survivors of trauma make great improvements.

• Cognitive behavioral therapy (CBT): With a trauma-informed CBT therapist, you can learn to identify unhelpful thought patterns at the root of your emotions and behaviors.
• Prolonged exposure therapy: Exposure therapy allows you to confront traumatic memories and emotions in a safe, controlled environment.
• Eye movement desensitization and reprocessing (EMDR): EMDR helps you process traumatic memories in a way that encourages new connections and rapid processing.
• Somatic therapy: Somatic therapies, also known as body-based therapies, can help reconnect the mind and body after trauma. If you feel “out of body” after trauma, this treatment approach could be especially helpful. Common types include somatic experiencing, sensorimotor psychotherapy, and the hakomi method.
• Medication: Antidepressants may ease some trauma symptoms.

With treatment, you can learn to practice different forms of self-care, like meditation and mindfulness, that help you navigate trauma symptoms in healthy ways. You can also learn to regulate your emotions when trauma symptoms feel overwhelming.

For support from a mental health professional, browse our therapist directory.

Get help now

If you’re struggling with your mental health after experiencing trauma, help is available right away:

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

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What is stress?

Stress is both a physical and mental response to change. It’s a normal part of life, and it happens during positive and negative life experiences.

As a short-term reaction, your body’s stress response is healthy and natural. It can help you:

• Stay awake and alert
• Focus your attention
• Stay motivated
• Avoid imminent danger
• Respond to threats
• Prioritize your safety and survival

When these short-term reactions turn into long-term symptoms, however, stress can compromise your mental and physical health.

What’s the difference between stress and anxiety?

Stress and anxiety are similar responses, and they often overlap. The key difference is that stress is your response to something external that you see as a threat. It eases once the stressful situation is over. Anxiety, on the other hand, can happen without any external “trigger”—and even if there’s a trigger, anxiety can last long after the initial trigger is over.

What causes stress?

You feel stress when an external “stressor”—that is, anything that causes you stress or tension—triggers your body’s stress response, releasing stress hormones like adrenaline and cortisol.

The definition of a stressor varies from person to person: For example, public speaking may be a stressor for some people and a joy for others.

Common types of stressors include:

• Routine stressors: Stress is part of our daily lives. Making dinner, sitting in traffic, handling work or school obligations, cleaning the house, taking care of family or friends—these all contribute to a general current of everyday stress.
• Disruptive stressors: Disruptive stress interrupts our daily routine and demands our attention. Unexpected illness or injury, a divorce or breakup, bankruptcy, and losing your job all qualify as disruptive stressors. Some disruptive stressors may reach the level of traumatic stress, depending on how we experience them.
• Traumatic stressors: Trauma is an emotional response to a deeply disturbing, stressful, or dangerous event, relationship, or circumstance that threatens or harms our health or safety. Events that cause traumatic stress include war, assault, abuse, natural disasters, terrorism, and severe accidents.

Types of stress

It’s useful to think about stress in three ways: how long it lasts, whether it’s physical or psychological, and whether it’s positive or negative. These qualities can determine how stress affects you.

Acute stress vs. chronic stress

Everyone experiences acute stress (also called “short-term” stress). You feel it in response to immediate change or danger—when you drop an object and catch it at the last second, for instance. You can also feel acute stress in situations or events that don’t last very long—for example, when you’re studying in the days leading up to a final exam.

On the other side of the spectrum, chronic stress happens in response to long-term or ongoing stressors that last for weeks or months. Financial struggles, divorce, or ongoing health problems can all result in chronic stress.

Physical stress vs. psychological stress

Psychological stress comes from the emotional and physical tension you feel in response to a perceived threat. This threat can be physical, mental, or emotional, and it can range from inconvenient to dangerous. For example, struggling to find your keys while you’re running late for work can result in psychological stress.

Physical stress, on the other hand, happens when a stressor physically strains your body. This strain can range from uncomfortable to incapacitating. Working in extreme heat or dealing with chronic pain from an injury are both examples of physical stress.

Positive stress vs. negative stress

We can experience stress as positive (“eustress”) or negative (“distress”). Eustress is healthy and can help you achieve your goals: You may feel it when learning a new skill, for example. Distress, on the other hand, is disruptive and can make it harder to achieve your goals.

It’s important to note that “positive stress” and “negative stress” are terms that refer to how you’re able to channel your stressful energy, and not the benefit or harm of the stressor itself. Joyful occasions don’t produce only eustress. Depending on how you manage your stress, you may still feel negative stress in response to positive life changes.

Effects of stress

Stress has both physical and mental effects, and they can differ depending on the type of stress you experience. With acute stress, for example, your body’s responses may include:

• Rapid heart rate
• Difficulty breathing
• Tension headaches
• Stomachache
• Sweating
• Fatigue
• Shaking
• Dry mouth
• Muscle pain

Fortunately, the symptoms of acute stress are temporary: Once the stressor is resolved, the effects go away.

The effects of chronic stress last longer and are and typically more severe. Common physical effects include:

• Insomnia
• High blood pressure
• Heart problems
• Diabetes
• Immunodeficiency
• Gastrointestinal (GI) issues
• Chronic muscle tension
• Infertility
• Irregular periods
• Erectile dysfunction

Common mental or emotional effects of chronic stress include:

• Irritability
• Isolation
• Loss of control
• Loss of sexual desire
• Difficulty concentrating
• Nervousness
• Overwhelming worry
• Feelings of hopelessness

Can stress make you sick?

Sometimes stress can lead to feeling physically ill. Symptoms like stomachaches, nausea, diarrhea, vomiting, headaches, or muscle pain can all actually be symptoms of stress. Stress hormones can also decrease how well your immune system works, so when you’re stressed, you’re more likely to get sick. Your primary care doctor can determine whether your symptoms are stress related.

Stress disorders

Stress disorders are mental health disorders that may develop after you go through or witness trauma. Common types include:

• Acute stress disorder (ASD), whose symptoms persist for less than a month after the trauma occurred. ASD symptoms include anxiety, dissociation (feeling disconnected from reality), and avoiding situations that remind you of the trauma.
• Posttraumatic stress disorder (PTSD), whose symptoms persist for more than a month after the trauma occurred. PTSD symptoms include intrusive memories, thinking and mood changes, and hypervigilance (extreme alertness to threats).

Disorders related to stress

Stress can contribute to, worsen, or be symptoms of other mental health disorders, including:

• Anxiety
• Depression
• Obsessive-compulsive disorder
• Insomnia
• Addiction

It’s important to note that this isn’t a complete list. Stress can worsen the effects of just about any mental health condition you can think of.

Stress treatment options

Stress is a natural response to change, but when our response to stressors becomes unhealthy or unhelpful, professional treatment is often necessary. There are many different treatment options for stress, including:

• Mindfulness-based stress reduction (MBSR) therapy: Specifically designed for stress management, this meditation therapy uses mindfulness practices to manage stress.¹ It can also be helpful for other mental health conditions, including anxiety and depression.
• Cognitive behavioral therapy (CBT): A CBT therapist can help you identify unhelpful or negative thought patterns that affect your emotions and behaviors. CBT can help you learn to prevent stress and respond to stress in healthy ways.
• Dialectical behavioral therapy (DBT): Originally designed to treat borderline personality disorder, DBT has proven effective for stress reduction as well. DBT teaches you self-regulation and stress management.
• Acceptance and commitment therapy (ACT): This mindfulness-based behavioral therapy encourages psychological flexibility. Challenging the idea that stress is inherently bad, ACT instead encourages you to accept both the stressors and joys of life, using acceptance as a launchpad for committed change.
• Somatic therapy: This holistic approach to mental health addresses your mind and your body, and it may be particularly effective for stress.
• Stress management: You can learn healthier ways to respond to stress on your own with techniques such as guided imagery, progressive muscle relaxation, and deep breathing. These tools are most effective when paired with professional therapy.

Find help now

Professional therapists can help you learn stress management skills while also treating any mental health disorders that may contribute to your stress. Browse our directory to find a specialist in your area.

If you’re in crisis, help is available now. For free, confidential 24/7 support, please call the 988 Suicide & Crisis Lifeline at 988 or 1-800-273-TALK (8255),or text HOME to 741741.

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What is acute stress disorder?

Acute stress disorder (ASD) is a mental health condition that can sometimes occur in the first month after experiencing a trauma.¹

The acute stress disorder timeframe is specific: Symptoms and diagnosis occur between three days and four weeks after a traumatic event. This short window helps doctors and therapists identify people who need early support.

Acute stress disorder vs. PTSD

ASD can sometimes precede posttraumatic stress disorder (PTSD), a longer-lasting condition that also affects people who have experienced trauma.

One of the main differences between the two is timing. ASD occurs within the first month after trauma. Acute stress disorder can become PTSD when symptoms continue beyond the four-week mark.²

However, not everyone with ASD develops PTSD. In fact, many people who develop PTSD did not initially meet ASD criteria.³ This means ASD is just one possible predictor.

Signs and symptoms of acute stress disorder

Acute stress disorder symptoms fall into five main categories: intrusion, negative mood, dissociation, avoidance, and arousal.⁴

Intrusion symptoms include:

• Recurring, distressing memories of the trauma
• Nightmares or night terrors (especially common in children)
• Flashbacks where you feel like the trauma is happening again
• Strong physical or emotional reactions to reminders of the event

Negative mood shows up as a lessened ability to experience positive emotions, including happiness, success, or love.

Dissociation can make you feel:

• Detached from yourself and your emotions
• Unable to remember parts of what happened

Avoidance appears as efforts to stay away from:

• Thoughts, memories, and feelings about the trauma
• People, places, or things that remind you of what happened

Arousal symptoms include:

• Trouble falling or staying asleep
• Feeling irritable or having sudden outbursts
• Being constantly on alert
• Difficulty concentrating
• Jumping at sudden sounds or movements

If you’ve experienced trauma and are struggling, consider reaching out to a mental health professional. They can help you create coping strategies and develop healthy approaches for moving forward.

Acute stress disorder causes and risk factors

Traumatic events

Not everyone who experiences trauma develops ASD, but certain types of traumatic events are associated with a higher likelihood of developing it.

Research shows that that prevalence rates of ASD after trauma include:⁵

• 13% to 21% after motor vehicle accidents
• 24% after assault
• 36% after interpersonal trauma⁶

An estimated 20% to 90% of people experience at least one traumatic event in their lifetime, and about 19% of those trauma-exposed people develop ASD.⁷ Of those that do develop ASD, about 1.3% to 11.2% go on to develop long-term symptoms.⁸

Personal and biological risk factors

There’s limited research on risk factors for ASD specifically. However, because they so closely resemble each other, it’s assumed that risk factors identified for PTSD can also be applied to ASD. 

Factors that can increase a person’s risk of developing ASD before, during, and after experiencing or witnessing a traumatic event include:⁹

Before the trauma:

• Having a history of past trauma or mental health conditions
• Lower education levels
• Using avoidant coping styles¹⁰
• Certain personality traits, particularly neuroticism

During the trauma:

• The severity of what happened
• Physical injury
• Experiencing assault or sexual violence

After the trauma:

• Financial difficulties
• Lack of social support
• Physical pain
• Additional life stress

Impact of acute stress disorder

Acute stress disorder doesn’t just affect your emotions—it can touch every part of your life.

Mental and physical health

ASD affects both your mind and body in significant ways:

• ASD can lead to depression, anxiety, panic disorder, and substance use problems¹¹
• ASD patients face 24 times higher risk of suicide attempts and twice the overall mortality rate compared to people without ASD
• Stress responses to trauma can cause real physical changes, including pain and a weakened immune system¹²

If you’re in crisis, help is available.You can call or text the 988 Suicide & Crisis Lifeline at 988 anytime, 24/7.

Work and academic performance

ASD symptoms can make it hard to function at work or school. Avoidance behaviors might lead to missing work, poor performance, or even job loss. For some people, this creates financial hardship that adds more stress to an already difficult situation.

Relationships and social life

Trauma changes how you relate to others. Many people with ASD find their relationships suffering. You might pull away from friends and family, or find it hard to connect emotionally with your partner. This isolation can create a cycle where lack of support makes symptoms worse.

Acute stress disorder treatment options

The good news is that effective treatments exist for ASD. Getting help early can reduce your symptoms and lower your risk of developing PTSD.

Trauma-focused cognitive behavioral therapy (CBT) is the gold standard treatment for acute stress disorder. This type of therapy helps you:

• Process what happened in a safe environment
• Challenge unhelpful thoughts about the trauma
• Gradually face trauma reminders in a controlled way
• Build coping skills

For people diagnosed with ASD, research shows that trauma-focused CBT (including cognitive restructuring and exposure) reduces PTSD symptoms at three to six months compared to supportive counseling or being on a waitlist.¹³ The therapy can be done in person, by phone, or online.

Psychological first aid (PFA) offers another helpful approach, especially right after trauma. PFA focuses on:

• Making sure you’re safe and have basic needs met (food, shelter, safety)
• Providing emotional support and reassurance
• Connecting you with practical resources
• Teaching simple coping strategies

People who receive PFA report feeling calmer, more in control, and better able to function and help others.¹⁴

Currently, there’s no strong evidence that medications effectively treat ASD. While some medications help with PTSD, research hasn’t shown clear benefits for acute stress disorder specifically.¹⁵

Support strategies

While professional treatment is important, these strategies can help too:

Build your support network. Social support plays a powerful protective role. Higher levels of support are linked to fewer ASD symptoms.¹⁵ Connecting with understanding friends, family, or support groups can help ease the fear and isolation that often follow trauma.

Grow your healthcare team. Seek out healthcare providers for any physical changes or concerns you experience, whether you think a specific trauma is the source or not. Regular visits and involved care workers can help catch any worsening symptoms early.

Connect with a mental health professional.  A mental health provider can help you understand your symptoms and create a treatment plan tailored to your needs. Speak to your employer about employee resources, search for free or affordable care resources, or search our directory to find available therapists near you.

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Have you ever walked into a room and felt certain you’ve experienced that exact moment before? The lighting, the sounds, even the conversation—all of it feels strangely familiar, even though you know it’s your first time there. This puzzling experience is called déjà vu, and most of us have experienced it at some point in our lives.

What is déjà vu?

Déjà vu is a brief experience where you feel false familiarity with the present moment despite knowing this familiarity is incorrect.¹ The term is French and literally means “already seen.”

Essentially, your brain is navigating a clash between two competing thoughts: the subjective idea that you recognize something and the objective knowledge that you’re experiencing it for the first time.

How common is déjà vu?

If you’ve experienced déjà vu, you’re in good company. Research shows that up to 97% of people experience it at least once in their lifetime, with 67% experiencing it regularly.²

Interestingly, déjà vu is most common in young adults. The frequency peaks between ages 20 and 24, when people experience it approximately 2.5 times per year on average.³ After that, it declines steadily with age.

What does déjà vu feel like?

People describe déjà vu as “living an experience you’ve already lived through,” often with such strong conviction that it feels like they could have predicted what would happen next.⁴

How long does it last?

Déjà vu episodes are typically very brief. Research shows that in healthy individuals:⁵

• 8.9% of cases last one second or less
• 66% last a few seconds
• 19.5% last one to two minutes

Some episodes can last much longer, up to several hours, but it’s quite rare.

What emotions come with it?

Most people experience déjà vu as an emotionally neutral, or even positive, experience.⁶ Common positive emotions include:

• Reassuring feelings
• Pleasant sensations
• Surprise

However, some people report negative emotions such as:

• Alarm
• Oppression
• Disturbance

The experience may also come with derealization—a sense that your surroundings seem unreal. However, overall dissociation is not associated with déjà vu.

While déjà vu is mostly a common and neutral experience, in some cases it can be an indicator of an underlying physical or mental health condition. If déjà vu feels intense or frightening, occurs often, or in anyway leaves you feeling unsettled, don’t hesitate to speak with a doctor or mental health professional.

Related memory phenomena

Déjà vu can be better understood by comparing it to other similar memory experiences that feel unusual or confusing.

The opposite of déjà vu: Jamais vu

While déjà vu means finding something familiar when it’s actually new, jamais vu is the opposite.⁷ It’s when you feel like a familiar situation has never been experienced before when, in fact, it has. This phenomenon occurs much less frequently than déjà vu.

The “butcher on the bus”

The “butcher on the bus” scenario has long been used to describe an experience similar to déjà vu in which our minds recognize familiar details even in unusual contexts.⁸

The example goes like this: You’re riding the bus and see someone you’re absolutely sure you know. The person seems familiar, but you can’t remember where you know them from. Eventually, it clicks; they’re the butcher from your local supermarket.

In this example, you actually do know the person, they’re just out of their typical setting. With déjà vu, however, the feeling of familiarity itself is false. You’re not recognizing something familiar in the wrong context—you’re experiencing false familiarity for something genuinely new.

What’s the difference between déjà vu and déjà vécu?

Déjà vécu (meaning “already lived”) is an experience often associated with dementia. In déjà vécu, patients experience false familiarity but aren’t able to identify it as false.⁹ They may create detailed explanations for the sensation or withdraw from activities because they’re convinced they’ve already experienced them before.

The key difference: With déjà vu, you know the familiarity is false. With déjà vécu, you believe it’s real.

Déjà vu also shares similarities with other memory experiences like involuntary memories and “tip-of-the-tongue” states.¹⁰ It’s been proposed that they all represent different outcomes related to the memory retrieval processes.

Why does déjà vu happen?

Scientists have identified several brain mechanisms that could explain what causes the déjà vu feeling.

Brain synchronization issues

Ictal déjà vu is a phenomenon that occurs during certain epileptic seizures. Research suggests that this is the result of abnormal synchronization between specific brain regions.¹¹ Additional studies may give us insight into how the brain’s memory networks connect past experiences with present awareness.

Recognition without identification

Déjà vu may involve what scientists call “recognition without identification.”¹² This happens when the brain signals a feeling of familiarity, but can’t successfully retrieve the memory that would explain it.

It’s like recognizing a melody but not being able to name the song. A memory of it may exist, but your brain can’t access it, creating the feeling that the experience has happened before.

Memory conflicts

One brain imaging study used fMRI to show that during induced déjà vu, specific regions light up—particularly areas involved in conflict resolution.¹³ This indicates that detecting and resolving memory conflict may play a central role in the déjà vu experience.

What does having déjà vu mean? Is it bad?

The good news is in typical presentations, déjà vu is likely a sign of healthy brain function, rather than something to worry about.

Research suggests that déjà vu represents your brain’s successful detection of conflict between familiarity and recognition.¹⁴ This would make it a helpful mechanism that allows you to recognize incorrect information.

It’s not clear the exact purpose déjà vu serves. But it does involve normal, healthy cognitive processes that reflect an awareness of reality and happens regularly in healthy people.

However, it is important to note that in some cases déjà vu can be an indicator of a more serious underlying physical or mental health concern. In particular, the experience has been linked to epilepsy.

Déjà vu and epilepsy

For most people, déjà vu is harmless. However, in some cases it can be associated with medical conditions, particularly epilepsy.

Ictal déjà vu (déjà vu occurring during seizures) happens in about 22% of epilepsy patients.¹⁵ It’s most common in temporal lobe epilepsy (19.6% of patients) but can also occur in other types.¹⁶

When to consult a medical professional

How do you know if your déjà vu experiences warrant medical attention? There are some warning signs. Epileptic déjà vu differs from typical experiences in these ways:¹⁷

• Intensity: It occurs with severe intensity
• Frequency: It happens several times per year, often in clusters
• Accompanying emotions: It’s often accompanied by negative emotions like fear¹⁸

It’s important to know that persistent déjà vu can appear months or even years before an epilepsy diagnosis.

If you experience frequent, intense, or prolonged episodes of déjà vu, or any similar experiences are leaving you feeling unsettled, speak to your doctor or seek help from a mental health professional by visiting our directory. Remember that there’s no threshold you need to reach to justify involving a professional in your care.

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It’s a gripping few minutes of video. Nicholas, a young bearded man, lies on a raised futon in what looks like a suburban den. He could be anybody’s kid, home from school, dozing restlessly in a T-shirt and sweatpants, the spidery ends of dark tattoos peeking out of his shirt sleeves. As the camera pans out, we see an older man and woman in chairs on either side of him. There’s a discarded eyeshade and headphones near him on the mattress. His eyes flutter as he starts to talk, relating what sounds like a horrifying dream in real time.

