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J.Huber,MS,LPC (580) 591-1609
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PsychoBlast Journals PsychoBlast 1 Therapeutic Sentence Completions Explorations
Please feel free to do these and respond back in whatever way is easiest and
most beneficial to you. I'd love to see what you fill in the blanks with and how
that relates to the issues you have been working on so far. It can be very
helpful to take a few alternative views on situations and look at different
steps and new possibilities which might lead to an even better outcome. I
apologize that there's no way for me to develop my own worksheet currently on
the website. I have provided numbers for each completion, so you can speed up
the process of sending back responses. Also, what other categories do you think
might be helpful? Feel free to add your own sentence completions as well if
these provide for you a suitable launchpad for your own inner journey. Thank
you. Relationships/Love I know things are getting better in my relationship
becauseThe best way for me to show how much I love someone is for me toIt's
easier to express love when you areThe easiest thing about being in a
relationship with me isBoundaries and rules in a relationship can be good
whenOne of my strengths which I feel is the most important in my relationships
is myMy greatest frustration in my relationship right now isI wish it was easier
with my relationship when it comes toThe main thing I wish my partner would do
differently in communication with me isIt's easier to express my love to my
partner when I am Self/Expectations/Beliefs 11 My expectations make a difference
in regards to 12 Thoughts, feelings, and behaviors are connected and can
influence each other at all time since 13 Little things that I do everyday can
make a big difference because 14 I feel better about myself when I am 15 The
future is always different than the past when I 16 No one has any power over my
feelings because I can always 17 My beliefs have changed about in my life is my
belief regarding 18 It would help my life so much if I would take more
responsibility for my actions in the area of 19 There's usually more than one
way to solve a problem if you're just able to 20 New solutions for problems in
my life can lead to new possibilities of Daily Goals Work/Career 21 I could
bring more fun into my day at both work and at home by 22 I've always been
really good at 23 Something I've always wanted to pursue as a job but never have
is 24 If I was more courageous when it comes to work I would be able to 25 Being
more disciplined and procrastinating less would give me the advantage of 26 My
imaginative power shines the brightest when I 27 I know being more assertive can
help me a lot when it comes to 28 One thing that I've learned to do that I'm
very proud of is 29 Focusing on the right priority at the right time simplifies
my life by 30 Taking more control of my time can help me feel better about
myself because Symptoms/Body/Mind 31 One thing that I find it hard to let go of
is 32 I like physical exercise the most when I 33 I know my limits when it comes
to 34 I have successfully changed my diet before and I can do it again if I want
to because 35 The best thing about my physical body is my 36 I wish I didn't
feel so ashamed when it comes to 37 I know I am a good person because 38 The
biggest mistake I ever made in my life is/was 39 The thing I don't like the most
about myself is my 40 The best way for me to feel a sense of calm and inner
peace is by Faith/Imaginations/Hope/Courage/Spiritual/Adventure/Future 41 I am
creating my future moment by moment by 42 The power of choice gives me the power
to 43 The deepest connection I feel with life is when I 44 If it didn't scare me
so much I would love to 45 The meaning of some experiences in my life has
changed since 46 No one can stop me except myself when it comes to 47 If I
didn't have an excuse at all to keep me from it I would 48 I know I am becoming
a better version of myself when I 49 The question I most need to answer about
myself and my life is the question of 50 The best way for me to feel better
about myself when I'm really feeling down is to Negative Language And Self-Talk
Pattern SolutionsI can take care of and speak up for myself.I can succeed step
by step.I have choices now. I can recover.I can stand it, handle it, and trust
myself.I can show emotions, ask, and set limits.I can decide what's right for
the situation.I can start over when relationships end.I can find love, caring,
and a purpose.Each person has both good and bad qualities.I am fulfilled,
connected, and I belong.I have value even when others disapprove.I still matter
when others don't "respect" me.I'm as good as others and vice versa.People can
love me without liking all of me.Understanding others helps me feel
better.Others have needs and struggles of their own.I am worthy even when others
aren't loving.I'm still lovable when others are attractive.I've survived before
and I'll survive again.I can handle it when things don't go my way.I have value
even if I make mistakes.Others can make mistakes and learn from them.I'm
responsible for only my part.There are many ways to do and fix things.I can
handle mishaps in the future.Most people have genuine, worthy qualities.Others
have needs and struggles of their own.I can find good intentions and ask
questions.I'm worthy despite others' comments and actions.I can defuse criticism
and find out it's cause.I can learn to belong, fit in, and make
contact.Disapproval does not equal rejection.I can learn to handle rejection or
criticism.I enjoy contact with others.I find freedom in relationships.People
have good, appealing attributes.I must ask questions to understand others.I'm
responsible for only my part (if at all).I can handle things which I can't
control.Discomfort is usually caused by my thoughts. Affirmations In Regards To
Love I love and accept all aspects of myself, both the positive and the negative
and I am safe. Love is eternal and as I express my love I am also eternal. The
love I express makes me feel free. It is safe for me to be in love. We are
always equal partners in love. We each take care of ourselves. People love me
when I am myself. I am worthy of love. I go beyond my parents limitations.
Loving myself and others gets easier every day. The more I love, the safer I am.
My partner and I respect each other's decisions. I now create a long-lasting
loving relationship. I give myself permission to experience love in it's
infinite and intimate forms. PsychoBlast 2 What is a negative thought that has
been recurring? How can you deconstruct it and turn it positive?What are three
affirmations you can tell yourself this week to improve your mindset?Are there
any books or tools you have found that have helped you learn about having a
positive mindset? What are they and what was the biggest lesson from them?What
cognitive distortions do you identify the most with? What are five positive
thoughts that you can tell yourself when you are feeling down?Write down as many
thoughts you’ve had during the day as you can. How many of them were negative?
How many of them were positive?Describe a day you’ve had that started out bad
but turned out to be a good day. How did you achieve that shift in mindset?Did
you know that you can control your thoughts? Today, try your best to only think
positive thoughts. At the end of the day describe how this went. Did you notice
any changes?
Therapy Journal Prompts About Your FeelingsWrite down 5 things, or activities,
that make you the happiest. Why do they make you happy?What are your triggers
that cause you to feel anxious? How can you avoid them or minimize their effect
on your mental health?Check in with yourself – how are you feeling physically,
mentally, and emotionally today?What makes you feel like your most authentic
self? Is it being around a certain person, doing a certain activity, etc..Write
one to three things that inspire you to be your best self?What helps brighten
your day when you are going through a hard time? What’s your love language
(words of affirmation, gifts, acts of service, physical touch, or quality time)?
How can you better show love to yourself through that?When was the last time you
cried and what helped you feel better?What causes you to get angry? Are there
any certain coping skills that help you calm down?What makes you feel the most
confident?What are the emotions that you feel the most? Are they mostly positive
or mostly negative?Who is someone in your life that always seems positive? How
can you learn from them to develop a more positive mindset? Do you express your
feelings easily? If not, why?Who are you the most positive around, and who seems
to bring out more negative thoughts?
Therapy Journal Prompts For After Your SessionHow did you feel 10 minutes after
your therapy session today?How are you feeling after your therapy session?Did
you learn anything new about yourself?Were there any surprising thoughts or
feelings that came up for you during your session?What are some practical tools
that you learned today that will help you when you are struggling?What stuck out
to you the most during your session?Were there any points during therapy today
that were tough to talk through?Was there something you wanted to discuss today
but it didn’t come up?Did you receive any homework or activities to do and/or
practice before the next therapy session? How do you feel about it?What do you
need to do to prepare for your next session?
Therapy Journal Prompts About Self Acceptance & ConfidenceWrite down three of
your favorite songs about self acceptance. What do the lyrics mean to you?Why do
you think you struggle with self acceptance?What makes you feel loved?Have you
taken the time to appreciate yourself lately? If not, how can you do that this
week?What parts of your personality, skills, appearance, etc. do you love the
most, and why?Describe a time in your life when you felt the most confident.