“I never had a problem when I watched my friends die,” he says. “When I watched Manny, Cliff, burn alive. When everybody gets blown up, you don’t just sit there and cry like a little baby: You keep on pushing and finish your job. I don’t know how they get that into you, but they do.” Nicholas goes quiet for a moment, and the woman draws closer. “It just doesn’t feel right,” he says plaintively. “It feels cold to feel like that.”

The older man’s voice rises softly off camera, encouraging him to stay with his distress. “I think what this is, is a wave of something painful that needs processing,” he says.

Long back from two tours as a Humvee turret gunner in Iraq, Nicholas is a Marine combat vet in the midst of a mighty struggle with treatment-resistant posttraumatic stress disorder (PTSD). Among the symptoms he’s grappling with is uncontrollable anger, causing him to blow up frequently at his wife and other people in his life. With him are psychiatrist Michael Mithoefer, a professor at the University of South Carolina Medical School, and his wife, Annie, a nurse. Together the two have been leading research into the effects of combining doses of MDMA, a pure form of the club drug ecstasy, with psychotherapy. They’re sitting with Nicholas for a session on the drug, having already prepped him in meetings beforehand to explore his trauma while under its effects.

Nicholas goes on to tell them, “I have this negative battle going on in my head, this part that’s just saying I’m a murderer and killer…that I wanted to do it, I wanted to go over there and hurt people… . That evilness—I don’t want any space for that in my life.”

“It’s a really important part of you that doesn’t want that,” Michael Mithoefer says, but reminds Nicholas that we all have parts that carry rage and the potential for violence; they just don’t need to be in charge. He suggests it may be time to understand that part of him and help it heal.

At first, the words don’t help; Nicholas says he can’t let them in because it makes him feel too helpless. But soon he’s sobbing, telling them a part of him wanted to die at war. “I just wanted to be done,” he says. The Mithoefers both put their arms around him as he cries, and they nod when he quiets and tells them, “I just don’t let myself feel sometimes, how much it hurts.”

The film skips ahead to another MDMA trip with Nicholas. He’s been listening to instrumental music to facilitate his inward journey and suddenly speaks up to tell the Mithoefers that its intensity has just reminded him that he was brave and strong in Iraq. “I saw myself in a whole new light,” he reports. “I’ve seen how low man can be…that side of the spectrum that’s so dark and so evil. There’s that other side that’s a balance to it. Accepting those things as one really just makes me feel complete.”

Now, instead of burying his past in a way that’s been hurting him, he wants to acknowledge all parts of himself, the warrior as well as the softer side. He wants to reconceive of himself as a “peaceful warrior.”

We see Nicholas a final time, in a chair on a stage wearing a well-tailored suit, his hair longer, his life different, as he talks about how he wouldn’t be here today without MDMA-assisted psychotherapy. He tells the audience that since his experience with the Mithoefers, he and his wife are going to have a baby. He says, “I finally feel like I have my head together. I didn’t want my child to see me the way I was before, and I’m so grateful for this therapy.” Without it, he adds, “I wouldn’t be alive.”

Tripping into breakthroughs

Since 2004, when the Mithoefers first started testing MDMA-assisted psychotherapy, more than a hundred vets, cops, firefighters, and sexual assault and abuse survivors have undergone treatment. The approach has proven so successful that the Food and Drug Administration has deemed it a “breakthrough therapy” for PTSD and is helping the Mithoefers speed along the final phase of trials with hundreds more trauma survivors. More than 20,000 people have already signed up to be part of it.

In 2018, the Journal of Contemporary Psychotherapy compared MDMA-assisted psychotherapy to talk therapies. The authors found trauma-focused cognitive behavioral therapy and cognitive processing therapy produced clinical improvement in 44% of their PTSD subjects. They also found commonly prescribed drugs, like Paxil, Zoloft, and other SSRIs, were effective 20% to 30% of the time. But in Mithoefer’s original phase-2 study with treatment-resistant PTSD subjects, who averaged 19 years with the disorder, a remarkable 83% of participants no longer met the criteria for PTSD after completing treatment.

When they followed up with them 45 months later, 74% had held onto improvement. They also reached out to subjects from all six of their phase-2 studies at the one-year mark. When they pooled those results, 68% still didn’t have PTSD, and one of the trial sites in Colorado says 80% of its subjects stayed well.

The neurochemical action of MDMA seems custom-made to treat PTSD. It releases a jumble of feel-good neurotransmitters, including serotonin, dopamine, and norepinephrine. It puts oxytocin, the hormone that increases our positive feelings about one another, in play. And it quiets the amygdala, the brain’s fear center, while amplifying the higher processing of the prefrontal cortex. The result is an exact reversal of the hyperanxiousness of the PTSD state, and it allows people to process deeply entrenched trauma without the clouding of an overwhelming emotional response.

Like Nicholas, all of Mithoefer’s study subjects are coached by therapists in lead-up sessions to try to let go and follow the drug wherever it takes them. This way, the MDMA can help people dive unimpeded into difficult places and break down hardened defenses through a deep, visceral sense of compassion for all aspects of their selves, past and present, before trauma and after. Also, the prosocial effects that have made MDMA a base for the popular club drug ecstasy accentuate feelings of trust in the therapists and the support they offer. It’s an effect that subjects say makes them feel deeply cared for during the experience.

The New York Times recently report­ed that these early study results have given hope to combat vets, some of whom are so desperate for relief from their PTSD symptoms that they’ve taken to doing MDMA illegally at home. This is concerning to the Mithoefers and their study funder, the Multidisciplinary Association of Psychedelic Science (MAPS), which is providing nearly $30 million for the research. They’re emphatic that for the treatment to work, the drug must be paired with therapy.

Preparatory therapy sessions help people feel safer on the drug and set an intention for their trip that can bring them to the heart of what they need to heal. And follow-up therapy sessions are a must, given that the powerful and often painful places MDMA takes them can trigger backlash later on—including flashbacks, heightened anxiety, and in some cases, suicidal ideation. Integrating those destabilizing feelings is critical, but doing this kind of work isn’t easy on therapists. While the standard appointment calendar of most trauma therapists revolves around weekly, 50-minute sessions, the kind of MDMA-assisted psychotherapy the Mithoefers envision necessitates a complete overhaul of their ordinary work pattern.

The MDMA protocol requires the drug to be prescribed in a clinic setting with a staff of at least two therapists, an assistant to stay overnight with the client after trips, and a prescribing doctor. Therapists must commit to long, quiet hours supporting clients as they go inward on the drug. They must also be available afterward for three 90-minute integrative sessions following each of the three trips, which are spaced weeks apart, and for phone contact 24 hours a day for the immediate week after each.

Talking with subjects in the Mithoefer study, one hears again and again how the treatment “saved” them and gave them back their life. Journalists are hearing similar tales and producing a steady stream of stories, on not only the success of the MDMA trials for PTSD, but the work of research teams focused on the therapeutic potential of psilocybin (the active ingredient in “magic mushrooms”), LSD, ayahuasca, and the psychedelic ibogaine, to treat depression, anxiety, addiction, OCD, eating disorders, and fear of death for cancer patients.

ABC, CBS, CNN, NBC, NPR, PBS, Chelsea Handler, the Guardian, The Late Show with Stephen Colbert, the Los Angeles Times, The New Yorker, the New York Times, Rolling Stone, Scientific American, and TIME have all beaten the drum about psychedelics being the next big thing in therapy. Even a conservative Fox News host encouraged viewers to have a psychedelic experience before they died.

The untapped promise of a good trip

Bill Richards, a grandfather of psychedelic science who’s still associated with Johns Hopkins’ psilocybin therapy investigations, likes to remind people that psychedelics have been used to promote healing for thousands of years. Ancient Mesopotamians did them so often that traces of the drugs still cling to their pottery. Cave paintings in northern Algeria showing human figures with psychedelic mushrooms date back to 5000 BCE. And 32 million Americans, including plenty of therapists, have taken these mind-expanding drugs.

I myself wavered at the edge of the psychedelic universe for years as a college student. Long before I knew anything about their potential for therapy, I was at a school awash in psychedelics, but I was too frightened of having a long, bad trip to try any of them. Instead, I fell into the role of “trip sitting” friends on MDMA or LSD, until eventually one begged to return the favor with what he swore would be a mild and short-acting experience on magic mushrooms. He’d stay sober and glued to my side, he promised, for the entire time. On a quiet weekend night, I agreed to a small amount, and we squashed bits of the dry, icky-tasting fungus into Oreo cookies. Like a cheerful suburban parent, he handed them to me on a porcelain plate, along with a tall glass of milk. “Down the hatch, sweet pea!” he giggled.

Once I’d choked them down—even Oreos can disguise only so much of the taste of petrified vegetable rot—I immediately lay down, expecting some head-spinning image parade. But after 10 minutes of ceiling staring and nervous expectation, it never materialized. So we gathered ourselves up and headed out into the warm night to try our luck at a campus party. When we crossed the threshold into a packed dorm room I suddenly felt overcome by a stunning and unfamiliar sensation—utter, unequivocal calm.

At this point in my college career, I’d become accustomed to being around proud geeks, some tortured for their nerdiness in high school, who’d found their intellectual nirvana and could spend hours drunkenly humiliating one another in searing, no-holds-barred debates. I found this practice and these young men, many of whom surrounded me in the room, abjectly cruel. But along with the odd sense of calm, this night I felt something else in their presence that I can still feel palpably as I write—a deep awakening to the profound depths of our mutuality.

It was as if I’d entered a room bathed in acceptance, and each person in it embodied a core of kindness and love that all their verbal battling had previously obscured for me. Now, for the first time, I saw their truth. They were good. I was good. My trip-sitting friend was so good he was glowing like a two-armed Vishnu. They were suffering. I was suffering. And whatever the lot of us had said or done to one another, whatever grandstanding, ignorance, or insecurities we’d all acted on in the time we’d been together, were just inessential, fluffy distractions: the blurting of groundless fears. Nothing personal. Nothing substantial. Nothing lastingly true.

This sense of oneness and profound acceptance that overtook me is the quintessential gift of the drug that Richards unabashedly equivocates with mysticism. In his book “Sacred Knowledge: Psychedelics and Religious Experiences,” he remarks on how we’re on the cusp of making these mystical healing powers of psychedelics come alive again. “For those who deeply believe in the promise of these sacred substances,” he says, “it is a hopeful time.”

Back in that dorm room, I felt myself smiling softly at each of the other partygoers. Many smiled back, some fully, some halfheartedly. With the halfhearted smilers, I felt a deep ache arching between us—the pain of having to disguise our essential bond to one another, as some protective part in them pretends at disconnection and difference.

I knew when I started thinking this way that it was the drug. But I didn’t discount or disbelieve what was happening. It was like watching an absorbing and hopeful documentary that was speaking to a reality I’d normally failed to see. I’d dug up an unassailable truth, I thought, that was mine now forever. And if I remembered it well enough, once the mushrooms finished their work, it might just reshape, in some significant way, my world view.

I turned to my friend. “I think I’m tripping now.”

He gazed at me with delight. “It’s great, isn’t it?”

I still call up my stirring, dorm-room trip when I have to give a lecture or defend my ideas to a group of overeducated meanies. It’s become my version of imagining an audience in their underwear. So you can bet that the idea of going back to the drug these many decades later—now with trained therapists and a real intention to roll back my various irrational fears—has grown exponentially more appealing with each new story of breakthrough or revelation I hear.

It’s intriguing, isn’t it? The idea of making huge strides in the span of a few trips with a treatment that, rather than requiring daily maintenance on drugs, or emotional sustenance in weekly therapy, might just last a deeply healing decade or two, or maybe even a lifetime.

So why have we left it on ice for so long?

A brief history

If you’re a therapist of a certain age, all this new excitement around psychedelics may feel like déjà vu. From the ’50s to the late ’60s, researchers and therapists were already working with LSD, mescaline, and psilocybin, and seeing the same effects being documented today. That was before their work was shuttered and psychedelics assigned the strictest of drug statuses—Schedule I—which precludes research without a special license from the FDA.

The word “psychedelic” is derived from the Greek and translates as “mind manifesting.” After 1938, when the Swiss chemist Albert Hofmann synthesized LSD, early researchers were hopeful that the drugs could produce therapeutic breakthroughs and illuminate the neurochemical underpinnings of psychosis. Hofmann, who was working for the chemical company Sandoz at the time, famously absorbed a large dose of the drug by accident and had a terrifying trip involving a nighttime bicycle ride. But soon after, the son of the head of Sandoz’s pharmaceutical department discovered that lesser amounts of LSD were useful in psychiatry for helping repressed thoughts and memories bubble up. The CIA took notice, hoping to turn it into a “truth drug” before ultimately finding it too unpredictable. By the 1950s, potential therapeutic uses were already under serious study.

Two Canadians tried scaring their alcoholic patients straight by giving them large doses of LSD, but the trips turned out to be more pleasant than frightening. So they changed their tactic and created homey rooms, in which they’d sit with clients and help elucidate a mystical experience that might be profound enough to loosen alcohol’s grip. Soon Stanislav Grof, a Czech psychiatrist who’d go on to invent holotropic breathwork for attaining different states of consciousness, was taking a similar tack to treat heroin addicts in Prague.

By this time, the ’60s counterculture was flourishing, and Harvard psychologist Timothy Leary was encouraging the general public to take LSD, mescaline, and psilocybin, insisting the drugs were safe, and famously advising people to “tune in, turn on, and drop out.” The fear began to grow that psychedelics were hastening the decline of cultural values. President Nixon, given to demonizing both the era’s countercultural paroxysm (which he labeled “the age of anarchy”) and Leary (the person he considered its de facto leader and “the most dangerous man in America”), agreed. Soon after, the FDA effectively halted psychedelic research.

MDMA has a different origin story. Though synthesized in the early 20th century by the pharmaceutical giant Merck, it wasn’t tested on humans and didn’t make it into psychiatric circles until the late ’70s and early ’80s. It was then that Alexander “Sasha” Shulgin, a chemist who’d worked at Dow in the 1950s and synthesized products so profitable he was given free rein to pursue his own interests, set his sights on psychedelics. Shulgin had a curiously good relationship with the DEA, which eventually granted him an investigative license to synthesize his own psychedelic compounds. He designed new psychedelics by manipulating old ones like mescaline, birthing an era of designer drugs—and he reintroduced the empathogen MDMA, which he tested on himself and promptly gave to San Francisco Bay Area psychotherapists.

But much like LSD, psilocybin, and mescaline before it, once MDMA went beyond the therapy community to become widely disseminated at parties and clubs, the government took note, this time under Ronald Reagan; and in 1985 the DEA declared an emergency ban on it, putting it out to Schedule 1 pasture.

Rick Strassman, a psychiatrist and researcher at the University of New Mexico, managed to get the FDA and DEA to release the hallucinogen DMT to him in the ’90s for his studies of addiction treatment for alcohol. (DMT is a derivative of one of the plants found in brewed ayahuasca, which is also being studied for its therapeutic potential.) Since then, the US psychedelic science scene has come roaring back, thanks in part to some very deliberate messaging by the now careful community of researchers and its funders, like MAPS and the Heffter Research Institute, which underwrites the Hopkins work. The ’60s free-for-all, and Leary’s calls for everyone to partake, have been replaced with a principled stand, asserting that these drugs need to be purposefully used and prescribed as therapy.

Psychedelic research is currently underway at an impressive list of top-rate research universities, including Johns Hopkins, Harvard, UC San Francisco, UCLA, New York University, Yale, and the Imperial College of London. Practitioners being trained to provide psychedelic therapies are encouraged to follow a protocol common to all the studies: Pay careful attention to preparation work with participants, set aside a room that’s warm and calming, encourage them to bring in a meaningful memento for the session, refrain from being directive when the participants are tripping, and ask them to don eyeshades and headphones that play instrumental soundtracks to support them going inward.

“Now I never want to die”

A participant in one of these carefully designed research studies was Rachael Kaplan. She was 31 at the time and had been in and out of therapy for almost two decades, trying countless treatments to alleviate her crippling PTSD symptoms. A survivor of childhood abuse, including sexual abuse that had started at age four, she found simple errands, like going to the grocery store, terrifying. She’d wake in the mornings, she says, afraid of existence itself.

Kaplan was painfully aware that other people could feel a sense of ease in their bodies, but not her. Her abuse had started so young that she didn’t understand such a feeling, and instead would be driven by her sense of extreme unease to dissociate and hurt herself. Plagued by nightmares and debilitated by flashbacks, she was hospitalized twice for suicidal ideation, and she thought about killing herself daily.

Over the years, she’d tried EMDR, residential treatment, and medications that did little to help her. She’d met with acupuncturists, energy workers, and equine therapists—so many therapists, in fact, that she trails off talking about them. It was a lot of effort with little progress.

“I was so terrified from my childhood trauma that my system wouldn’t let down its guard enough to allow anything from the outside to affect it,” she says. In fact, she started thinking that she might be psychotic. “It was easier to blame myself,” she explains, than face the truth of what had happened.

In her 20s, she started a counseling degree, but the PTSD got in the way of her finishing it. She was still taking classes at Naropa, the Buddhist-informed liberal-arts school near her home in Boulder, when she stumbled on a talk about the stunning early results of MDMA-assisted therapy. Then a friend told her that a trial was happening right there in Boulder, and her heart leapt. “Truthfully, I was willing to try almost anything at this point,” she says. “But this actually sounded amazing. I kept thinking, ‘This has to help.’”

To be approved for the study, she met with therapists and a doctor, and went through medical and psychological assessments. Schizophrenia, psychosis, heart problems, and a bipolar history—all of which the drug can exacerbate—were study disqualifiers. She was thrilled to learn she’d been chosen, but then terrified. “Taking something where I wouldn’t be in control of myself, not knowing how it would affect me, I was really scared,” she recounts. “And working with two people I’d really just met? I’m supposed to be vulnerable with them and take a drug with them after such a severe history of trauma? It was very hard.”

Kaplan had three preparation sessions with the two therapists who’d be with her when she’d take the drug for the first time, and for all the integrative sessions that followed. “In those preparatory sessions, they reassured me that they’d keep me physically safe so I could let go on the medication. And they validated my fears that, yeah, it’s a scary thing to do. That in itself was helpful.”

Kaplan couldn’t sleep the night before her first session. In the morning, she gathered the meaningful objects she’d been asked to bring—she chose a blanket, candles, photos of her dog and of friends who loved her—and entered a room with peaceful pictures on the walls, a couch made into a soft bed with more blankets, and flowers in vases set nearby. The therapists pulled two chairs up to the couch. Kaplan’s blood pressure was taken, and a doctor she’d met in the preparatory sessions came in to give her the pill. She lay back, put on headphones, and tried to relax. It was half an hour before she felt anything at all.

She and the therapists had spoken beforehand about setting an intention. Hers was to learn whatever she needed to heal her trauma. But she says she was disappointed that the drug didn’t make it easy to do this, even with the two therapists by her side. It wasn’t as tough as an initial talk therapy session, but it also didn’t feel like a breakthrough. She wondered if the drug was working, or if maybe they’d given her the placebo. On the upside, she adds, “I did feel closer to and safer with my therapists than I normally would have, and that was really helpful. Something about the drug helped me start to trust them in a deep way.”

In the week that followed, she had intense flashbacks to her abuse and made use of the phone calls and integration sessions to work through them. Going into the second session, she says, she no longer thought she’d fall apart or lose total control on MDMA, but now she was worried about other things. “I wondered what would come up this time. When I took the drug the first time, I could actually feel my defenses softening. I thought maybe they’ll soften even more this time, and then what? It’s like consciously unarming, and that makes my whole system freak out.”

Despite her fright, Kaplan never thought about stopping. Her new intention? “Get past whatever’s keeping me from deeply connecting with myself and loving myself. Go wherever I need to heal my trauma.”

This time, she got her wish.

“I felt the medicine from the beginning, and I saw myself being surrounded by angels. It was the most beautiful feeling of love and peace and light,” she explains. “For the first time in my life, I could feel what it was like to be connected and safe with other people and in my body. It made me more able to talk about my trauma, and as I did, I felt a lot of love for my present self and for my younger, traumatized self. I was able to let that love and the love and support of others in, for the first time ever.”

When her final session came around, Kaplan was ready to go all in. She asked to have the initial dose and a booster dose (usually given later in the session) together at the start, and aimed for what she calls “the dark place.” She says, “I knew there was something I wasn’t facing and my intention this time was to go there.”

At first, she hit a wall and couldn’t get close to the darkness. But then the drug zoomed her through to a place where previously unspoken, troubling scenes of her childhood trauma took shape. Her therapists leaned closer and held onto her as she gave a second-by-second accounting of the abuse, helping her name it for what it was.

If the horrible memories that were unfolding had been conjured in talk therapy, she says, she’d have been too overwhelmed to process them. But floating in the feelings of love and safety that the MDMA was accessing in her, she believed that the memories could no longer overpower her, and she stayed with them. “With trauma, it’s so easy to go to self-hate when you’re processing this kind of stuff, so to do it while awash in love was really powerful,” she says.

All these years later, her voice still cracks when she talks about that final trip. “I’m still profoundly grateful for that experience,” she explains. “I saw what was keeping me stuck and in so much pain—and holding myself in love while I experienced it, all that was new and different.”

This revelatory trip wasn’t a silver bullet. In the weeks that followed, she dissociated again and had more flashbacks, even some fleeting suicidal ideation. But she managed to work through it all in the integration sessions, and by letting herself grieve. She’d kept her primary therapist throughout the study trial and further integrated the effects with her. She found the newly arrived-at sense of love and connection held fast.

“It was the most profound healing I’ve ever experienced,” she reports. “Now I never want to die. I feel safer being around people, being in the world. I feel like I can actually rest in my body. There’s something so powerful about having been to such a dark place and coming out the other side. I now have this trust in myself that no matter what happens in life, I’ll be okay.”

Kaplan has completed her degree at Naropa and is now trained in transpersonal psychology and wilderness therapy. And her friends have noticed a big change: She talks more. “I’m still fairly quiet, but while I used to be so scared to talk to people, now I want to connect more and do things with them. I even love shopping for my food!” she says.

Beyond “I”

The psychiatrist Roland Griffiths and a team of researchers at Johns Hopkins are investigating the effects of psilocybin-assisted therapy with cancer patients to help ease anxiety and fear of death. Along with other sites, they’re also testing its healing potential with addiction and depression.

But Griffiths, who is a meditator, has an additional interest: understanding the spiritual component that seems to undergird the therapeutic progress most of their study subjects make on the drug. To start, he’s looking at what devoted contemplatives who’ve been mediating for many years might get out of it. Does it bring them new insights, or merely reflect back to them something they already know through their spiritual practices? Are the revelations it provides any different, any deeper?

Jonathan Foust, a meditation teacher, trainer, and former president of the Kripalu Center, a popular Massachusetts yoga and meditation retreat, gave it a go. “While they were exploring the psilocybin experience for those with terminal illness and chronic addiction, they found that virtually everyone who participated had a peak spiritual experience,” Foust says. “Now what effects would such an experience have on those who’ve dedicated a good proportion of their life to meditation? For me, the effect was profound, transformative, and deeply inspiring.

“Through many years of meditation, I’ve had many insights into the nature of reality. At the same time, I can’t deny the profound insights I had with this experience. It’s deeply corroborated my life purpose. From my perspective, as someone practicing the Buddhist tradition, the sense of ‘I’ and ‘my’ begins to fall away on psilocybin. You open to profound insights into how we perceive the world. I had a recall of some early traumatic experiences that was extraordinarily helpful for showing me how I viewed the world through a traumatized perspective.”

When he’s teaching meditation, he concentrates on suffering and the end of suffering. Because the drug reacquainted him with his suffering, he says, “It’s reinforced my commitment to try to make a difference.”

Manish Agrawal, an oncologist affiliated with Johns Hopkins, became interested in incorporating psilocybin in his work after seeing a series of videos of terminally ill patients in a psilocybin study. One features Tony, a middle-aged actor from New York with prostate cancer that spread to his lymph nodes. The diagnosis caused panic attacks and a fatalism that he says was oppressive. He thought about his illness all the time.

Once the psilocybin had taken over, Tony’s concerns faded away, and he felt himself transported to “a place of infinite space.” He says, “The most glorious part of this trip was this connection to this thing or power that was out there. It was incredible, and it took my breath away. I have an inner grounding now that’s just there. So the anxiety comes, and I deal with it and move on.” Since the experience, he says his outlook has remained positive—about both life and death. “My sense is that I’ll be going to that place that I was [on the trip], and there’s nothing wrong with going there.”

Agrawal regularly sees patients like Tony with advanced cancer. “For most, it’s a very hard stage of life,” he says. “I see a big need for people to make this time of suffering into something meaningful, but many of us never fully deal with our death until we’re faced with it.”

Agrawal imagines oncologists like himself becoming prescribers at psilocybin-assisted therapy clinics attached to cancer treatment centers. The experience would closely mirror the MDMA-psychotherapy protocol. But he believes psilocybin delivers a decidedly mystical experience, making it more appropriate for those at the end of life.

When asked if he hesitates to give an already physically and emotionally vulnerable cancer patient a powerful psychedelic drug, he demurs. “We oncologists give a lot of bad drugs to a lot of people. I prescribe chemo nearly every day. It’s important to put the benefits of drugs like psilocybin into context. They’re relatively safe, and the psychological impact is profound.”

What if clients get addicted?

Not everyone is enthused about the rebirth of psychedelic therapies. Some addiction professionals are concerned that their jobs will get harder if drugs like MDMA and psilocybin are relieved of their Schedule 1 status. They cite the reasons for which the government affixes that status to drugs in the first place: They’re thought to have no true medical use, carry a high risk of abuse, and be unsafe, even under a doctor’s supervision. These clinicians also raise concerns that psychedelics and empathogens are too potent, neurochemically messy, and potentially damaging for psychologically fragile addicts who need steady, long-term intervention.

The Fix, an addiction-community magazine, reports that heavy users of MDMA are at risk for high blood pressure, fainting spells, verbal and visual memory impairments, paranoia, sleep and panic disorders, and depression. Colleges like Brown University report that a third of users abuse the drug. Deaths from the drug are rare, but dangerous hyperthermia and brain swelling, exacerbated by the heat of dance clubs, has been reported.

Still, psychedelics and empathogens are rated markedly safer in harm comparisons with drugs like cocaine, heroin, alcohol, marijuana, methamphetamines, and benzodiazepines. These comparisons measure whether the drug causes harm to the self or the drug-taker harms others. In fact, MDMA ranks about a tenth as harmful as alcohol. It comes out marginally less safe than LSD and psilocybin, but less risky than anabolic steroids. According to last year’s Global Drug Survey, mushrooms containing psilocybin are the safest recreational drug of all. Of 12,000 users in the previous year, a mere 2% required medical intervention.

This question of risk is also on the radar of research institutions around the world looking to psilocybin-assisted therapy as a way to treat drug addiction. Among them is Johns Hopkins, which has been studying its effectiveness with long-term smokers. The University of New Mexico has been looking at its effects with alcohol addiction, the University of Alabama at Birmingham with cocaine, and the Imperial College of London with heroin.

Sara Lappan is working on the trials in Alabama, which are pairing cognitive behavioral therapy with psilocybin to treat cocaine addicts, many of whom are so undone by the cycle of addiction that they’re living on the street. Researchers suspect psilocybin may increase insight and motivation in addicts—and decrease their cravings. Lappan says that because it delivers a sense of awe, it can help users feel like a whole and connected being, not the thrown-away, isolated addict the people she sees often feel that they are.

Beyond the psychospiritual effects, Lappan explains that psilocybin has neurochemically important, anti-addictive properties. It’s an agonist and works on serotonin levels in the brain that affect dopamine levels, effectively blocking their uptake. Press-a-lever studies have been undertaken with mice using psychedelics. Those mice, like the ones who famously pushed their levers nonstop for hits of cocaine and heroin, have been given unrestricted access to LSD or psilocybin, but they turn away from their levers after the first experience, showing no interest in tripping again.

Bill Richards quips about the difference between an addictive substance like heroin and a psychedelic by saying “one is for forgetting, and one is for realizing.” He believes that most adults can handle such a distinction.

So far, a statistically significant number of those receiving psilocybin in the Alabama study have had longer periods of prolonged abstinence than their control group. And like the therapists in the other MDMA and psilocybin trials, Lappan has witnessed subjects undergo profound experiences on the drug. She’s held onto some who wept cathartically, one who spoke emotionally to a loved one who’d passed away, and another who took an oddly revelatory ride through his intestines. It’s a way of working that’s satisfyingly faster than the therapy she’s done before.

In July, psychiatrist Rick Strassman at the University of New Mexico called for caution in a Scientific American op-ed after a few members of the psychedelic research community had advocated relaxing government restrictions on the drugs. He wrote that outside the structure of specialized treatment settings, “psychedelics are no less abusable, acutely debilitating and liable to result in psychological damage—sometimes severe and unremitting—than they ever were.” Strassman is calling for the drugs to be removed from Schedule I so they can be administered under medical supervision and studied, but he wants a new schedule number to be implemented, one that will restrict them from sale to the general population, meaning only those with specialized training could administer them.

Stephen Delisi, assistant dean at the Hazelden/Betty Ford Graduate School of Addiction Studies and a psychiatrist with a background in trauma, confesses to liking how MDMA-assisted therapy for PTSD “promotes highly trained people doing an established program.” He says, “Psychedelics are different from other drugs of abuse: They’re not potent activators of the dopamine system. But we still need to hold the field accountable for maintaining fidelity to these evidence-based practices. What happens if clinicians begin to ignore the treatment protocol, or people feel they can begin treating themselves?”

Setting clients free

After seven decades, it seems that psychedelic-assisted psychotherapy will soon be upon us. The cloud of suspicion and disapproval hovering over it has dissipated, as it’s being ushered through by generations of government officials and scientists who may well have once taken—and liked—the drugs themselves. Given the right rollout, with clinics that hold up the researchers’ strict standards, it has the potential to revolutionize not only how we treat trauma, but eventually other common issues, like depression, anxiety, addiction, OCD, and eating disorders.

It’s been nearly 30 years since SSRIs came on the scene, but despite their ubiquity and their pairing with a variety of talk- and body-centered treatments, research shows that trauma, depression, and anxiety rates are soaring, and suicide numbers have dramatically spiked. Could the ineffable insights psychedelic and empathogenic drugs bring—the sense of spiritual grounding, of uber-connectedness, of vaporized defenses, of ultimately being part of something more than the terrible traumas and daily difficulties of our lives—finally deliver clients to the states of self-acceptance and belief in the less onerous world we ache to help them find?

Therapists affiliated with the MDMA-assisted psychotherapy trials all told me the same thing: They’re champing at the bit to do this work full time. In fact, the satisfaction of seeing people who’d lived with unremitting trauma and fear suddenly be free of it made the idea of returning to the ways they’d conducted therapy before simply unacceptable.

“What’s the alternative?” one woman asked me. “Keep working with someone for years when you know—you know—their lives could turn around in a couple of sessions?” Perhaps it really is time for this profession, as the blundering Timothy Leary once said, to “grow with the flow.”

Lauren Dockett is a senior writer at Psychotherapy Networker.

The post Therapy’s psychedelic renaissance appeared first on therapist.com.

What is main character syndrome?

Main character syndrome (MCS) is an informal term that describes a person who views themselves as the hero in their own life story. Their behavior reflects this mindset, and they may treat everyday experiences as if they were scenes from a movie or novel.

A certain amount of ego is healthy, and it’s not a bad thing to root for yourself. But MCS becomes a problem when it makes you feel like your experiences matter more than those around you.

Is main character syndrome real?

Main character syndrome isn’t a clinical diagnosis. It’s a social media phenomenon and cultural observation rather than an actual syndrome.

However, the term can describe real behavior patterns that impact mental health and relationships. For instance, some MCS traits overlap with conditions like narcissistic personality disorder (NPD).

That said, people can have “main character energy” without it meaning they have any mental health conditions. This is especially true in today’s social media-driven culture where self-documentation and personal narratives are common. For some people, MCS may simply be a way of making sense of their experiences that feels meaningful.

Main character syndrome examples

A person could be said to have main character syndrome for many reasons. There are certain behaviors and beliefs associated with the MCS mindset, and not all of them are negative.

Here are some signs that you may have MCS tendencies.

Viewing your life as a movie

• Expecting life-changing moments to occur at significant times
• Viewing personal setbacks as character development opportunities
• Believing coincidences are part of a larger narrative arc
• Frequently comparing your life to movies or books
• Feeling disappointed when life doesn’t follow expected “plot points”
• Mentally rehearsing reactions to future scenarios

Reading meaning into the mundane

• Overanalyzing interactions for deeper meaning or symbolism
• Making ordinary moments seem more significant than they are
• Creating elaborate scenarios in your mind about everyday situations
• Having dramatic internal monologues during routine activities
• Romanticizing mundane activities like grocery shopping or commuting

Needing to be the center of attention

• Viewing others as supporting characters in your personal narrative
• Seeking validation through carefully curated social media posts
• Assuming strangers are paying attention to your actions
• Crafting a certain aesthetic or personal brand

Main character syndrome versus narcissism

While MCS and narcissistic personality disorder (NPD) share some surface-level similarities,¹ they’re very different from each other. NPD is a diagnosable mental health condition that involves patterns of grandiosity, a need for admiration, and lack of empathy. MCS is as a playful, and often self-aware, form of self-focus.

People with MCS usually recognize they’re playing up the drama in their lives, and that everyone’s story has value. But people with NPD genuinely believe in their own superiority and may struggle to acknowledge others’ perspectives or needs.

People with main character syndrome can still maintain healthy relationships and empathize with others, even while viewing themselves as the protagonist of their life story. They understand that their “main character” perspective is just one way to interpret experiences, not an absolute reality. This is very different from NPD, where people might struggle to recognize their behavior’s impact on others or maintain meaningful connections.

If you’re struggling to maintain healthy relationships for any reason, consider consulting a mental health professional.

Main character syndrome psychology, explained

The psychological root of main character syndrome may be our natural tendency to center ourselves in our own life narratives. But realistically, any number of factors could influence its development and expression.

Some potential motivators for MCS include:

Personality traits: Traits like egocentrism,² extraversion, and a desire for attention may predispose people to developing narcissistic tendencies like those seen in MCS. These traits may make people care more deeply about how they appear on social media.

Cognitive biases: Several cognitive biases might reinforce MCS. For instance, the spotlight effect causes people to believe others are paying more attention to them than they actually are. Other cognitive biases include:

• Narrative bias, which can cause a person to seek patterns and stories in random events
• Self-serving bias, which leads people to attribute successes to personal qualities while blaming failures on external factors
• Confirmation bias, which involves noticing information that confirms a person’s own self-narrative while ignoring anything that contradicts it

Social media influence: The rise of social platforms has normalized constant self-documentation and personal storytelling. This environment could encourage people to craft and present their lives as ongoing narratives, potentially making a person’s MCS unhealthy.

Cultural factors: Modern media often emphasizes personal narratives and individual journeys, encouraging the idea that everyone’s life should be an adventure. This emphasis on personal growth and transformation can lead people to view their experiences through a cinematic lens.

Developmental stages: Teens and young adults may be more susceptible to MCS as it’s an important time in identity formation. During these formative years, viewing yourself as the protagonist can help make sense of life transitions.

Emotional regulation: MCS may help some people cope with stress and anxiety. By framing challenges as part of a larger journey, some people may find it easier to process difficult emotions and maintain optimism during tough times.

Do we all have main character syndrome on some level?

To some extent, we all have a tendency towards main character syndrome. We all have a desire to make sense of life’s seemingly random series of events. As human beings, we’re naturally inclined to view the world through our own lens and to place ourselves at the center of our narratives.

In moderation, this tendency can be a good thing. It allows us to create meaningful narratives and find purpose in our lives. A healthy sense of self-importance can contribute to self-confidence, motivation, and resilience in the face of challenges.

However, MCS can become problematic when someone starts acting like they’re the main character of not only their story, but everyone else’s. It can lead to narcissistic behaviors, a lack of empathy, and difficulty in maintaining healthy relationships.

How to deal with main character syndrome

If you think your MCS is becoming a problem, try to regularly practice self-reflection and mindfulness. Remember to view situations from the perspective of others.

Make conscious efforts to:

• Listen actively to others without relating everything to yourself
• Practice gratitude for the “supporting characters” in your life
• Recognize that everyone has their own complex story
• Limit social media use
• Share the spotlight and celebrate others’ achievements
• Challenge your internal narrative
• Develop empathy through volunteer work or community service
• Consider therapy if MCS impacts your relationships

Remember that having a main character mindset isn’t inherently negative. It’s about finding balance. A therapist can help you develop healthy coping strategies and maintain perspective while still honoring your experiences.

Visit our directory to find qualified mental health professionals in your area. They can help you identify and address challenging patterns in a healthy and constructive way.

The post Main character syndrome (MCS): What it is and how to deal with it appeared first on therapist.com.

Anxiety is a state of worry or tension that people experience as a natural response to stress. Though all kids get anxious at times, some have intense, persistent episodes that disrupt their daily lives. When this happens, it may be a sign of an anxiety disorder.

Anxiety can interfere with a child’s home life, friendships, or schoolwork. Anxiety disorders are the most common mental health disorders diagnosed in young people, affecting an estimated 1 in 12 kids and 1 in 4 adolescents.^{1, 2}

What types of anxiety are common in children?

Children can experience different types of anxiety, including:

• Separation anxiety is the worry or fear someone may feel when they’re away from a person they’re attached to, such as a parent. This type of anxiety is common and normal in babies and toddlers. But if intense separation anxiety lasts past early childhood, it may be a sign of a more serious condition called separation anxiety disorder.
• Generalized anxiety disorder (GAD) involves feeling serious anxiety about a wide range of concerns. A child with GAD may worry about the future, school, extracurricular activities, their social life, family issues, or past actions.
• Social anxiety is intense anxiety about interacting with other people.
• Obsessive-compulsive disorder (OCD) involves unwanted, recurring thoughts (obsessions) that lead you to do specific things (compulsions) to try to ease those thoughts. For example, a child might repeatedly count to a specific number because they believe something bad will happen if they don’t.
• Panic disorder may be diagnosed after a child has had at least two panic attacks—periods of sudden, extreme anxiety with physical symptoms like shaking, clammy hands, shortness of breath, and a rapid heartbeat.
• Selective mutism is a type of social anxiety where a child can’t speak in certain social situations, even though they talk freely in others.
• Phobias are extreme fears about specific objects, people, or situations. They may develop after a distressing experience, or a child might learn them from a parent or loved one with the same phobia. 

Signs and symptoms

Anxiety may be harder to recognize in kids because it can resemble other mental health conditions, such as depression. In addition, some children prefer to keep their fears and worries private, making symptoms harder to notice.

Some children with anxiety cry frequently, dread school or other events, or have physical symptoms like headaches, stomachaches, or fatigue. Other common signs of childhood anxiety include:

• Aggression
• Irritability, anger, or tantrums
• Clinginess
• Trouble at school
• Appetite changes or digestive problems
• Trouble concentrating
• Sleeping too much or too little
• Social withdrawal
• Restlessness

Why do children get anxiety disorders?

A variety of factors can play a role in why some children develop anxiety disorders:

• Anxiety disorders may have underlying genetic causes.
• Difficulties coping with stress can lead to an anxiety disorder.
• A child may pick up anxious beliefs, thoughts, and behaviors from the people around them.
• Traumatic experiences—like abuse or neglect, a loved one’s death, frequent moves, growing up in poverty, being bullied, or getting seriously ill or injured—can increase a child’s risk.
• Other mental health concerns, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), can increase risk.

How to help

Childhood anxiety can be treated in a number of ways. Talk therapy is often recommended. Medication may sometimes be prescribed, either alone or in combination with therapy. In all cases, parents, caregivers, and loved ones can help children learn and practice everyday coping techniques.

Therapy

Cognitive behavioral therapy (CBT) is a common, effective treatment for anxiety in children. In CBT, a child shares their thoughts and feelings while the therapist helps them learn what anxiety is, how to recognize its signs, and how to replace negative or flawed thinking patterns with more positive, helpful ones.

Another common form of treatment is exposure therapy, in which a therapist helps the child gradually face their fears in a controlled, safe way. Over time, the child learns to interrupt and regulate their emotional response in situations that cause fear and anxiety.

Two other types of treatment for anxiety are acceptance and commitment therapy (ACT), which helps kids learn to stay in the moment and observe their thoughts and feelings without judgment, and dialectical behavior therapy (DBT), a highly structured treatment method that helps children learn to manage intense feelings.