What made you feel that way?What does self acceptance mean to you?How do you
think your life would change if you loved and accepted yourself just as you
are?When was the last time you were proud of yourself?How do you feel when
someone compliments you?
Therapy Journal (List) PromptsWhat are five things you are grateful for in your
life right now?Describe yourself in three words, then explain why you picked
those words.What are five things that you love about yourself?What are five good
thoughts you have had recently?Who are five people in your life that you are
grateful for?Describe three times in your life when you felt the happiest.What
are three things you want to tell your past self?What are three things you want
to tell your future self? Write down five compliments you have gotten from
friends and family.What are five things you can remind yourself of when you are
having anxiety.Beverly Hills MD
Therapy Journal (Letter) PromptsWrite a letter to someone that inspires you to
keep going.Write a letter to someone who has had a negative impact on your life.
Write an encouraging letter to yourself to read on a bad day. Write a letter to
encourage someone else.Write a letter to someone who has been a positive
influence to you.Write a letter to someone you are thankful for.Write a letter
to yourself ten years in the future. Then seal it in an envelope to be opened
ten years after today’s date.Miscellaneous Therapy Journal Prompts If you could
travel anywhere in the world, where would you go and what would you do?What is
something that you’ve always wanted to do but fear has held you back? How can
you face that fear and go after what you want?What does your perfect day look
like?If you could spend the day with anyone, dead or alive, who would it be and
what would you do?What are your monthly, yearly, and/or life goals? How do you
plan on achieving them?How do you define these words: success, happiness,
contentment, growth?What is something you are hoping to overcome? How are you
going to make that happen?Find an inspirational quote and write it out. What
thoughts come to mind when you are reading it?How do you practice self care?Do
you find yourself comparing yourself against others? When do those feelings
typically come up, and how can you put a stop to them?How has journaling
impacted your mental health? Journal PromptsJournal Entry 1: The Pillars of
Positive Psychology (Due Week 2)Research suggests that people who flourish in
life, and are happy and productive, have certain psychological traits in common.
These traits are habits of perceiving and thinking about the world and our place
in it. The term commonly used for these habits of thinking is “positive
psychology”. The most important thing for you to realize is that positive
psychology traits can be learned through practice. YOU can learn habits of
thinking that will help you be happier, more productive, excel in college, and
change the world around you.The following journaling exercises will help you
learn the pillars, or principles, of positive psychology and begin to implement
the practices into your daily life. Our goal is that by the end of Fall term you
will internalize and practice habits that will help you excel in college and the
rest of your life.A Connection to Something Bigger We tend to exist largely
within psychological boundaries that can restrict our experience of the world.
This exercise is to gently push the edges of your boundaries and connect with
larger experiences in ways that have purpose. In other words, we want to do
things not merely for the sake of doing them but to contribute to something
bigger than ourselves. This exercise involves steadfast commitment. Without the
commitment to implement habits of positive psychology, it is unlikely you will
experience the full benefit. Create a new Journal entry on Blackboard. Please
answer the prompts honestly; only you, the Peer Leader and your Instructor will
be able to read your answers.Begin by thinking of things that you have not yet
accomplished in life but want to, your “bucket list”. These can be careers you
would enjoy, places you want to go, people you would like to meet, activities
you want to try, etc. Don’t be concerned about how you will accomplish the
things on your list, just imagine! Try to come up with 8 to 10 items and write
them in your journal.Review the four principles, or “pillars”, of Positive
Psychology below. You don’t need to know every term, but try to gain a sense of
what each pillar stands for. Pillar #1: Positive Emotion: subjective well-being,
happiness, gratitude, savoring, flow, signature strengths, imagining
possibilities.Pillar #2: Meaning: positive institutions, virtues, contribution,
service, altruism, hope, future-mindedness, positive deviance.Pillar #3:
Positive Relationships: social connections; intimate relationships, positive