Family therapy can also be beneficial for helping everyone in a family communicate better and learn how to navigate a child’s anxiety in a healthy, supportive way.

Medication

Selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant, are usually the first medication choice for childhood anxiety. Benzodiazepines may be used for short time periods, but they’re less commonly prescribed because they can be addictive. Combining medication with talk therapy may be more effective than using medications alone.

Coping with childhood anxiety

While it may be tempting to avoid situations that make a child feel anxious, avoiding them doesn’t allow the child to address the root causes of their feelings.

It’s useful for kids to develop the ability to manage some level of anxiety. Parents and guardians can help by:

• Listening to the child’s thoughts and feelings, trying to understand them, and acknowledging that the child’s feelings matter
• Helping the child identify what triggers their anxiety
• Modeling confidence for children in situations where they might be anxious
• Breaking down overwhelming tasks into smaller, more manageable steps
• “Previewing” experiences with children by talking through them and explaining what the child can expect
• Providing confidence-building opportunities (like household tasks) and acknowledging their efforts
• Slowly exposing children to anxiety-producing situations and helping them manage their anxiety in tolerable amounts

It’s important to avoid minimizing a child’s anxious feelings (“That’s not something you should worry about!”) or labeling certain emotions, like fear or worry, as “bad” and others as “good.” Compassion, understanding, and empathy can help a child feel supported as they learn to face their fears.

Some specific techniques that can help children tolerate and manage anxiety include:

• Practicing meditation and mindfulness
• Doing deep breathing exercises
• Putting their feelings into words or expressing them in art
• Tightening, then relaxing all their muscles
• Imagining themselves in a safe, happy, comfortable place
• Focusing on their senses using the 5-4-3-2-1 technique: noticing five things they can see, four things they can touch, three things they can hear, two things they can smell, and one thing they can taste
• Taking a walk

In addition to the ideas above, you can help a child develop a strong baseline for managing anxiety by encouraging them to get good sleep and nutrition, spend time with friends, and get regular physical activity.

Find help today

If your child is struggling, a therapist who specializes in childhood anxiety can help. Browse our directory to find a licensed mental health professional near you.

If you or your child is in crisis, call or text the free, confidential 988 Crisis Lifeline at 988. It’s available 24 hours a day, seven days a week.

The post Anxiety in children appeared first on therapist.com.

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 Health 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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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 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.

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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 Health 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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Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that allows you to work through heightened emotions or traumatic experiences. Psychologist and educator Francine Shapiro, PhD, created and developed the method in the late 1980s, and since then therapists have used it to treat posttraumatic stress disorder (PTSD), bipolar disorder, anxiety, and more.

In 2008, author and clinical psychologist Laurel Parnell, PhD, director of the Parnell Institute, created attachment-focused EMDR (AF-EMDR), a modified approach that infuses traditional EMDR with the principles of attachment theory. While both EMDR and AF-EMDR can treat trauma, AF-EMDR also helps you build new resources for healing, growing, and connecting with others.

What is attachment theory?

Attachment theory is the idea that that our very early bonds with primary caregivers shape our lifelong development. Those early experiences also lead us to develop one of four attachment styles, or ways of bonding with people:

• Secure attachment develops when an infant knows their primary caregiver will provide comfort, understanding, and safety consistently in times of stress.
• Anxious attachment develops when children form worried, insecure patterns of interacting after getting inconsistent care from their primary caregiver.
• Avoidant attachment occurs when children have learned their primary caregiver can’t meet their needs reliably, so they rely on themselves instead.
• Disorganized attachment describes children who demonstrate a combination of avoidant and anxious attachment styles.

When we don’t form secure attachments in childhood, it can lead to problems in personal relationships, as well as conditions including:

• Depression
• Guilt, self-hatred, and low self-esteem
• Anxiety and panic attacks
• Compulsive and obsessive behaviors
• Emotional numbness
• Frightening thoughts and excessive worrying
• Difficulty concentrating
• Insomnia and other sleep disturbances
• Hypervigilance

AF-EMDR and other types of attachment-based therapy can treat these and other common attachment-related challenges. An attachment-based therapist’s goal is to create a safe, secure bond with you, then help you change unhealthy patterns.

How does EMDR work?

In EMDR, a therapist uses a technique called bilateral stimulation (BLS) to help you explore and work through traumatic memories. BLS is believed to help the left and right sides of your brain communicate more efficiently, similar to what happens when you’re in REM sleep.

BLS methods can include:

• Following your therapist’s finger from left to right with your eyes
• Visually tracking dots on a screen as they move from left to right
• Listening to soft tones through headphones, alternating from left to right audio channels
• Squeezing a ball in one hand and then the other
• Holding buzzers in each hand that vibrate back and forth
• Slow, rhythmic tapping on the knees or shoulders

EMDR specialists work with clients to safely revisit the thoughts, feelings, and beliefs associated with their traumatic memories. Once the memories are accessed, the therapist adds BLS. Bilateral stimulation seems to encourage rapid processing in the brain, allowing the client to work through the trauma more effectively.

Following treatment, Parnell says, you still remember what happened but it’s less distressing: “It feels like the moment or memory happened in the past, and you’re no longer activated by that trauma.”

The limitations of EMDR

Traditional EMDR works very well on many people, says Parnell, but it can have limitations when a client has attachment difficulties or chronic relational trauma.¹ Parnell’s interest in overcoming those limitations led her to develop AF-EMDR.

For EMDR to be successful, Parnell says, the recipient has to be able to tolerate intense feelings. Research has shown that people with secure attachment styles have an easier time navigating high-intensity emotion than people who are insecurely attached.² EMDR also requires that you form a strong bond with your therapist, which can be challenging if you struggle with secure attachment.³

Principles of attachment-focused EMDR

According to the Parnell Institute, AF-EMDR has five basic principles:⁴

Client safety: The clients’ physical and psychological safety are paramount. This may mean extending how long a client needs to talk and get comfortable with their counselor before the EMDR practice begins.

The importance of the therapeutic relationship: Practitioners recognize that forming a strong bond with their clients is foundational and essential.

Client-centered practice: Practitioners aim to be flexible and can adapt according to the needs of their clients—for instance, using the client’s preferred type of BLS. Therapists should also take cultural norms into account. “People from some cultures don’t feel comfortable speaking negatively about their parents, for example,” says Parnell. “In that case, we’ll work in a different way to talk about difficult memories.”

Repairing deficits: Practitioners work to find out what psychological or developmental resources the client is missing and help fill in those gaps.

Modified EMDR (EMDR-M): Practitioners use advanced techniques to help clients access memories and repair early childhood wounds.

Learning to repair old wounds

What makes AF-EMDR stand out is the level of repair it aims for. Using their imaginations, clients are asked to fill in the gaps they perceive were left by a challenging childhood. Here’s what that process can look like.

If a client says they wish they’d had a nurturing and present father figure, Parnell will ask them to imagine that parent. “What are his different qualities? What would he look like? Describe and imagine his physical sense and presence,” she explains. “Once we have an image of him, we tap it in—meaning we use BLS and form new neural networks carrying the image of this father.”

The client then revisits moments from their childhood and adolescence when having that father figure would have been important. “I ask the client to imagine how they feel in that moment, whether it’s loved and supported or just happy,” Parnell says. “Then we tap those feelings in.”

New neural networks created by this process override the gaps left by the client’s initial deficit, easing their feelings of hurt, inadequacy, and loss. The sense of support and love the client never received from a father figure in real life then becomes a resource for them throughout their healing journey.

Find support now

If you’re interested in working with a therapist who specializes in EMDR, attachment-focused EMDR, or another attachment-based therapy, search our directory to find a licensed professional near you.

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What is somatic therapy?

Somatic therapy is a holistic treatment approach that addresses both the mind and the body. It prioritizes the mind-body connection, exploring the effect of our physical health on our mental health and vice versa.

People go to therapy to address, change, or better understand their thoughts, emotions, behaviors, relationships, and physical sensations. Some approaches, like cognitive behavioral therapy (CBT), address thoughts in order to affect feelings and behaviors. These therapies work from the “top down,” trying to enact change by engaging with our cognitive processes first.

Somatic therapy, on the other hand, works from the “bottom up.” This means it addresses your physical sensations and symptoms to help you explore how stress or trauma may be affecting you. This groundwork can lead to physical, emotional, and even spiritual healing.

How the body responds to trauma

When we’re confronted with a dangerous or life-threatening situation, our bodies prepare us to survive the perceived threat with a host of physical changes. Our heart rate speeds up, our lung capacity increases, our muscles tense, and adrenaline flows through our bodies. These changes represent our “fight-or-flight” response in action.

But “fight” and “flight” aren’t the only two possible responses to danger. Other options include “freezing” or “fawning.” When we freeze, we may stay still, avoid making decisions, or feel as if we’re outside our own bodies. When we fawn, we try to please the person threatening us in order to avoid or reduce harm or conflict.

When we fight back or flee in response to a threat, our bodies use up the energy and resources that were released for our survival. But freezing and fawning don’t engage the body in the same way. The energy built up from a stress response lingers in the body, unused and unprocessed. As a result, we may be left in a perpetual state of hypervigilance, which can harm our health. Even if our physical trauma response slows down in the moment, it may resurface later through other physical symptoms.

What conditions can somatic therapy treat?

Somatic therapy is used to treat mental health concerns such as:

• Anxiety
• Depression
• Addiction
• Trauma
• Stress
• Posttraumatic stress disorder (PTSD)

This type of therapy can be helpful for physical conditions, including chronic pain, insomnia, and sexual dysfunction.

Common types of somatic therapy

Somatic experiencing

Somatic experiencing (SE) allows your nervous system to process and resolve the physical effects of trauma.¹ It’s meant to help you release energy that wasn’t used during your body’s trauma response. Techniques practiced by SE therapists may focus on:

• Resourcing: Drawing on positive memories to help you stay calm as you reprocess your trauma
• Titration: Reprocessing your traumatic experience slowly, step by step, as a way to expand your “window of tolerance” for stressors and trauma triggers
• Pendulation: The natural expansion and contraction of all things; shifting attention between these different aspects of experience may help people move from a fixed state to one of increased flow or capacity

Sensorimotor psychotherapy

Sensorimotor psychotherapy is similar to SE in that it guides the body through a trauma response.² But the two methods have different foundations.

While SE tries to help you release unused energy from a trauma response, sensorimotor psychotherapy operates under the belief that your body’s trauma response is unfinished. The idea isn’t that your leftover energy needs to be discharged, but rather that your body’s trauma response needs to be completed for healing to begin.

Sensorimotor psychotherapy follows a three-step process:

1. Stabilization and symptom reduction: Your therapist will help you feel safe and relaxed before engaging in sensorimotor psychotherapy.
2. Processing: Your therapist will lead you through your traumatic experience and help you notice and regulate your physical and emotional responses.
3. Integration: To complete the trauma response, your therapist will help you avoid freezing or fawning. Instead, you may say or do things you wish you’d done during the original trauma. For example, if you’re reprocessing a physical assault where you didn’t speak, you might say, “Stop!”

The Hakomi method

The Hakomi method is a mindfulness-based approach to somatic therapy. Its central idea is that each of us has what’s called our “core material.” This material is made up of thoughts, feelings, and beliefs, and it affects our personality even if we’re unaware it exists.

The Hakomi method allows people to become aware of their core material and accept, challenge, or transform it. This is accomplished through the method’s five core principles:³

1. Mindfulness: Living in the present moment allows us to observe, meditate, and reflect on our beliefs from a place of compassion and nonjudgment.
2. Nonviolence: It’s important to support (rather than try to overcome) a person’s defensive mechanisms in an effort to learn from them.
3. Mind-body integration: The mind and the body both reveal our core material, and they work together to influence our behavior.
4. Unity: Each person contains their own internal system of distinct parts while also operating as part of the larger system of the world.
5. Organicity: The self is naturally bent toward healing, wisdom, and wholeness.

Is EMDR somatic therapy?

Eye movement desensitization and reprocessing (EMDR) is a helpful therapy often used to process trauma, but it’s not a somatic therapy. While a therapist may incorporate somatic interventions into EMDR treatment, they’re not a requirement.

Somatic therapy techniques

Across the various types of somatic therapy, there are a number of common techniques (called “interventions”) clients are often taught to use. These include:

• Grounding: Using your senses to fully experience the present moment, which calms the nervous system
• Mindfulness: Observing your thoughts, feelings, and behaviors in the moment, without judgment
• Self-regulation: Noticing, managing, and adapting your emotions and behaviors to suit different situations
• Movement and processing: Listening to your body in order to gain insight and solve problems

Certain forms of exercise, such as yoga, Pilates, and dance, can also be adapted to incorporate somatic interventions.

Is somatic therapy evidence-based?

The effectiveness of somatic therapy is a topic of ongoing research, but recent studies have shown promising results, especially for treatment of trauma and PTSD.⁴

Keep in mind that while somatic therapy can be helpful for some people, it may not be right for everyone. In particular, some somatic therapy interventions that use physical touch to release tension may not be suitable for people who’ve been sexually abused or assaulted.

Find treatment now

If you’re in crisis and need support right away, call or text the 988 Crisis Lifeline at 988 anytime.

To find out how the mind-body connection may be able to help your healing journey, browse our directory to connect with a somatic therapist near you.

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What is high-functioning anxiety?

“High-functioning” anxiety is a trendy but unofficial term used to describe people maintaining successful careers, relationships, and outward appearances despite experiencing anxiety. High-functioning anxiety is an informal description, not a diagnosis like generalized anxiety disorder (GAD) or social anxiety disorder.

The social media effect

While mental health awareness has reduced stigma, the popularization of terms like “high-functioning anxiety” on social media has also created concerns.¹

Many viral posts present oversimplified checklists of common behaviors (like perfectionism or people-pleasing) as definitive signs of anxiety disorders. This has led to what some experts call an “overinterpretation cycle,” where people self-diagnose based on relatable but generic symptoms.²

Clinical anxiety disorders differ from everyday anxiety by being more severe, lasting longer, and significantly disrupting daily life. Casual use of clinical terms can minimize serious mental health conditions while making normal feelings seem like signs of illness.

If you’re experiencing anxiety symptoms, avoid self-diagnosing based on content online. Instead, consult a licensed mental health professional who can properly assess your situation and provide evidence-based support.

Why it’s difficult to spot “high-functioning” anxiety

Common misconceptions about anxiety can make it challenging to recognize and understand.  Some people believe anxiety appears as visible distress or that anxious people can’t maintain successful careers and relationships. These myths can prevent people from seeking help or receiving appropriate support.

Some widespread myths about anxiety include:³

• That anxious people must avoid all stress
• That anxiety can be cured through lifestyle changes, like diet and exercise
• That anxiety disorders always stem from childhood trauma
• That medication is the only effective treatment
• That constant reassurance and help avoiding triggers is beneficial

The reality is more nuanced:

• People with anxiety can face challenges and build successful lives
• Avoiding anxiety may reinforce it rather than help
• Treatment can focus on developing skills to manage current thoughts and behaviors
• Many forms of treatment can be effective

Rather than looking for a single picture of what anxiety “should” look like, it’s important to understand that it appears differently in different people.

Some may experience panic attacks, while others might channel their anxiety into perfectionism. The huge variety in how anxiety can present is exactly why professional assessment is so important. Mental health professionals are trained to recognize anxiety’s many forms and distinguish between normal stress responses and clinical concerns.

Signs and symptoms of anxiety

As we’ve noted, high-functioning anxiety is not a medical diagnosis. There are no symptoms of high-functioning anxiety specifically.

But looking at anxiety in general, there are many clinically recognized symptoms. These symptoms typically fall into several categories:⁴

Cognitive symptoms

• Difficulty focusing
• Fear of losing control
• Frightening thoughts
• Poor memory or confusion
• Hypervigilance for potential threats
• Fear of judgement from others

Physical symptoms:

• Fast heart rate or palpitations
• Feeling short of breath
• Feeling sweaty
• Having hot flashes or chills
• Trembling or shaking
• Muscle tension
• Dizziness or lightheadedness
• Upset stomach
• Chest tightness or pressure

Behavioral symptoms:

• Avoiding challenging situations
• Asking for reassurance often
• Restlessness or agitation
• Difficulty speaking
• Looking to escape stressful situations
• Freezing up when overwhelmed

Emotional symptoms:

• Feeling nervous or tense
• Being easily startled or “jumpy”
• Feeling fearful or frightened often
• Feeling impatient or frustrated

Some people who identify as having “high-functioning” anxiety report specific experiences that include:⁵

• Appearing calm while experiencing intense internal worry
• Using perfectionism as a coping mechanism
• Taking on excessive responsibilities to prove their worth
• Struggling with work-life boundaries
• Experiencing imposter syndrome
• Feeling exhausted from trying to look put together

Once again, it’s important to remember that these signs and symptoms should not be used for self-diagnosis. If you’re experiencing anxiety symptoms—regardless of how well you’re managing daily tasks—you should consult a mental health professional. This is the only way to receive proper assessment, diagnosis, and treatment.

High-functioning anxiety and well-being

High-functioning anxiety, while not a recognized disorder, has entered the public conversation. A recent exploratory study investigated the concept of high-functioning anxiety and its potential impact on work performance.⁶

The study found that news reports and research support several potential anxiety-related work performance strengths, including:

• Increased productivity and motivation
• High-quality work
• Enhanced creativity

However, these potential advantages can come with significant costs to well-being. Even when people maintain their daily responsibilities, chronic anxiety can take a severe toll:⁷

• Small mistakes feel like personal failures
• Excessive time is spent on routine tasks
• Responsibilities are hard to delegate
• Overwork and risk of burnout are high
• Nothing feels “good enough”
• Imposter syndrome remains despite success
• There’s internal pressure to maintain a perfect image
• Fear of judgment creates isolation

Because anxiety can be closely tied to sought-after qualities like productivity and organization, it’s often difficult to identify when normal stress crosses a line.

Remember that success at work or school doesn’t cancel out anxiety’s impact on well-being. If anxiety is affecting your life, seeking professional help isn’t a sign of weakness. It’s a step toward better mental health and more sustainable achievement.

How to cope with high-functioning anxiety

High-functioning anxiety treatment options depend on symptoms and severity. Some people may require therapy or medication, while others may be able to manage their symptoms through lifestyle adjustments. A mental health professional can work with you to create healthy coping strategies and determine which treatment options would work best for you.

There are steps you can take to manage typical stress in your daily life. Professionally, these steps include:⁸

• Practicing time management with realistic to-do lists and priorities
• Setting clear boundaries around work hours and email checking
• Communicating with supervisors about workload when needed
• Taking regular breaks, including short walks or breathing exercises
• Identifying trusted colleagues who can provide support
• Staying organized to prevent crisis situations
• Avoiding taking on too many commitments

In your personal life and everyday routine, managing stress may look like:

• Keeping a thought diary to identify anxiety triggers
• Practicing mindfulness and meditation techniques
• Challenging perfectionist thought patterns
• Celebrating accomplishments before moving to the next task
• Accepting that some anxiety is normal and manageable
• Learning to recognize the difference between productive and harmful motivation
• Maintaining consistent sleep patterns, exercising regularly, and eating a balanced diet
• Limiting caffeine and alcohol
• Scheduling regular vacation time
• Making time for enjoyable activities outside of work
• Practicing self-care without guilt

If life feels overwhelming, consider working with a mental health professional. They can help you develop coping strategies and offer support. Visit our directory to find a qualified therapist in your area who specializes in anxiety and stress management.

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What is religious trauma? 

Religious trauma occurs when a person’s experience in their faith-based community is stressful, degrading, dangerous, abusive, or otherwise harmful. Many forms of religious trauma are not associated with specific events but instead accumulate over a long period of time through harmful messages enforced by their community.

For example, some LGBTQIA+ people  grow up in conservative religious communities who believe their identity is sinful. In this case, religious trauma can stem from the internalized message that who you are somehow puts your relationship with your god, your family, and your community at risk. 

In some cases, specific events are interpreted through the lens of spirituality and come to carry religious weight. This can unfold over several stages: 

1. A person experiences a trauma: The trauma may be directly related to religion (such as an abuse of power by a religious leader) or it may be indirectly related or unrelated, such as a divorce in the family. 
2. The trauma has religious implications: The trauma is shaped by, and processed through the lens of, a person’s religion. For example, someone going through a divorce may feel pressure from their faith community to “work harder,” make unwise compromises, or even tolerate abuse to keep the marriage from dissolving.
3. The response of the religious community may retraumatize: Religious leaders may ignore or outright deny reports of physical, sexual, emotional, or spiritual abuse. The religious community may ostracize the victim of a trauma, minimize their experience, or unfairly assign blame. The victim may avoid sharing their experience for fear of what it could mean for their place in the faith community. 

Religious trauma may also occur when a person decides to leave their religious community. Even when it’s a healthy choice, it can be disorienting for someone whose life has been guided by a certain set of beliefs, rules, and expectations.  

Leaving a religious community may result in strained, damaged, or even broken relationships with friends, family, or partners. Sacrificing an entire worldview, community, and support system—which may result in trauma of its own—can be an incredibly difficult step.

What is religious trauma syndrome (RTS)? 

Although not yet added to the Diagnostic and Statistical Manual of Mental Disorders, the term “religious trauma syndrome” (RTS) is gaining traction with some therapists, and other experts, to describe the negative mental health effects of unhealthy or harmful religious experiences. 

For our purposes, “religious trauma” and “religious trauma syndrome” offer similar descriptions and are used interchangeably.

What is spiritual abuse? 

Abuse is the harm or mistreatment of another, often for the purpose of exerting power or control. Spiritual abuse occurs when a person’s religion or spirituality is used for these purposes. 

Signs of spiritual abuse 

If you feel you may have been subjected to spiritual abuse, ask yourself: 

• Has someone ever used or attempted to use my religious beliefs or practices to manipulate me into certain actions? 
• Am I free to practice my faith how I see fit? 
• Has a parent or partner ever tried to force their religion on me? 
• Have my religious leaders ever tried to justify harmful behavior using religious teachings? 
• Have my religious leaders ever recommended I stay in an abusive or harmful situation in order to grow closer to my god? 
• Do I have freedom of choice in how I live my life, raise my children, interact with my partner, and so on? Or are those decisions made for me by my religious leaders? 

Spiritual abuse vs. religious trauma: What’s the difference? 

These experiences are closely related, but they are distinct. 

Spiritual abuse is an interpersonal experience between people within a faith-based community. Often the abuser is a religious leader attempting to control or manipulate someone lower in the religious hierarchy (such as a volunteer, community member, or visitor).

Religious trauma more broadly refers to the experience between a person and their religion, and the resulting impacts. This type of trauma is not necessarily linked to one specific person, but to a pattern of treatment or messaging over time. 

10 signs and symptoms of religious trauma 

Trauma can have far-reaching impacts on many areas of your life. Signs of religious trauma can include: 

1. Self-esteem issues

Some religious movements contain the idea that certain people are inherently less worthy than others. This can elevate certain identities over others, leading to marginalization, discrimination, and oppression. This may result in low self-esteem when internalized. 

2. Shame 

Shame occurs when you equate an action with who you are as a person, causing you to view yourself negatively. Unhealthy religious communities may use shame as a way to influence and control others. Instead of extending forgiveness to themselves and others, people in shame-based religions may cover up or deny anything that could be considered “wrong” by their community. 

3. Perfectionism 

Some religious communities may identify certain actions or behaviors as indicative of a person’s moral value. They may promote certain careers or types of families as spiritually superior. This can result in perfectionism, which is often accompanied by high levels of anxiety and stress, as well as the setting of unrealistic goals. 

4. Hypervigilance 

Some religions paint a picture of a vindictive god who punishes people whenever they fall short. Others promote apocalyptic ideas and suggest that a violent end to the world is near. These ideas may lead to heightened levels of anxiety, resulting in hypervigilance. Hypervigilance is a constant state of anxiety meant to protect a person from perceived or actual threats of harm. 

5. Difficulty with making decisions 

People who experience religious trauma may be accustomed to making decisions in the context of a certain doctrine or hierarchy. If they choose to change their relationship with these institutions or leave them entirely, they may struggle with autonomy and making their own decisions. 

6. Loss of community 

For many, religion provides community. If a person changes or leaves their faith, they may lose contact with many friends, family members, and acquaintances.  

Some people who leave their religious community may experience a season of loneliness and isolation. It can be intimidating to rebuild a community, especially if people outside their faith were often labeled as flawed or untrustworthy. 

7. Lack of boundaries 

Being part of a religious community often means accepting some amount of feedback regarding how you live your life. Many faith communities also have expectations for volunteering and service.  

These can be considered healthy aspects of religion, as long as boundaries are clear and respected. When boundaries are blurred or nonexistent, it can affect how a person acts in the rest of their life. They may have a hard time saying no to certain tasks or prioritizing self-care. 

8. Delayed milestones 

Purity culture is a religious concept that focuses on ideas about gender, sexuality, sex, virginity, marriage, and procreation. Religions that rely heavily on purity culture may scrutinize or monitor mixed-gender interactions and socially separate kids based on their assigned sex. 

Additionally, LGBTQIA+ people in particular may not have the chance to experience social milestones, such as first dates or kisses, until adulthood. This delay can be frustrating, and some people who had overly restricted lives as teenagers may make impulsive or reckless decisions as adults if they leave their religious communities. 

9. Sexual dysfunction 

Religions that overemphasize purity culture may not prepare their followers for healthy sex lives, even in the context of marriage.  

Some people who struggle with religious trauma practice abstinence until marriage and may feel dirty or guilty when engaging in sex. People from religious backgrounds that preach traditional gender roles may struggle to confront realities about desire, drive, and performance that don’t align with what they learned. Some religions teach about sex in a way that centers obligation instead of consent, resulting in unhealthy, harmful, or even criminal sexual behaviors. 

10. Mental health disorders 

Like other forms of trauma, religious trauma can cause, contribute to, or otherwise worsen mental health disorders. Mental illnesses commonly associated with trauma include: 

• Posttraumatic stress disorder (PTSD) 
• Depression 
• Anxiety 
• Obsessive-compulsive disorder (OCD) 
• Eating disorders 
• Addiction 

If you suspect that you or someone you love may be struggling with religious trauma-related symptoms, know that help is available. A religious trauma therapist can assess your symptoms and provide specialized support.

What causes religious trauma? 

Religious trauma can occur in authoritarian institutions set up in ways that perpetuate injustice or allow harmful behavior. The divine power that some religions claim to possess is often so meaningful to people’s lives that they’ll concede to actions and behaviors they wouldn’t otherwise tolerate. 

Psychologist Marlene Winell, PhD, who coined the term “religious trauma syndrome,” teaches that religion can be traumatizing in two distinct but often overlapping ways: 

1. Enduring the trauma/spiritual abuse 
2. Leaving the faith community 

A person may have lived their entire life in an unhealthy religious community but not become aware of its traumatizing impact until they leave that community.  

Similarly, a person may experience trauma in a religious context, leave their faith community, then feel overwhelmed by the traumatic experience of having to rebuild a life outside of the context of their faith. Both are real sources of trauma that often interact with each other in a person’s journey to spiritual healing. 

Though any religious context can lead to religious trauma, Christianity in particular has been the focus of research that suggests certain interpretations of its doctrines create climates of shame.¹

Is religion necessarily traumatic? 

Religion is not always traumatic. It is often associated with a number of mental health benefits, including: 

• A sense of community and belonging 
• Reflective practices that encourage rest and meditation  
• Love and support for those who are marginalized, grieving, or struggling 
• Emphasis on moral values, such as love, compassion, forgiveness, and empathy   

Trauma can happen in all kinds of groups, from families and peer groups to schools and workplaces. Religious institutions aren’t exceptional in this sense. The way people within an institution respond to trauma—and what steps they take to prevent it from happening in the first place—is what matters most. 

Healing from religious trauma 

Religious trauma therapy 

If you’ve experienced religious trauma, you are not alone. Trauma of any kind can be difficult to process without the help of a mental health professional. Many therapies have proven helpful for survivors of trauma, including religious trauma, such as: 

• Cognitive behavioral therapy (CBT) 
• Cognitive processing therapy (CPT) 
• Eye movement desensitization and reprocessing (EMDR) 
• Prolonged exposure therapy 
• Radically open dialectical behavior therapy (RO-DBT) 
• Somatic therapy 
• Faith-based therapy 

If you’re looking for support in the form of religious trauma counseling and therapy, browse our directory to find a professional near you.

Other tips for recovery 

Some mental health remedies rely more heavily on individual rituals and reflection than others. These methods can help people who are (or were) religious heal in ways that feel familiar to them.

Mental health practices that may be comforting or accessible to people of a more spiritual mindset include mindfulness, meditation, and journaling. 

While self-help strategies can be valuable supplements to healing, therapy for religious trauma provides support that self-care alone cannot replace. A qualified therapist can help you process complex emotions, develop healthy coping mechanisms, and rebuild your sense of self in ways that individual practices may not fully address.

The post Religious trauma: Definition, signs, causes, and treatment appeared first on therapist.com.

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.

In the 1989 movie version of Stephen King’s “Pet Sematary,” one character has a sister named Zelda who was locked away as a young woman, and the memory of her haunts the rest of the cast. I used to be absolutely horrified by Zelda. For years, I couldn’t even think about her without having nightmares.

Recently I came across an image of Zelda. I felt a familiar jolt through my body, and panic came over me. I quickly got rid of the image, but a few weeks later felt drawn to it again. Instead of terrifying me, the jolt felt exciting—like the kind of rush you might feel on a roller coaster.

These quick hits of adrenaline motivate many of us to seek out scary experiences like horror films. But what does regular exposure to fear do to our mental health? Are we just having fun, or could be we doing ourselves any damage?

The difference between fear and panic

Clinical psychologist Kevin Chapman, PhD, who specializes in treating phobias, explains it this way: “Panic and fear are the same exact clinical phenomenon,” he says. “The difference is that with panic, we experience a false alarm—and with fear, we experience a real alarm.”

“Fear is a response to present danger, which triggers our fight, flight, or freeze response,” continues Chapman. For example, if you’re threatened physically, you may instinctively use fight or flight. If you spot a mountain lion on a hiking trail, you might freeze as a protective measure.

When you watch horror, Chapman says, “You’re experiencing these responses somewhat out of context.” Your body may have a flight response, but the danger isn’t real, so there’s no resolution. Instead you can wind up with a prolonged emotional response, which may have a negative impact on your mental health.

Your physical health might take a hit, too: Long periods of fear can have lasting effects such as high blood pressure, headaches, or a weakened immune system.¹

What’s behind our fear response?

It’s Friday night, and I’m streaming an episode of “The Office” while my kids cuddle up in the dark watching “Get Out” for the thousandth time. I sometimes envy their ability to enjoy horror. I wish I could feel that rush and know it’ll fade by bedtime.

If you’ve ever wondered why your friends and family have a different reaction to horror than you do, Chapman says there are a few personality traits at play.

• Neuroticism: Some people have a personality trait called neuroticism, meaning the tendency to have negative feelings like anger, anxiety, self‐consciousness, irritability, emotional instability, and depression.² Chapman says that having this trait dramatically changes how people handle being scared. They tend to “experience negative emotions coupled with the perception that ‘the world around me is threatening and I’m ill-equipped to cope with it,’” he says. If you’re exposed to something scary and you suffer from neuroticism, you’ll most often respond negatively. When coupled with horror, this outlook is a recipe for anxiety.
• Extroversion: This personality trait, also called extraversion, includes characteristics such as sociability, assertiveness, high activity level, positive emotions, and impulsivity.³ If you’re a “high extrovert,” Chapman says, “you have a tendency to experience more positive emotions”—so you might have an easier time processing horror. “Extroverts like feeling a high level of arousal and don’t view it as frightening,” he explains.

According to Chapman, our response to fear can also change with life experience. The way you react to certain types of horror or a specific kind of character can depend on what Chapman calls your “memory associations.” If you’ve suffered trauma related to physical violence, for example, exposure to a violent movie can trigger a trauma response.⁴

Can you change your fear response?

Yes, Chapman says, if you work at it through exposure: “Exposure means confronting a situation enough times not necessarily so that the distress reduces, though that happens. It’s more about learning a new nonthreatening association attached to that stimulus.”

For instance, if you prepare yourself to learn something new when you watch horror, says Chapman, “Your brain and your limbic system attach new memories, and you interpret that arousal differently with that goal in mind.”

After talking with Chapman, I decided to try a little exposure on my own. My goal was to change the way I thought about the character of Zelda. Instead of picturing an evil force locked in an attic, I tried to think of her as a person suffering from spinal meningitis, as King wrote her. My anxiety didn’t disappear, but I did make it through her entire scene. This is progress.

The upsides of fear

If you’ve watched enough horror movies, you know what to do when you hear a noise outside: Do not, under any circumstances, go out there alone to investigate. What else can we learn from horror? Can that jolt we get from being scared have any positive effects?

Fear can protect us. “You can think of fear as something that helps you navigate your world successfully, just like anger, anxiety, or sadness,” says Chapman. “Fear, like all those other core emotions, serves an adaptive purpose, not a harmful one, and it can protect us.” Redefining fear as a safety measure can help it feel less threatening.

A bit of anxiety can help us think more clearly. That jolt I’ve mentioned comes from a surge of anxiety, and some of it can be beneficial. In a classic study measuring performance in relation to arousal or anxiety, researchers found that individual performance tends to improve with a certain amount of increased stress—but beyond that amount, performance decreases.⁵

Fear can help us learn from others. Humans are social creatures, and sometimes being in a scary situation with another person can help change your reaction to it. Think about watching a horror movie with friends and reaching for someone’s hand at a scary moment. If that person seems more at ease than you do, those feelings can be contagious and lessen your fear as well.⁶

Why can I watch true crime and not horror?

Horror movies are hard for me, but I’m fine with just about anything involving true crime. And I’m not alone: People are watching more true crime than ever before.⁷ What’s the distinction?

“The difference between a true-crime scenario or documentary versus a horror movie is there’s no element of surprise,” Chapman says. “There are no jump scares. It’s all very predictable and has nothing to do with you. So it’s not like you have the point of view of a main character. You are a bystander.”

Part of me does watch true crime to gain a sense of control. If I see enough shows about break-ins, for example, I feel like I can take steps to prevent one from happening to me. But horror scares us by not following the rules. Ghosts, goblins, and evil clowns are forces we can’t reckon with.

Know yourself and your limits

For some, horror offers fun and excitement; for others, it’s just terrifying. Then there are the people in the middle who like a small jolt, but not too much. The secret is knowing yourself and how much you can handle.

I’ve come to accept that I can only stand a little Zelda at a time. After too much exposure, I get anxious, my heart races, and the burst of adrenaline is no longer enjoyable. That’s my body’s way of telling me I’m done.

Sometimes when I see my daughters curled up watching a scary movie, covering their eyes and giggling, I wish horror could be that fun for me. Then I lock the doors, check the windows, and remember why I’m just fine with missing out.

The post A little horror goes a long way appeared first on therapist.com.

All personalities are unique, but most can be categorized into a smaller range of different types.  Understanding personality type can help you discover new insights about yourself, as well as other people.     

What Is Personality?

Personality is a dynamic attribute of your sense of self. It consists of how you think, feel, behave, and interact with others. Genetics, environment, culture, family of origin, and past experiences all contribute to your personality. 

A healthy personality is malleable and multifaceted. It may change in response to positive experiences as well as negative stressors. Certain aspects of someone’s personality may be overemphasized or underplayed, depending on the situation. However, most people identify a small group of core personality traits as key to their sense of self. 

Different Personality Types

Most personality typing frameworks are descriptive, not prescriptive. That means that they describe certain commonalities experienced by people of a specific personality type; they don’t prescribe rules about what a specific personality type can or can’t do. 

Personality typing should offer language to help people understand and share their internal experiences. It should not be used to stereotype or put people into boxes. 

The Big Five

Most psychologists use the Big Five personality traits as part of their methodology. Each of the five traits (represented by the acronym OCEAN) exists on a spectrum:

• Openness: Openness measures your willingness to embrace new experiences. People who score high on openness tend to be more creative and receptive to new ideas. People with low openness scores tend to prefer sticking to their routine.
• Conscientiousness: Conscientiousness measures a person’s ability to make a plan and stick to it. People with high conscientiousness scores tend to prefer a methodical approach to work that allows them to focus on details. A low conscientiousness score means you prefer a less structured approach and may struggle with follow-through. 
• Extraversion: Extraversion (also spelled as extroversion), measures how outgoing, friendly, and social a person is. People who score high on extraversion are extroverts, and people who score low are introverts.
• Agreeableness: Agreeableness measures how much care people feel for others. High scorers in agreeableness may be idealistic because it suggests that people put others’ needs and happiness ahead of their own. Low scorers in agreeableness may suggest people view others as competitors or even enemies.
• Neuroticism: Neuroticism measures the emotional turbulence a person typically experiences. A high score in neuroticism corresponds with more frequent bouts of moodiness and anxiety. A low score in neuroticism corresponds with higher levels of emotional stability.

Your score for each trait corresponds with another personality term, also known as a facet. The Big Five Inventory (BFI)¹ includes 44 different facets of the original five traits. For example, someone with a low conscientiousness score may correspond with being “frivolous,” while a high conscientiousness score would correspond with being “reliable.”

MBTI

MBTI stands for Myers-Briggs Type Indicator. Also known as the 16-personality test, MBTI is based on the work of Katharine Briggs and her daughter, Isabel Briggs Myers. Myers and Briggs based their model on the work of famous psychiatrist Carl Jung.

MBTI types people as one of 16 different personalities, based on four binaries:

• Introversion (I) vs. extroversion (E): Introverts get their energy from solitude, while extroverts get their energy from being around others.
• Intuition (N) vs. sensing (S): Intuitive types value abstract methods to problem solving while sensing types prefer hands-on experiences.
• Thinking (T) vs. feeling (F): Thinkers rely on analytical reasoning, while feelers rely on emotional reasoning.
• Judging (J) vs. perceiving (P): Judging types prefer to follow systems of rules, while perceptive types prefer the freedom to be flexible.

A person’s score on each of the four binaries is represented by a four-letter personality type (for example, an ISFP would be introverted, sensing, feeling, and perceiving). The four binaries allow for 16 different personality types:

1. ENFJ: Enthusiastic communicator
2. INFJ: Passionate idealist
3. ESFJ: Popular altruist
4. ISFJ: Caring protector
5. ENTJ: Confident leader
6. INTJ: Strategic planner
7. ESTJ: Dedicated administrator
8. ISTJ: Methodical analyst
9. ENFP: Joyful seeker 
10. INFP: Creative peacemaker
11. ENTP: Charismatic brainstormer 
12. INTP: Analytical experimenter
13. ESTP: Energetic risk-taker
14. ISTP: Inquisitive experiencer
15. ESFP: Social improviser
16. ISFP: Artistic explorer

MBTI is popular for both personal and professional use. However, it is not often used in therapeutic settings. MBTI relies on binaries instead of spectrums, prioritizing the direction of a personality trait (intuitive vs. sensing) instead of the intensity of it (not intuitive, less intuitive, somewhat intuitive, more intuitive, most intuitive, etc). As a result, MBTI is not as nuanced as more spectrum-based personality frameworks.

Enneagram

The Enneagram is a personality typing framework based on people’s motivations, not just their behaviors. It consists of nine personality types² that are related to one another in different ways. Each personality type is referred to by its number, as well as a name summarizing the main desire or motivation associated with that type:

1. One: The Reformer
2. Two: The Helper
3. Three: The Achiever
4. Four: The Individualist
5. Five: The Investigator
6. Six: The Loyalist
7. Seven: The Enthusiast
8. Eight: The Challenger
9. Nine: The Peacemaker

The Enneagram symbol is a circle consisting of nine numbers with lines connecting numbers related to one another in times of stress and security. For example, Twos take on the positive aspects of Fours in times of security, but take on the negative aspects of Eights in times of stress. 

A person’s personality type may also have a wing, meaning that it takes on some of the aspects of the Enneagram number next to it on the wheel. For example, a Nine on the Enneagram could have an Eight wing (9w8) or a One wing (9w1), depending on if they are more combative like Eights or idealistic like Ones.

Some therapists use the Enneagram to inform their approach to treatment, especially faith-based therapists. The Enneagram is particularly popular in Christian communities in the U.S. and may be used in Christian counseling.

Other Personality Typing Frameworks

There are many other personality frameworks used in personal or professional life. Common ones used in the United States include DiSC® and CliftonStrengths (previously known as StrengthsFinder). Often, these are used in the workplace to help with hiring and team collaboration. They are not typically used in therapeutic settings.