interactions, pets, church/spiritual communities, professional work, interest
groups: teams, military units, support groups.Pillar #4: Positive
Accomplishments: mastery, competence, achievement, success, new skills
acquisition.Refer to the list you created in Step 1: Next to each of the things
you listed, assign a number that represents the pillar that best matches that
item. You may list more than one pillar next to an item. Select one item from
your list and write about how the item will positively influence your life. One
way to do this is by expanding on the pillar(s) you assigned the item.Think
about how you might accomplish the item on your list and at the same time
contribute to another person’s life, your community, a population in need,
society at large, or some social issue. Write in your journal how you hope to
influence the “world beyond” through your activity.Now write about what it will
take to actively pursue the item you have selected and list the steps you will
take to make your pursuit a reality. Journal Entry 2: Your Best Possible Self
(Due Week 4)Subjects in an experiment (Sheldon & Lyubomirsky, 2006) were
instructed to spend time visualizing and writing about their best possible
future selves. Test subjects were told:“You have been randomly assigned to think
about your best possible self now, and during the next few weeks. “Think about
your best possible self” means that you imagine yourself in the future, after
everything has gone as well as it possibly could. You have worked hard and
succeeded at accomplishing all of your life goals. You are identifying the best
possible way that things might turn out in your life, in order to help guide
your decisions now. You may not have thought about yourself in this way before,
but research suggests that doing so can have a strong positive effect on your
mood and life satisfaction. So, we’d like to ask you to continue thinking in
this way over the next few weeks, following up on the initial writing that
you’re about to do.”After four weeks, test subjects who practiced this
visualization technique experienced more positive emotions than control
subjects. The purpose of this journaling exercise is to help you increase your
positive emotions and optimism for your future through visualization
practice.Create a new Journal entry. Visualize your best possible future self, a
future in which all things went well. Document that vision in your journal by
answering the following questions:Describe in detail your ideal future life.What
would your future self be doing to achieve this ideal life?How would your future
self be relating to others and feeling like you are part of a greater
community?What can you do now to work towards your ideal future?In four weeks
you will reflect on these questions again. Based on your daily experiences
between now and then, try to detail your “best possible future self” by
reflecting each night on your vision and the strengths you have right now to
help achieve it. Journal Entry 3: Mindset Assignment (Due Week 8)One of the
primary attributes of people who flourish in life is a "Growth Mindset" which
enables them to keep positive, adapt to change and excel in what they do. We all
have Fixed Mindsets in some ways, the key is identifying them and working to
change to a Growth Mindset.Read the differences between a Fixed Mindset and a
Growth Mindset and then identify where you are for each category, Desire,
Evaluation of Situations, etc. A “fixed mindset” assumes that our character,
intelligence, and creative ability are static givens which we can’t change in
any meaningful way, and success is the affirmation of that inherent
intelligence. A “growth mindset,” on the other hand, thrives on challenge and
sees failure not as evidence of unintelligence but as a heartening springboard
for growth and for stretching our existing abilities.In your Journal describe
the ways you have a Growth Mindset and the ways you have a Fixed Mindset. What
BEHAVIORS can you implement to have more of a Growth Mindset? Behaviors are
important to focus on because saying "I'll change the way I think." is vague and
easy to forget. Practiced behaviors can become habits and solidify a Growth
Mindset.DesireEvaluation of SituationsDealing with
SetbacksChallengesEffortCriticismSuccess of othersResult Journal entry 4:
Revisiting “Your Best Possible Self” (Due Week 10)We are now returning to
Journal Assignment 2, "Imagining your best possible self", to see how reflecting
on your strengths has helped you on the path to achieving your best possible
self. Remember the goal is to imagine yourself in the future, after everything
has gone as well as it possibly could. You have worked hard and succeeded at
accomplishing all of your life goals. You are identifying the best possible way
that things might turn out in your life, in order to help guide your decisions