Links Between Personality and Mental Health

Personality and Stress

Stress affects everyone, no matter their personality. However, some personality types may be more prone to stress than others, depending on the situation at hand. Examples based on the different personality typing frameworks include:

• The Big Five: Someone with a low openness score may experience more stress in new or unfamiliar situations than someone with a high openness score.
• MBTI: Introverted personality types may experience more stress in social situations than extroverted personality types.
• Enneagram: Ones may be excited to give their opinion on a topic they’re passionate about, while Fives may feel stressed when asked to share their thoughts.

Can Stress Change Your Personality?

Stress can affect how you behave and express yourself. For example, high levels of workplace stress may affect how you interact not just with your coworkers, but also with your family at home. Some personality typing frameworks, such as the Enneagram, take into account how stress can affect your personality: Threes, for example, are driven by achievement, but they take on the passivity of Nines when stressed.

Some kinds of stress can have a temporary or lasting effect on someone’s personality. Routine stressors, such as making dinner or going to work, are unlikely to result in personality changes. Disruptive stressors, such as an unexpected illness or injury, may cause temporary personality changes that are likely to dissipate once the stressor is resolved. Traumatic stressors, such as surviving an assault or natural disaster, may cause more permanent changes to someone’s personality that may only be resolved through professional mental health treatment.

Personality and Depression

Some personality types are more prone to depression than others. Psychologists may use the Big Five personality traits to determine a person’s tendency toward emotional distress and depression. In particular, those who have high scores in neuroticism have been found to respond to stress with “clinically significant levels of depression.”

Some people associate depression with specific personality types, often relying on stereotyping to do so. Fours on the Enneagram, for example, are often associated with moodiness and depression. However, depression can occur in anyone, no matter their personality type. Stereotypes do not mean that depression is normal or unavoidable for certain personalities.

Personality and Anxiety

Both nature and nurture play a role in the development of personality. Someone may be born with a genetic predisposition toward shyness, for example, but may become more confident if taught how to socialize in group sports or clubs at a young age. 

This is also true for mental illness. A person may be born with a predisposition toward anxiety, but genetics aren’t destiny. If that person is raised in a loving home in which it is okay to try and fail, their anxiety may never fully emerge. Conversely, if that person is raised in a home that demands perfection and punishes failure, they may develop an anxiety disorder to cope with the pressure.

Certain personalities are associated with anxiety more than others. For example, people with anxiety often score highly in conscientiousness, taking their desire for careful planning to the extreme. Ones on the Enneagram may be more prone to anxiety disorders like obsessive-compulsive disorder (OCD) as they try to ensure that the way they are living is “right.” 

However, it’s important to note that, just like with depression, anxiety is a mental illness, not a personality trait. Living with extreme or constant anxiety is not normal for any personality.

Mental Illness & Personality

What Is a Personality Disorder?

Personality disorders are characterized by pervasive and enduring patterns of thinking, feeling, and behaving that lead to significant distress or impairment in a person’s life. There are three main types of personality disorder, known as clusters, each marked by certain characteristics:

• Cluster A: Suspicion and eccentricity
• Cluster B: Unpredictability and instability
• Cluster C: Extreme anxiety and fear

Common personality disorders include:

• Borderline personality disorder (BPD)
• Antisocial personality disorder (ASPD)
• Narcissistic personality disorder
• Dependent personality disorder

Can Mental Illness Change Your Personality?

Mental illness of any kind may change how you think, behave, and express yourself. Your personality may be affected by a mental health disorder, even if it is not specifically a personality disorder.

Is It Your Personality or Mental Illness?

It can be difficult to determine whether or not your thoughts and behaviors are affected by mental illness. Personality tests can identify and provide language for your behaviors and motivations, but they cannot do the work of treatment that professional therapy can. A therapist can help ​​if you think your thoughts, feelings, or behaviors may be unhelpful or harmful to yourself or others,

Personality-Informed Therapy

Many therapists use personality types to help inform their treatment plans. Browse our directory to find a therapist near you who can help you understand your mental health in the context of your personality. 

If you or someone you love is suffering from a personality disorder, consider the following effective therapies:

• Cognitive behavioral therapy (CBT)
• Acceptance & commitment therapy (ACT)
• Dialectical behavioral therapy (DBT)
• Interpersonal psychotherapy
• Psychodynamic therapy

The post Personality types and mental health appeared first on therapist.com.

Body dysmorphia, also called body dysmorphic disorder (BDD), is a mental health condition where a person is obsessed with their own physical flaws. These flaws may be real but minor, or they may be entirely imagined.

An estimated one in 50 people are affected by body dysmorphia, but the figure could be much higher because people with the condition tend to hide their symptoms.¹ BDD has similarities with obsessive-compulsive disorder (OCD), but body dysmorphia is more common, often more severe, and frequently unnoticed in clinical settings.²

How body dysmorphia relates to other conditions

Negative body image

It’s possible to have a negative body image without having body dysmorphia. People with a negative body image may be dissatisfied with their physical appearance, but they don’t necessarily experience the same level of distress or obsessive thoughts that someone with BDD does. Even so, if it goes unaddressed, negative body image may develop into body dysmorphia.

Gender dysphoria

Gender dysphoria is related to body dysmorphia, but they’re different conditions. Having gender dysphoria means feeling uncomfortable or dissatisfied with the gender you were assigned at birth—this may be focused on specific body parts that cause distress, such as an Adam’s apple or other secondary sex characteristics. BDD involves feeling unsatisfied with minor or imagined flaws in your body that may or may not be related to your gender. The two conditions are interconnected, but they don’t cause one another.³ People can experience one or the other condition, or both at the same time.

Eating disorders

Eating disorders and BDD both center on being preoccupied with your body, but eating disorders focus on body size, weight, and shape. People with eating disorders are typically concerned with losing or gaining weight through their eating habits. People with body dysmorphia, on the other hand, focus on specific physical features they dislike, which may or may not include weight. That said, people with BDD often have eating disorders as well, because they tend to count weight among their perceived flaws.⁴

Signs and symptoms

The most common signs and symptoms of body dysmorphia include:

• Being preoccupied with your physical flaws (real or imagined)
• Believing others are staring at or making fun of you
• Constantly looking at yourself in the mirror, avoiding mirrors altogether, or a mix of both
• Thinking obsessively about your body and physical appearance
• Constantly comparing yourself to others
• Avoiding social events or activities
• Using clothing or makeup to hide perceived flaws
• Seeking frequent reassurance
• Grooming yourself constantly
• Picking at your skin
• Spending a lot of money on cosmetic treatments or products
• Exercising too much
• Dieting constantly
• Feeling anxiety, depression, or shame

Muscle dysmorphia

Muscle dysmorphia (also known as “bigorexia,” “megarexia,” or “reverse anorexia”) is a specific type of body dysmorphia where you think your body is too small and weak, even if you’re fit and muscular. People with muscle dysmorphia spend a ton of time and energy working out, monitoring their weight and appearance, and judging themselves harshly when they don’t meet their own standards.

Body dysmorphia by proxy

This type of BDD is less common and usually involves a loved one, such as a parent or partner, who’s obsessively concerned about the other person’s appearance. The concerned person may assess the other person’s features constantly, comment on their looks, or try to “fix” their appearance.

What causes body dysmorphia?

The exact cause of body dysmorphia is unknown, but several factors may increase your risk of developing it:

Genetics and family history: Research shows that genetic factors influence dysmorphic concerns. Many people with BDD have a family member who’s been diagnosed with the disorder.⁵

Early life experiences: In a study of 75 participants with body dysmorphia, nearly 80% reported negative childhood experiences, including neglect and abuse, and 40% reported severe maltreatment.⁶

Cultural influences: The physical concerns of people with BDD tend to reflect the beauty standards of their respective cultures and ethnicities.⁷

Low self-esteem: People with low self-esteem often have difficulty seeing their positive qualities and tend to focus more on their perceived flaws, so it makes sense that body dysmorphia is associated with low self-esteem.⁸

Age, gender, and sexual orientation: Body dysmorphia tends to be higher among young adults aged 15 to 28, particularly girls and women.⁹ LGBTQIA+ people may also be more likely to experience body dysmorphia.¹⁰

Personality traits: Perfectionism, neuroticism, and aesthetic sensitivity have been linked to body dysmorphia.¹¹

Social media: Time spent on social media platforms is linked to having a negative body image, which can lead to body dysmorphia.¹² Some experts say that “Snapchat dysmorphia,” where cosmetic surgery patients use social media filters as inspiration for their desired changes, is a growing issue.¹³

Preexisting mental health conditions: It’s common for people with body dysmorphia to also struggle with anxiety, social anxiety, depression, eating disorders, and OCD.¹⁴

The impact of body dysmorphia

The distress of body dysmorphia can affect you in many ways. BDD increases your risk for:

Anxiety and depression: Studies link anxiety and depression with body dysmorphia, especially in young adults.¹⁵

Social isolation: It can be hard to leave the house when you don’t feel okay about your appearance, and it can be hard to socialize and connect if you have overwhelming shame, anxiety, or embarrassment about your looks.

Substance abuse and addiction: Many people use drugs, alcohol, and other kinds of self-medication to cope with distressing conditions. In one study, 68% of participants with a substance abuse disorder reported that body dysmorphia contributed to their substance misuse.¹⁶

Eating disorders: Body dysmorphia can distort your view of your body size and increase your risk for eating disorders like anorexia and bulimia.

Self-harm: In a study involving 39 participants with body dysmorphia, 46% reported self-harming behaviors.¹⁷

Suicidal ideation: Body dysmorphia may be so distressing and debilitating that it leads to thoughts of suicide. If you’re in crisis, contact the 988 Lifeline for free, confidential support 24 hours a day, 7 days a week: 988 or 1-800-273-TALK (8255). 

Getting a diagnosis

If you think you may have body dysmorphia, seek help from a mental health professional. To be diagnosed, you must have symptoms that suggest you’re:

• Excessively preoccupied with one or more perceived flaws
• Having severe enough thoughts about your perceived flaws that they affect your daily functioning
• Experiencing symptoms that aren’t caused by other underlying mental health conditions

Treatment options

Body dysmorphia can be treated with psychotherapy, medication, or a combination of the two.¹⁸ Cognitive behavioral therapy (CBT) can be very effective for BDD because it can help you challenge distorted thoughts about your body and learn new strategies for coping with those thoughts. Other types of counseling, such as interpersonal therapy or group therapy, may also help.

Certain medications, such as antidepressants and anti-anxiety meds, may help reduce your anxiety and improve your mood. However, medication shouldn’t be used as a replacement for therapy.

If you have symptoms of body dysmorphia or are struggling with your body image in other ways, support is available. Browse our directory to connect with a therapist who can help you manage your symptoms and start to build a healthier relationship with your body.

The post Body dysmorphia: Signs, symptoms, and treatment appeared first on therapist.com.

Many thousands of years ago, fear helped our ancestors survive challenging environments. Today, this basic emotion can still motivate us to protect ourselves and respond to all kinds of perceived threats.

Fear is normal, and it can be both healthy and helpful. But if you feel fear that’s constant or out of proportion to the situation, you may find it hard to function.

Common fears

Our fears can be totally rational, based on the genuine likelihood of danger—for example, being afraid of falling when you ride a bike for the first time. Sometimes, though, our fears are persistent, outsized, or based on things that don’t realistically pose a threat.

Very common general fears include:

• Fear of death: You may be afraid of encountering life-threatening situations, losing a loved one, or aging and facing mortality.
• Fear of failure: You may worry about not being able to achieve your goals or live up to your own expectations.
• Fear of losing control: Many people fear the consequences of losing control of their bodies, minds, environments, or possessions.
• Fear of the unknown: Uncertainty, unfamiliarity, or unpredictability can sometimes cause strong anxiety, as can things like having to make decisions without knowing all the facts.
• Fear of change: Change can be especially hard to deal with if it’s unexpected or outside your comfort zone.
• Fear of intimacy: If you’re afraid of being rejected or hurt, you may steer clear of close relationships.
• Fear of rejection: You may worry that you’re not good enough or that you’ll be criticized if you put yourself out there.
• Fear of abandonment: You may fear being alone or being left behind by loved ones.
• Fear of commitment: You may hesitate to commit to a relationship, job, or responsibility because you’re afraid of becoming trapped.
• Fear of success: Some people never achieve their goals because their fears about the responsibilities that come with success outweigh their desire to succeed.

More specific types of common fears include being afraid of heights, spiders, darkness, enclosed spaces, and needles. Some of these fears may also be considered phobias—and if any of them feel familiar, it can help to know you’re not alone.

What are phobias?

A phobia is a type of intense fear that’s persistent and out of proportion to the actual threat. People with phobias may go to great lengths to avoid the things they’re afraid of, even if it disrupts their lives. For example, phobic fear of dogs (cynophobia) might cause someone to avoid all sidewalks for fear of encountering a dog on a leash.

Fear vs. anxiety

Fear and anxiety are closely related and can produce overlapping physical responses, but they’re not the same thing. Fear is a response to something you see as an immediate threat, while anxiety is a more general feeling of unease or worry.

One way to think about the difference is to imagine walking down a remote road in the dark. The uneasy feeling that you have as you walk is probably anxiety—imagining what might happen causes your physical and emotional response.

If a large growling dog rushes up or you hear footsteps behind you, you might feel fear. In those examples, a specific potential threat causes your response.

Causes of fear

Fear is a complex emotion. Factors that can contribute to it include:

• Trauma: Profoundly stressful experiences such as sexual assault, natural disasters, car accidents, or combat can cause you to develop posttraumatic stress disorder (PTSD). PTSD symptoms include fear that you may continue to feel long after a traumatic event is over.
• Genetics: Fearfulness can be passed down through generations. Anxiety disorders, for instance, may run in families.¹
• Physiology: Your brain’s particular structure and functioning can make you more prone to fear or anxiety. Research also shows that people with anxiety disorders tend to have higher levels of the stress hormone cortisol.²
• Personality: Personality traits like neuroticism and social anxiety may make you more likely to feel fear.
• Environmental factors: If you grew up in a chaotic or abusive household, you may be more likely to develop a phobia or have an exaggerated fear response.³
• Conditioning: Fears can be learned from others. For example, if you see your parent shudder and move away every time a bee flies by, you may learn to be afraid of bees as well.
• Media exposure: Taking in frightening events through the internet, news, movies, TV, and books can trigger fear—especially in younger kids whose brains haven’t yet learned how to process such intense scenes.
• Lack of knowledge, understanding, or experience: You may fear unfamiliar things because you don’t know what to expect or how to prepare.

How we feel fear

Our physical response to danger and stress is known as the fight-or-flight response. It’s meant to help us respond to threats. There are four basic response categories:

• Fighting (retaliating)
• Fleeing (escaping)
• Freezing (becoming immobile or unresponsive)
• Fawning (submitting or cooperating to try and reduce harm)

When you perceive something frightening, your brain sends signals that release different hormones into your bloodstream. Those hormones cause physical reactions such as:

• Heart palpitations
• Shallow or rapid breathing
• Chills, hot flashes, or sweating
• Trembling or shaking
• Muscle tension
• A rush of energy
• Dry mouth
• Upset stomach or nausea
• Chest pain
• Dilated pupils

In some cases, these physical responses to fear can be so intense that they lead to a panic attack, even when there’s no actual threat. Panic attacks themselves can be extremely frightening. They can even make you feel like you’re having a heart attack.

While your physical response to fear is mostly automatic and immediate, your psychological response is more complex. Fear can make you feel a range of emotions, including:

• Anxiety or worry
• Frustration or anger
• Embarrassment or humiliation
• Guilt or shame
• Sadness, helplessness, or hopelessness
• Overwhelmed or out of control

Fear can also affect your thinking: It can make you more likely to jump to conclusions or make decisions without thinking them through. Sometimes fear can even lead to hallucinations or delusions.

How fear impacts your mental health

Fear is a normal emotion that everyone experiences, but when it becomes chronic or feels uncontrollable, it can lead to or worsen mental health conditions such as:

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

A therapist can diagnose and treat conditions that include fear as a symptom. While the clinician’s approach will depend on each patient’s unique situation, treatment may include:

• Medication to treat anxiety or depression
• Cognitive behavioral therapy (CBT) to help you learn to change your thought patterns
• Exposure therapy, which involves gradually exposing you to the source of your fear
• Relaxation techniques such as yoga or meditation
• Group therapy or support groups for people with similar experiences and feelings

How to manage fear

Fear can’t be “cured,” but it is possible to manage it in healthy ways. Sometimes you might even be able to use fear to your advantage. Try these tips for managing fear:

Identify your triggers. What situations or events make you feel afraid? Once you know what your triggers are, you can start to avoid them or prepare for them in advance.

Breathe. When fear sets off your fight-or-flight response, it can be hard to think clearly. One way to counter this is to focus on your breathing and do some deep breathing exercises.

Focus on the present. Fear is often related to worry about the future. To counter this, focus on the present moment and what you’re doing right now. This can help you feel more in control and less overwhelmed. Looking at colors or shapes around you can also help ground you in the present.

Challenge your thoughts. One of the hallmarks of anxiety is negative or irrational thinking. When you’re feeling afraid, take a step back and examine your thoughts. Are they based in reality? What’s the evidence for and against them?

Find a creative outlet. Some people find that fear can be motivating or even inspiring. If this is the case for you, try channeling your fear into a creative process like writing, painting, or music.

Talk about it. Talking to someone you trust about what you’re feeling can help you gain a different perspective and figure out a plan to deal with your fear.

If you’re struggling to manage your fears on your own, help is available. Visit our directory to find a therapist who can help you learn what’s behind your fears and how to manage them.

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Imposter syndrome (or “impostor syndrome”) is a pattern of questioning your own abilities or accomplishments and believing they aren’t good enough. You may feel like a fraud, worry other people will discover you’re not as good as you seem, or believe you’re inferior even when evidence says otherwise.

Is imposter syndrome a mental illness?

Imposter syndrome is a cognitive distortion—a faulty set of thoughts, feelings, and beliefs—but it isn’t a mental illness. It can’t be diagnosed or treated like a mental illness can, but it can affect your mental health if left unchecked.

It’s normal to feel inadequate or unsure of yourself from time to time, but the persistent self-doubt of imposter syndrome can make it hard to believe you deserve success. And if these feelings become so distressing and extreme that they interfere with your daily life, that may be a sign of an underlying mental health condition such as anxiety or depression.

Imposter syndrome vs. anxiety

Imposter syndrome and anxiety share many qualities, but they’re not the same thing. Anxiety involves worry or fear that’s out of proportion to a situation. Imposter syndrome is more related to self-doubt and questioning your own worth.

Imposter syndrome vs. low self-esteem

Low self-esteem is when you have an overall negative view of yourself and your abilities. People with imposter syndrome may feel intense self-doubt, but it’s often linked to specific situations, abilities, or accomplishments. You may feel like a fraud one day and confident the next. Low self-esteem, on the other hand, is more persistent.

Types of imposter syndrome

Imposter syndrome can take different forms in different people. Valerie Young, EdD, a leading expert in this syndrome, outlines five main types:

Perfectionists tend to fixate on how things should be done and have impossibly high standards for themselves. Even small or insignificant errors can make them feel like a failure.

Experts believe they lack the necessary knowledge, experience, or qualifications to succeed in their field, so they constantly seek out more information, training, and credentials—but more is never enough.

Soloists are lone wolves who feel like they need to do everything themselves. They rarely, if ever, ask for help because they think it’s a sign of failure.

Natural geniuses think that if they don’t immediately become good at something, it’s because they just don’t have what it takes.

Superhumans/superheroes think they should be able to take on—and excel in—as many roles as possible. If they can’t be an excellent manager, coworker, friend, spouse, parent, neighbor, and volunteer all at once, then they believe they’re failing.

Signs of imposter syndrome

Whether you identify with one of the above types or not, common signs of imposter syndrome include:

• Belief that you’re inadequate or a fraud
• Low self-confidence
• Self-doubt
• Procrastination
• Perfectionism
• Negative self-talk
• Tendency to compare yourself to others
• Fear of criticism, failure, or being exposed
• Worry or anxiety over living up to expectations (your own or others’)
• Difficulty accepting compliments or praise
• Difficulty believing you’re capable of success
• Sense of self-worth that’s based on your accomplishments or other external factors

Risk factors and triggers

Up to 82% of people experience imposter syndrome at some point in their lives.¹ Celebrities including Maya Angelou, Tom Hanks, and Michelle Obama have opened up about their personal struggles with it.^{2, 3, 4} Experts don’t know its exact causes, but it often seems to be a combination of internal and external factors.

Certain personality traits, such as perfectionism and neuroticism, may make you more prone to imposter syndrome.⁵ The way you’re raised and exposed to gender stereotypes may play a role.⁶ And while imposter syndrome affects people of all genders, ages, and backgrounds, it seems to be especially prevalent among people of color, transgender and nonbinary people, and other people with marginalized identities.⁷ Professional milestones such as graduate school or a job promotion can also trigger it.^{8, 9}

The impact of imposter syndrome

Imposter syndrome isn’t always a bad thing—for example, it can help motivate you to strive for excellence in your work or personal life. Some people are able to move past this syndrome on their own over time, but for others, no amount of personal success seems to help.

Long-term effects of imposter syndrome can include:¹⁰

• Anxiety (including social anxiety)
• Depression
• Low self-esteem
• Difficulty forming and sustaining relationships
• Worsened job performance and less job satisfaction
• Increased risk of burnout

How to overcome imposter syndrome

It can be hard to see yourself as worthy of success when you feel so much self-doubt, but it is possible to overcome that feeling. The following tips can help you take control of your inner critic and build more confidence.

Notice your negative self-talk or criticism. Acknowledging these thoughts as they happen improves your self-awareness, which can help you shift your mindset.

Challenge yourself to reframe your thoughts. When a negative thought enters your mind, try to look at it from a different perspective and come up with three positive statements to counteract it.

Journal about your worries and anxieties. Writing down your thoughts can help you identify feelings or beliefs that contribute to imposter syndrome.

Avoid comparing yourself to others. Everyone has their own unique journey and experiences. If you’re already feeling inadequate, comparing your life to someone else’s can make it worse.

Remind yourself of your abilities and accomplishments. Make a list of all the successes you’ve had, including notes about why you think you had them.

Focus on the progress you’re making, rather than the outcome. Break down large tasks into smaller ones and concentrate on the process of completing them.

Practice accepting compliments and praise with grace. Instead of brushing off a compliment out of habit, practice thanking the person instead.

Ask for support. Talking to a friend or loved one who understands what you’re going through can make a big difference in how you feel about yourself.

Be kind to yourself. Celebrate small wins, and practice self-compassion when you make mistakes.

Get help from a professional as needed. Talking with a therapist or counselor can help you understand where your imposter syndrome is coming from and develop a plan for working through it.

Visit our directory to find a provider. You don’t have to face mental health challenges all alone.

The post What is imposter syndrome? appeared first on therapist.com.

What is infidelity? 

Broadly speaking, infidelity means being unfaithful to your partner. Exactly what being unfaithful means depends on each person’s perspective. It typically involves breaking the promises you’ve made, or rules you’ve agreed to, in your relationship.  

What’s considered infidelity is largely determined by the boundaries set within each relationship. Some couples may view flirting as harmless, while others consider it a serious breach of trust. Women tend to have stricter views on the definition than men, and younger people are usually less tolerant of it than older people.¹  

One study showed that roughly 1 in every 4 married or cohabitating partners reported either they, their partner, or both having been intimate outside of the relationship.² Sexual infidelity is considered to be one of the most damaging forms of infidelity.³ 

Types of infidelity 

There are countless examples of what infidelity can look like. But regardless of the exact act, it generally falls within one of several types:  

• Physical or sexual infidelity: Having intimate physical contact with someone outside the relationship 

• Emotional infidelity: Developing romantic feelings or intimate bonds with others (sometimes called an “emotional affair”) 

• Digital infidelity: Inappropriate online relationships, sexting, or viewing pornography when you agreed not to

• Financial infidelity: Hiding money or making secret purchases 

Infidelity signs 

Both the unfaithful partner and the faithful partner may behave differently due to a transgression.⁴ 

In the unfaithful partner, signs that may indicate infidelity include:⁵ 

• Increased anger  

• Being more likely to argue 

• Exaggerated affection 

• Difficulty becoming aroused 

• Avoiding sex 

• Significant changes in sleep patterns 

• Increased demand for privacy 

• Making excuses to spend time alone 

• Changing passwords or not allowing access to phone or computer 

Whether they’re fully aware of the betrayal or not, the faithful partner will likely notice a change in their relationship’s dynamic. They may experience: 

• A loss of trust in the relationship 

• Decreased self-esteem 

• Feelings of isolation or disconnection 

• Emotional distress 

• Relationship dissatisfaction 

• Extreme sensitivity and suspicion of the other partner’s activities 

• Obsessive thoughts about their partner’s behavior 

• Difficulty sleeping 

• Trouble focusing on work or other tasks 

• Checking behaviors, such as calling more or looking at partner’s electronics 

If you suspect your partner is being unfaithful, it’s important to avoid making accusations without evidence. Try to have an open, honest conversation with your partner about your concerns and feelings. 

If you’re unsure how to address the issue, consider speaking with a mental health professional who specializes in relationships. They can provide emotional support and help you think through your next steps. 

Causes of infidelity 

Research suggests multiple factors contribute to how likely infidelity may be in a given relationship.⁶  

These factors include: 

• Relationship dissatisfaction, whether it stems from unmet emotional needs, poor communication, or lack of quality time together 

• Certain personality traits, such as neuroticism and permissive attitudes towards sex 

• Opportunity and circumstance, such as working closely with members of the opposite sex, traveling frequently for work, or spending extended periods apart 

• Cultural and societal factors, such as an increased presence of women in the workplace and greater social acceptance of divorce 

• Technology and social media, which have made it easier to engage in digital infidelity through dating apps, social media platforms, and messaging services 

• A personal history of cheating, which can make it significantly more likely to happen again in the future 

How infidelity impacts couples 

Infidelity can have a profound and devastating impact on couples.⁷ The betrayed partner may experience intense feelings of anger, insecurity, jealousy, and humiliation. They may struggle with depression, anxiety, low self-esteem, and even symptoms similar to those of posttraumatic stress disorder (PTSD). 

In many cases, the betrayal damages or destroys the romantic relationship, leading to separation or divorce. The breach of trust can be so severe that couples find it impossible to rebuild their connection. 

While the emotional impacts alone can be overwhelming, new research suggests infidelity can also have long-term implications for physical health.⁸ People who experienced it reported worse chronic health conditions, even after controlling for factors like age, gender, education, ethnicity, employment status, and income level. 

Can you overcome infidelity? 

While surviving infidelity is challenging, many couples successfully rebuild their relationships through dedicated effort and with professional help. The healing process requires complete transparency, patience, and understanding from both partners.  

Key steps in rebuilding after infidelity include:⁹ 

• Assessing the damage 

• Restating commitment 

• Creating accountability 

• Rebuilding the connection 

• Communicating openly 

• Regaining trust 

• Moving towards deeper forgiveness 

The couple’s shared history and cultural backgrounds, and support from others (whether from friends and family or a therapist), can shape how they experience and heal from infidelity.  

Unsurprisingly, researchers found that rebuilding trust is not easy for the betrayed partner.¹⁰ Whether trust can be rebuilt depends on several factors, such as: 

• Whether or not the betrayed partner can forgive 

• The partner who was unfaithful making positive, consistent changes in their behavior 

• The partner who was unfaithful being more open, cooperative, and supportive in the relationship 

People are less likely to forgive their romantic partners for sexual and technology-based cheating (like sexting) than they are emotional indescretions.¹¹ This is especially true for anxiously attached people, who find it harder to forgive these betrayals. 

Does infidelity pain ever go away? 

While the pain of infidelity can diminish over time, it may not disappear completely. Certain triggers—like anniversaries, certain locations, or situations similar to the betrayal—can resurface painful memories years later.  

Research shows that how people perceive their partner’s infidelity can significantly influence how the betrayal impacts their emotional and mental health.¹² People who blame their unfaithful partner for causing the infidelity, and feel they should be held accountable, tend to experience more stress. This stress can lead to increased symptoms of depression and anxiety. 

However, the same study also found that self-esteem can be an important factor in dampening the impact of infidelity. People with high self-esteem tend to view themselves as capable of handling stress and are better at self-regulation. Because of this, self-esteem can be a strong defense for the stress, and the heartache, that follows infidelity. 

How therapy can help with infidelity 

Therapy can play an important role in helping couples communicate openly, process emotions, deepen forgiveness, and gradually restore trust after infidelity.¹³  

Common therapeutic approaches which have been shown to improve intimacy and forgiveness among partners include:¹⁴  

• Integrative behavioral couple therapy (IBCT)¹⁵  

• Emotionally focused therapy (EFT)

• Cognitive behavioral couple therapy (CBT)  

Not all infidelity counseling is the same. Research has shown certain therapists have higher levels of comfort, preparedness, effectiveness, and confidence in treating infidelity than others.¹⁶ In particular, therapists who attend infidelity training, have higher education (such as a doctoral degree), are highly experienced, and specialize in marriage and family therapy may be most effective.

Remember, if you’ve experienced infidelity from either side, help is available. Visit our directory to find qualified therapists in your area who specialize in infidelity recovery. 

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What is retroactive jealousy?

Retroactive jealousy is when you feel jealous or insecure about your partner’s past relationships or sexual experiences. It often involves intrusive thoughts and mental images, as well as emotional distress about your partner’s romantic history. It can happen even if your partner cut ties with their past partners months or years ago.

Is retroactive jealousy normal?

It’s normal to feel a little curious, or even slightly uncomfortable, about a partner’s past. But retroactive jealousy can sometimes go beyond normal levels of concern.

It becomes problematic when it interferes with your current relationship or well-being. In some cases, retroactive jealousy may be a sign of relationship obsessive-compulsive disorder (ROCD). ROCD involves obsessive thoughts and compulsive behaviors related to intimate relationships.

Signs of retroactive jealousy

Some common signs of retroactive jealousy include:¹

• Obsessive thoughts about your partner’s past relationships
• Constantly asking your partner questions about their exes
• Having trouble understanding your partner’s romantic history from their perspective
• Feeling considerably angry, anxious, or depressed about your partner’s romantic history
• Comparing yourself to your partner’s exes
• Feeling inferior or inadequate because of your partner’s past relationships
• Difficulty trusting your partner due to their past
• Checking up on your partner’s exes on social media
• Difficulty enjoying intimate moments with your partner
• Acting impulsively on emotions in ways that harm intimacy
• Guilting or punishing your partner into feeling bad about their past
• Feeling powerless over your thoughts and actions, leading to guilt and shame

Retroactive jealousy triggers

In general, anything that threatens your sense of self-esteem or your perception of your relationship could trigger retroactive jealousy.² This might include:

• Hearing about or seeing reminders of your partner’s past relationships
• Discovering new information about your partner’s romantic history
• Encountering your partner’s ex in person or on social media
• Watching movies or TV shows featuring infidelity
• Discussing relationship histories with friends or family
• Experiencing relationship milestones that your partner has already experienced with someone else
• Feeling insecure about your own romantic history or lack thereof
• Encountering situations that highlight differences between you and your partner’s exes

What causes retroactive jealousy?

It isn’t fully understood what causes retroactive jealousy because it’s a relatively under-researched emotion. Most of our understanding comes from building on findings from studies about traditional jealousy, which typically focus on current or future threats to relationships.

One possible explanation is that retroactive jealousy is caused by a disruption in the sufferer’s sense of meaning in relationships. Basically, when a person learns about their partner’s past relationships, it threatens their belief that their current relationship is special or unique. This threat has been found to predict retroactive jealousy.³

The rise of social media has also contributed to increased retroactive jealousy. Social networking platforms can present unhealthy opportunities for comparison by preserving evidence of past relationships. Research shows that people often use these platforms to gather information about their partner’s past or fact-check information they’ve disclosed, potentially fueling retroactive jealousy.⁴

Traditional jealousy is associated with anxious attachment styles.⁵ But one of the few studies specifically examining retroactive jealousy found that attachment style wasn’t a significant predictor.⁶ This suggests that the processes behind retroactive jealousy may differ from those of traditional jealousy.

It’s possible that the stage and commitment level of a relationship may play a role. Research on traditional jealousy indicates that partners who are less committed, or who are in the early stages of their relationship, are more likely to experience jealousy compared to those in more established, committed relationships.⁷

Certain personality traits have also been linked to typical forms of jealousy.⁸ Higher levels of neuroticism and lower levels of agreeableness and openness have been found to predict higher levels of romantic jealousy. Although these findings aren’t specific to retroactive jealousy, they may offer insights into why some people are more prone to jealousy than others.

How retroactive jealousy affects mental health

Retroactive jealousy can have a significant impact on your mental health and well-being. Research has identified three main ways this type of jealousy can affect you:⁹

1. Negative feelings about yourself and your relationship, often stemming from comparison to your partner’s exes. You might also start to see your partner and your relationship in a more negative light, or feel like you’ve been wronged somehow.
2. An overwhelming need to know more, which usually leads to more distress. You might keep asking your partner for details or reassurance, which often makes things worse instead of better.
3. Constant, uncontrolled thoughts, as if there’s a “devil on your shoulder” making illogical and hurtful suggestions. These jealous thoughts become a constant backdrop to your relationship, always present at some level.

These experiences can be extremely draining. People with retroactive jealousy often feel exhausted, powerless, anxious, and ashamed of their thoughts and behaviors. You might create imaginary scenarios about your partner’s past that feel very real and cause a lot of pain. These thoughts can feel uncontrollable, making you feel even more helpless.

Even if you generally know that that you have a choice about how to behave, retroactive jealousy may cause you to frequently lose control and act against your values. As a result, your sense of self-worth may suffer.

If your mental health is suffering because of retroactive jealousy, or any other relationship challenges, a licensed therapist can help.

How to deal with retroactive jealousy

You can recover from retroactive jealousy, but overcoming it may require going above and beyond trying to accept or move on from your partner’s past. Therapy that focuses on helping you build a special romantic relationship, develop a stable sense of self, and act according to your values rather than your fears may be most effective.¹⁰ Retroactive jealousy treatments might involve:

• Psychoeducation, which can teach you that feelings of betrayal and jealousy are natural (but not always helpful) responses to past events. Understanding this can help you create healthy ways to deal with these feelings.
• Cognitive defusion techniques, which are often used in acceptance and commitment therapy (ACT) to help you distance yourself from certain thoughts. These techniques can include recognizing that thoughts are just thoughts, not facts, or visualizing them floating away like clouds.
• Models like the Sound Relationship House from the Gottman method of couples therapy, which provides a framework for improving communication, trust, and commitment between partners.

Even though attachment insecurities don’t appear to be heavily linked to retroactive jealousy, it could still be helpful to address attachment-related concerns in therapy. This may involve exploring early relationship experiences and developing more secure attachment patterns.

To learn more about recovering from retroactive jealousy, visit our directory to find a therapist in your area.

How to date someone with retroactive jealousy

Supporting your partner as they deal with retroactive jealousy can be challenging, but there are strategies that can help:

• Practice patience and empathy
• Set clear boundaries to protect your own well-being
• Avoid sharing unnecessary details about your past
• Focus on building trust and intimacy in your current relationship
• Reassure your partner of your commitment
• Engage in open, honest communication about your feelings
• Encourage your partner to engage in interests and activities that boost their self-esteem

Remember that you’re not responsible for managing your partner’s emotions. Encourage your partner to seek professional help if their jealousy is significantly impacting your relationship or their mental health.

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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 

What’s the difference between sociopathy and psychopathy? 

Sociopathy and psychopathy overlap in some ways, but they’re two distinct conditions. 

Some experts think that psychopathic tendencies have a genetic cause—and that people with psychopathic traits have physiological differences in parts of the brain related to emotion and impulse control. People with psychopathy lack remorse and tend to be more callous and unemotional, qualities that can make them more effective at being manipulative, charming, and calculating. Unlike people with sociopathy, they tend to plan their behavior carefully. Psychopathy is also much less common, occurring in less than 1% of the US population. 

Sociopathy, meanwhile, is largely thought of as something you develop in response to a harmful living environment, especially in childhood (though genetics play some role as well). People with ASPD can be manipulative and can lack remorse, but they don’t have the superficial charm and charisma of psychopathy. In addition, they tend to be more impulsive and hot-headed—behaviors that tend to make them less effective. “The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5), estimates that 0.2 to 3.3% of the US population meets the diagnostic criteria for ASPD. 

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 the Dunning-Kruger effect?

The Dunning-Kruger effect is a type of cognitive bias in which we overestimate our abilities in areas we know little about. Essentially it states that the more incompetent someone is, the less aware they are of their own incompetence.

This bias was identified in a late 1990s study by psychologists David Dunning and Justin Kruger, who asked 65 participants to take a test measuring their logic, grammar, and sense of humor, then rate their own perception of their skills.¹ Those who scored lowest in skill showed the biggest gap between their actual score and their predicted score.

Examples of the Dunning-Kruger effect

Here are some common Dunning-Kruger effect examples that illustrate how this cognitive bias shows up in everyday situations:

• Someone without government or public service experience believing they’d be a highly effective elected representative
• A student interrupting and challenging their professor throughout lectures despite not having read the required material
• Someone from a privileged social group feeling qualified to speak on behalf of a marginalized social group despite lacking shared experiences
• A heckler believing they’d be more entertaining onstage than the professional entertainer they paid to see

Is the Dunning-Kruger effect harmful?

We’re all vulnerable to experiencing the Dunning-Kruger effect from time to time—it’s a normal part of learning new skills and exploring unfamiliar territory. A little overconfidence can even be helpful, giving us the courage to try things we might otherwise avoid.

However, the effect becomes problematic when your confidence significantly outweighs your actual competence and continues despite feedback. Harmful examples of the Dunning-Kruger effect include:

• Dismissing feedback or criticism, assuming others are wrong
• Believing you performed well when objective results or expert opinions tell you otherwise
• Failing to acknowledge mistakes or gaps in understanding
• Feeling no need to learn more, assuming you already know enough

The Dunning-Kruger isn’t necessarily bad, and it will likely resolve naturally as you gain experience and receive feedback. However, you may benefit from professional support if unfounded confidence is consistently damaging your relationships, career prospects, or decision-making in important areas of life.

A therapist can help you develop better self-awareness and metacognitive skills. They can also help address any underlying insecurities or need for validation that might drive persistent overconfidence in unfamiliar areas. 

What causes the Dunning-Kruger effect?

The Dunning-Kruger effect is the result of overconfidence combined with a lack of “metacognition,” or awareness and understanding of our own thought processes and patterns.

Many of us believe incorrectly that the knowledge we have is applicable elsewhere, or that we can pick up new skills and understand new information more easily than is realistic.² Our desire to prove that we can “keep up” may also tempt us to overestimate our competence in new or unfamiliar areas.

The four stages of competence

Also called “the hierarchy of competence,” these four stages describe our learning process in terms of our awareness and competence.

1. Unconscious incompetence: You’re ignorant of what you don’t know.
2. Conscious incompetence: You’re aware of what you don’t know, but you haven’t taken steps to learn more.
3. Conscious competence: You’re actively learning and acquiring knowledge about a subject.
4. Unconscious competence: You’ve mastered a subject so extensively that you may forget or take for granted how much you truly know.

The Dunning-Kruger effect is strongest when we’re in the first stage, unconscious incompetence. If we don’t know what we don’t know, the Dunning-Kruger effect says, then we’re actually more likely to feel confident than others at higher stages of competence. This is protective in some ways, but it can have consequences.

Who’s most likely to have the Dunning-Kruger effect?

The Dunning-Kruger effect applies to everyone. We all have major gaps in our skills or areas of knowledge, and we’re all susceptible to cognitive bias.

The Dunning-Kruger effect vs. imposter syndrome

The Dunning-Kruger effect and imposter syndrome are inverses of each other. If you have imposter syndrome, you’ve likely achieved high levels of success, mastered a skill, or know a great deal about a particular topic, but you still doubt your abilities. You may even feel like a fraud despite the amount of evidence to the contrary.

This is the opposite of the Dunning-Kruger effect, in which someone has little or no knowledge but feels very confident in their abilities.

What are cognitive biases?

Cognitive biases are shortcuts in our decision-making that we take all the time without knowing it. Although they’re often illogical, they affect the way we perceive things and move through the world.

We like to believe we make decisions and observations based only on facts and truth, but most of us are actually influenced by a mixture of biases, influences, instincts, and emotions, as well as (or even despite) hard facts.

In addition to the Dunning-Kruger effect, common cognitive biases include:

• Actor-observer bias: Attributing your own actions to external factors (“I didn’t turn in my homework because my laptop failed”) while attributing others’ to internal factors (“My classmate didn’t turn in their homework because they’re lazy”)
• Anchoring effect: Being overly influenced by “firsts”: first impressions, first pieces of information, first offers, etc.
• Availability bias: Using examples that easily come to mind for your decision-making, and as a result giving popular or commonly repeated data more influence than it should have (such as avoiding air travel after reading several news reports about plane crashes, even though your risk of dying in a car accident is much higher)
• Bandwagon effect: Adopting certain thoughts, feelings, beliefs, or actions to go along with a larger group (also called “herd mentality” or “groupthink”)
• Confirmation bias: Favoring information that supports your current beliefs
• Loss aversion: Feeling more pain from loss than pleasure from gain (such as noticing when gas prices increase but not when they decrease)
• Narrative bias: Interpreting the world through a particular story, even when the details aren’t related or don’t fit the ultimate narrative (for instance, believing your boss will fire you when they unexpectedly request a meeting, despite the fact that you’re an excellent employee)
• Self-serving bias: Attributing your successes to yourself while assigning the blame for your failures to external factors (for example, believing that your good test grade was due to your intelligence and skill while a bad test grade resulted from a lack of sleep, unfair questions, and so on)

How to overcome cognitive biases

Cognitive biases like the Dunning-Kruger effect can make decision-making feel simpler and more obvious. But these biases can also get in the way of more nuanced thinking, especially when it comes to complex decisions.

Here are some ways to challenge your cognitive biases so you can overcome them:

• Begin with data. Facts alone won’t always defeat cognitive biases, but they’re a good place to start. By searching for evidence-supported information, you’re at least admitting you don’t know everything.
• Widen your scope. Cognitive biases can affect your learning process. Resist your biases by widening your scope and looking specifically for arguments against what you already believe.
• Investigate your emotions. Be honest about your emotional state when you make decisions. Is this a run-of-the-mill choice, or will it have serious effects on your life? Your feelings may sway your decision one way or another. By investigating your emotions, you can be aware of and honest about how your feelings and desires may affect your choice.
• Ask for feedback. As you start to develop a position or make a decision, ask trusted friends what they think. They may help you see information from a different perspective. If possible, seek feedback from experts whose views differ from yours.
• Value learning. You may feel ashamed of what you don’t know. By identifying learning as a value, you can remind yourself that learning isn’t a weakness, but a strength.
• Embrace the idea that you might be wrong. Even after a long, thoughtful process, you may still arrive at a wrong or unhelpful conclusion. That’s okay. Accept the fact that you may not get every choice right—and even after you settle on a decision, stay open to the idea of change.
• Seek therapy. Biased or harmful beliefs are often at the root of unwanted behaviors. Some forms of therapy, such as cognitive behavioral therapy (CBT), focus on identifying and changing unhelpful biases. Browse our directory to find a licensed provider near you.

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You’ve likely heard your clients explain their feelings of conflicting emotions — “a part of me wants to…and then there’s a part of me that doesn’t…” as they grapple with their internal “Self,” desires, and behaviors. In Internal Family Systems (IFS) therapy, the idea of multiplicity of the mind is normal. Every part has a good intention, and every part has value. Even for trauma survivors. 

In the treatment of trauma, IFS therapy is different from traditional phase-oriented treatments. Instead of starting with building resources in clients before processing traumatic memories, it welcomes extreme symptoms from the onset, learns about their positive protective intentions, and gets their permission to access the traumatic wounds.

But before we can begin the work of healing trauma with IFS therapy, we have to first begin by unblending our client’s various parts. We do this by walking our clients through the 6Fs: Find, Focus, Flesh it out, Feel, beFriend, and Fear.

The process is simple, and you can use the following steps as a guide to help you unblend parts with your clients…

The 6Fs: The steps we use to help protective parts differentiate from the self

The first three steps (find, focus, flesh out) involve helping parts to unblend.

1. FIND the part in, on, or around the body.
   • Who needs your attention right now?
   • Where do you notice it?
     
2. FOCUS on it.
   • Turn your attention inside.
     
3. FLESH it out.
   • Can you see it? If so, how does it look?
   • If not, how do you experience it? What is that like?
   • How close are you to it?
     
4. How do you FEEL toward the part?
   • This question is our Geiger Counter for Self-energy. Any answer that is not in the ballpark of the 8 Cs (the qualities of Self-energy: curiosity, calm, clarity, connectedness, confidence, courage, creativity, and compassion) means that a second part is influencing our thoughts. We ask this second part if it is willing to relax so we can talk to the target part. “If it is not willing to relax,” we ask it what it needs us to know. This process may lead us to a second (or third, fourth…) target part.
   • Reactive parts often need to feel heard and validated. We stay with them until they are willing to let us get to know the target part.
   • Once they agree, we ask the client, “How do you feel toward the (target) part now?”
     
5. BeFRIEND the part by finding out more about it.
   • The fifth step involves learning about the target part and developing a friendly relationship. This builds relationships internally (Self to part) and externally (part to therapist). “How did it get this job?” “How effective is the job?” “If it didn’t have to do this job, what would it rather do?” “How old is it?” “How old does it think you are?” “What else does it want you to know?”
     
6. What does this part FEAR?
   • “What does it want for you?”
   • “What would happen if it stopped doing this job?”

This key question will reveal any lurking polarization.

“If I stop feeling anxious, I’m afraid the suicidal part will take over.” Or it will reveal the exile it protects. “If I stop feeling anxious, I’m afraid Jane will feel all alone and worthless.”

Use this simple exercise to help your clients understand and work with their internal parts to begin the deep healing process that trauma requires.

Want more? Check out this free IFS therapy worksheet

Clients with complex trauma often develop extreme protective responses in an attempt to keep the emotional pain away. When encountering these extreme reactions, it’s common for you to feel frustrated, overwhelmed, bored, and at times reactive yourself. As a result, therapy can get stuck, and clients can begin to feel unsafe and re-experience the helplessness they felt in their original trauma.

But there’s an easy way to get therapy back on track…

Use this free worksheet to help you identify the roots of your client’s extreme response and determine what neuroscience-informed interventions are best for helping your clients get beyond their extreme trauma reactions — so you can help them find relief faster.

Want the 6-step IFS therapy process to jumpstart healing infographic?

Read the blog on our parent company PESI’s site to download your free infographic and help your clients separate protective parts from the self. This free resource is an excellent starting point for adding IFS therapy to your practice.

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What is insomnia?

Insomnia is a sleep disorder characterized by trouble falling asleep, staying asleep, and/or getting restful sleep. You may spend hours trying to fall asleep, or you may stay awake the entire night.

You may even fall asleep easily, but wake up after a few hours and struggle to fall asleep again. When you do fall asleep, the quality of your sleep may be poor, leaving you feeling unrested.

Symptoms of insomnia

The most common signs of insomnia include fatigue, irritability, and difficulty concentrating. And insomnia itself may be a predictor or symptom of stress, grief, or mental health concerns such as:¹

• Anxiety
• Depression
• Addiction recovery
• Bipolar disorder
• Eating disorders
• Posttraumatic stress disorder (PTSD)

How long does insomnia last?

Insomnia is discussed as being “acute” or “chronic.” In general, acute insomnia occurs over a brief period of time (perhaps a few days or weeks), whereas chronic insomnia may last for months or longer.

Various studies have attempted to give a more specific distinction between the two forms.² In general, if you’ve noticed a pattern in your struggle to sleep, and it’s affecting your ability to function, it’s time to see a doctor.

Types of insomnia

Not everyone experiences insomnia the same way. It comes in various forms, and your insomnia may be distinct based on several features:

1. Duration: Acute insomnia could be the result of one specific stressor and pass relatively quickly. Chronic insomnia will likely persist even when stressors pass.
2. Cause: If your insomnia is “primary,” it seems to occur on its own, rather than as the result of a health problem. “Secondary” insomnia, also called “comorbid” insomnia, occurs alongside another medical problem, like depression or acid reflux disease.
3. Severity: You may suffer from mild insomnia that simply leaves you fatigued for a day or two. Or you might have a more moderate case that affects your ability to function. A severe case of insomnia results in serious limitations on your life and may endanger your health.
4. Timing: In “onset” insomnia, you have trouble falling asleep. In “maintenance” insomnia, you have trouble staying asleep. With “terminal” insomnia, you wake up early without meaning to and cannot return to sleep.

It’s possible to have more than one type of insomnia at the same time. Consider speaking with your doctor or a mental health professional if you’re experiencing insomnia symptoms.

What causes insomnia?

Anyone can develop insomnia. If you have a family history of sleep disorders, you may be at a greater risk for it. Age also increases your risk, with older adults being more susceptible.³ And many people struggle with insomnia because of changeable factors like stress or poor sleep habits.

Insomnia has multiple causes—some you can address, and some you can’t. Common causes include: 

• Stress: Stress affects our physical and mental well-being, and insomnia is a common side effect.⁴
• Medications: Certain medications can cause insomnia.⁵ Your doctor may switch you to a different medication if your current prescription affects your sleep. However, it’s important that you don’t stop taking your medication without consulting your doctor first.
• Travel: The stress of travel can lead to acute insomnia.⁶ Flying across two or more time zones in particular can disturb your sleep schedule. Jet lag may trigger a few days of disrupted sleep.
• Stimulants: Caffeine, nicotine, and other stimulants can make it hard to fall asleep.⁷ If you have them later in the day, they may keep you awake most of the night.
• Alcohol or drug use: Although alcohol is a depressant and may cause you to fall asleep faster, it interferes with sleep quality.⁸ Drug or alcohol use can also disrupt your sleep schedule.
• Poor sleep habits: It’s important to create a dark, quiet, calm environment to sleep in. Habits like using your phone in bed or eating right before bed could alter your sleep.^9,10
• Certain mental health disorders: Insomnia may be attributed to mental health disorders such as anxiety or depression.¹¹
• Hormonal changes: People who menstruate may have insomnia at the same time in their cycle each month.¹² Insomnia during pregnancy is also common, with rates as high as 80%.¹³
• Other health conditions: Secondary insomnia can be caused by physical health problems in addition to mental health ones.¹⁴

Effects of insomnia

Lack of sleep affects your physical, mental, and emotional health. Chronic insomnia’s effects can build up over time and put your health at risk. 

Physical health risks

Over time, insomnia can increase your risk of:¹⁵

• Stroke
• High blood pressure
• Heart disease
• Diabetes
• Obesity

Mental health risks

Some studies suggest that insomnia can impact your mental health and cognitive abilities, negatively impacting your ability to:¹⁶ 

• Pay attention
• Use your working memory
• Complete tasks using executive function
• Concentrate

How to treat insomnia

Insomnia treatments may help you overcome the sleep disorder, and a variety of treatment options are available. Several of them are below.

Insomnia therapy

Cognitive behavioral therapy for insomnia (CBT-I) is one of the most effective insomnia therapies.¹⁷ It specifically addresses thoughts, feelings, and behaviors that make it hard to sleep.

CBT-I retrains your brain, teaching you to associate your bed with sleeping and not other activities (like eating, working, or watching TV). It also helps you create healthy habits that promote restful sleep.

If you’re interested in learning and practicing healthy sleep habits, help is available. Browse our therapist directory to find a licensed therapist near you.

Medications for insomnia

Insomnia medication can provide help if you’re struggling with acute insomnia. However, it’s less effective against chronic insomnia. Ask your doctor about possible side effects before trying over-the-counter sleeping pills—and don’t take medication for other conditions (such as Benadryl or other antihistamines) just because it also makes you sleepy. 

Improve your sleep habits

You may be able to stop acute insomnia by practicing these healthy sleep habits: 

• If you’ve tried to fall asleep for more than 10 minutes, get out of bed until you feel tired enough to sleep.
• Avoid using your phone or engaging with screens at night.
• Practice deep breathing.
• Avoid napping during the day.
• Follow a regular sleep schedule, even on weekends.
• Don’t eat within two hours of going to bed.
• Avoid caffeine, drugs, or alcohol before bed.
• Create a dark, quiet, cool sleeping environment.
• Practice relaxation techniques such as meditation to prepare yourself for sleep.
• Keep a sleep diary to track what helps and harms your sleep.

Natural remedies for insomnia

Several natural remedies are commonly suggested for those struggling with insomnia. These include:

Herbal teas, which some people may find beneficial to drink before bed. Chamomile is known for its relaxing properties and is often recommended as a sleep aid.¹⁸

Aromatherapy, which uses the soothing properties of essential oils to calm the mind and body. Lavender essential oil is associated with improved sleep quality, though it may not be enough to help with insomnia.¹⁹

Supplementing with melatonin, which may help if you have trouble sleeping. But sleep supplements’ effectiveness is debatable.²⁰ Be sure to speak with your doctor before trying any over-the-counter supplements. 

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What is family enmeshment?

Family enmeshment is when family members become overly involved in each other’s lives and have a hard time setting boundaries. It’s often driven by a desire to maintain close relationships, but it can have negative consequences.

Imagine that you and your family members are each represented by a strand of yarn. In an enmeshed family, all the strands are tangled up together. Because everyone’s lives are so intertwined, individual needs and identities can get lost.

Closeness vs. enmeshment

The difference between an enmeshed family and a close-knit family lies in how they handle boundaries and individuality.

When families are close, members have strong bonds and care for each other, but they also respect each other’s personal space and independence. They encourage each other to grow as individuals and make their own choices without feeling pressured or guilty.

When families are enmeshed, the boundaries between family members become blurry. They may be so involved in each other’s lives that it’s hard for individuals to make their own decisions and separate out their own thoughts and feelings. They may feel obligated to do things to please their family, even if it’s not what they truly want.

Are enmeshed family members codependent?

Enmeshment and codependency are related, and both can happen in families as well as other kinds of relationships, but they’re not exactly the same.

Enmeshment happens when two or more people are so deeply involved in each other’s lives, relationships, and decision-making that their autonomy and mental health are compromised. In a codependent relationship (such as a romantic couple, friends, or a parent and child), one member relies too much on the other for emotional support, validation, or a sense of identity.

Members of an enmeshed family may show signs of codependency, but that doesn’t mean they’re always codependent. The degree can vary among family members, and people may display different levels of codependency in different relationships.

Enmeshment in different cultures

Familial values, norms, and dynamics can vary widely, both within and between cultures. In cultures or communities that emphasize autonomy and independence, boundaries between family members are often expected to be more defined. But in other cultures, enmeshment may be a more common and valued means of maintaining strong family bonds.

Cultural factors can affect not just a family’s dynamics, but children’s experiences with those dynamics. In communities that place a strong emphasis on intergenerational responsibility, children may be expected to prioritize the needs and wishes of their parents and extended family, and this doesn’t necessarily have a negative impact.

One study of South Korean immigrant families in the United States, for example, found that enmeshment benefited children’s emotional well-being, especially when the families were less adapted to American culture.¹ In another study of European American and African American families, African American children who took on adult responsibilities by providing emotional and practical support—called “parentification”—didn’t experience negative outcomes in terms of their psychological well-being, while European American children did.²

Signs of an enmeshed family system

In an enmeshed family, love and support can come with high levels of intrusiveness.³ Signs of enmeshment vary depending on the people involved, and not all families with enmeshment exhibit the same behaviors. That said, there are some common signs.

Signs in adults

When parents, caregivers, and other adult members of enmeshed families (including grandparents, aunts, uncles, and so on) have difficulty setting boundaries with their own children or other children they’re related to, they may:

• Be overly protective and shield children from challenges
• Micromanage children’s lives and make their decisions for them
• Guilt-trip children to get them to do what the adult wants
• Invade children’s privacy by going through their belongings and/or monitoring their activities
• Rely heavily on children for emotional support and validation
• Want to be their child’s “best friend”
• Refuse to accept that children are growing up and becoming independent
• Enforce family unity over individual pursuits or outside relationships
• Avoid family conflicts to keep the peace or out of fear of negative consequences

Signs in children

Children in enmeshed families may become extra sensitive to their parents’ or other family members’ emotions and needs.⁴ They may also:

• Have trouble making decisions
• Struggle to become independent as adults
• Not develop their own interests and values separate from their family’s preferences
• Feel like it’s their job to keep their family happy
• Have difficulty making or keeping friends because their emotional needs are mainly met within the family
• Avoid stating their own needs to avoid upsetting family members
• Express strong emotions, especially during family conflicts or crises
• Reverse roles and end up taking care of their parents emotionally or financially

If some of these signs feel familiar, and you’d like support in understanding or processing your own experience of family enmeshment, visit our directory to find a therapist near you.

Why do families become enmeshed?

Enmeshment in adults can stem from their own history of being raised in an enmeshed family. People with an anxious attachment style are more likely to be part of an enmeshed family and contribute to the enmeshment dynamic.⁵ They may have grown up with inconsistent or unpredictable caregiving, which led them to seek out excessive closeness and validation from their family members.

One study suggests that mothers who struggle with their sense of self, lack healthy adult companionship, experience emotional instability, and show symptoms of mood disorders (such as depression) are more likely to be enmeshed with their children.⁶

Other contributors to enmeshment include external factors, such as traumatic events and cultural expectations. During times of crisis, family members are more likely to turn to each other for emotional support and security, which is often healthy—but in some cases can lead to blurred boundaries and codependency. Cultural expectations may also weigh on family members, who might feel obligated to prioritize household harmony over personal growth.

The impact of enmeshment

Enmeshment can have some positive effects. Children raised in enmeshed families may feel a strong sense of loyalty, belonging, and emotional support. They may also develop a strong interpersonal connection with their parents and extended family members.

However, the negative effects of enmeshment can be serious. Children from enmeshed families in some cultures may have difficulty making their own decisions, asserting their own needs and desires, and forming healthy relationships outside their family.

For parents, constantly striving to maintain control and closeness with their children may lead to high levels of stress and burnout. They may struggle to maintain their own identities separate from being a caregiver, a best friend to their child, or an emotional support system. This can put a strain on their relationships with extended family, friends, and romantic partners in the long run.

Since there’s such a strong focus on maintaining harmony and closeness in enmeshed families, both children and parents may have a tough time dealing with conflicts, which can lead to unresolved issues that simmer beneath the surface. Not having the chance to develop healthy conflict resolution skills can hinder personal growth and prevent open communication. Overall, higher levels of enmeshment have been associated with greater family stress and dissatisfaction.⁷

Enmeshment trauma

Enmeshment trauma can happen when a child is so involved in a parent’s emotional life and relationships that it harms the child’s well-being and affects their ability to set boundaries in adulthood.

Adults who’ve experienced enmeshment trauma may struggle with depression, anxiety, and patterns of unhealthy or emotionally unrewarding relationships.⁸ This type of trauma can leave people feeling unable to separate their own emotions and needs from those of others.

Healing from the negative effects of family enmeshment

Breaking free from enmeshment can be difficult because people generally don’t realize that the closeness they have with one or multiple family members is causing problems in their adult lives. They may understand that something feels off, but it often takes help from a therapist or counselor to detect that their issues are tied to unhealthy family dynamics.⁹

Once a person becomes aware of enmeshment and the impact it has on their life, healing can begin. This requires challenging long-held and deeply ingrained beliefs about themselves and the relationships they have within their family.

Types of therapy that can be helpful for healing from enmeshment include:

• Cognitive behavioral therapy (CBT), which helps people identify and change negative and behaviors associated with enmeshment
• Dialectical behavior therapy (DBT), which helps people regulate their emotions and develop skills to improve their relationships
• Family therapy, which helps family members improve communication, set boundaries, and address dysfunctional patterns
• Attachment-based therapy, which helps people develop healthier attachment styles and learn to establish secure and appropriate boundaries
• Emotionally focused therapy (EFT), which draws from attachment theory and family systems therapy to help people restructure their emotional responses and strengthen their relationships
• Group therapy, which provides a supportive environment for people to connect with others who’ve had similar experiences

In addition to therapy, there are practices you can try on your own to build a sense of individual identity as you process your experience of enmeshment. This may involve:

• Taking time to reflect on your values and beliefs
• Exploring personal interests, hobbies, and passions
• Being open to trying new things
• Connecting with others who share similar interests
• Reflecting on your thoughts and emotions
• Practicing self-compassion

You don’t have to power through healing by yourself—help is available. Browse our directory to connect with a therapist who can support you.

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