now.After four weeks, previous test subjects who practiced this visualization
technique experienced more positive emotions than control subjects. The purpose
of this journaling exercise is to help you increase your positive emotions and
optimism for your future through visualization practice. Create a new Journal
entry.Have you been regularly visualizing your best possible future? As you've
gotten deeper into college, how has that vision changed through the quarter? As
you've had ups and downs, how have you amplified your strengths to achieve
success?What are your strengths and how have they served you well? Beyond time
management, describe your challenges through the term.Describe your plan for
building on your strengths for maximum success. “What progress have I made in my
life in the past five years, five months, five weeks?”“What things about my body
am I the most thankful for?” (The fact you can smell gorgeous flowers, dance
through fields, or swim through the ocean using our body?)“What are my ten
favorite compliments I’ve received?”“What do I love about the people who are
close to me?” (List their individual traits that you enjoy.)“What are ten things
I’ve done that I’m thankful for having done?” “What are some positive things I
learned from “bad” events in my life?”“What advice would my older, wiser and
more loving self give me right now?” “What can I do to show myself love?” Our
journals, desk pads and planners come complete with lots of prompts for a
positive mindset, making your life easier as you don’t have to add that many of
your own! Personal Growth Journal Prompts for Self-AwarenessSeeing is
undoing—once you see your negative beliefs, thought patterns, and habits, you
can start to undo them. Becoming aware of them gives you the option not to
engage with them, or to change them to empowering beliefs, thought patterns, and
habits. “How do I sabotage myself?”“What are some of the consistent negative
thoughts I have?” “What limiting beliefs do I have about
money/relationships/career/friendships/health/etc.?” (Pick one at a time.)“What
are the functional thoughts (positive beliefs) I have around
money/relationships/career/friendships/health/etc.?” (Pick one at a time.)“What
are the things in life that make me feel good, or make me laugh?”“What motivates
me?” (Is it fear that motivates you to perform well at work, or the idea of a
nice paycheck, or perhaps praise? Go through different areas of your life to
find out what motivates you.)“Whose opinions do I care about the most? What
would my life be like if I did not care about those peoples’ opinions?”“What are
my main coping mechanisms? Are they serving me well?” (This one comes from Eric
Sangerma and is well worth pondering— what we do to survive is not always what
we need to do to thrive.) Growth Journal Prompts for Dream JournalingNot all
growth journal prompts are complicated. Sometimes, it’s as easy as writing down
what you dreamt about last night. You can also add prompts to check in on
recurring themes in your dreams and write about what they mean to you. For
example, you might have been dreaming about water a lot lately. Or maybe you
felt chased by something in your dreams? Is stress chasing you in real life? Or
is it something else that’s chasing you? It’s usually only when we look back at
the last week, or month, that we find patterns. So keep journaling about your
dreams every day and write down prompts that remind you to have a look at
recurring themes and journal about what they mean to you. Journal Prompts for
Goal SettingThere are some goal setting prompts everyone should have in their
journal. “What did I accomplish this day/week/month?” “What would I like to
accomplish more of tomorrow/next week/next month?” (Be sure to include personal
and professional goals, as well as specific relationship goals with different
people—whether you want to set time aside to spend more time with someone, or
compliment them more often.)“What are the actions I need to take to achieve my
goals this day/week/month?”“What are my main life goals?” “Which main life goals
do I wish to focus on right now?” “What do I need to do to get to where I want
to be one year, three years, and five years from now?” “What might I do to
accomplish my 5-year goal in 6-months, if a gun was up against my head?” (This
prompt comes from Tim Ferriss and is a great one to ponder if you want results
fast—less great if you go into overwhelm and try to do too much at once…but then
again, that’s not what you would do if you had to accomplish all your goals in
six months, is it?!)Where in my life can I trade a short-term, incremental gain,
for a potential longer-term game-changing upside? (Benny Glick recommends this
prompt and it’s truly something worth pondering when you are setting your
goals.) Where do I want to be in 5 years?My happiest memory is….One way I could
love myself more is by….Write yourself a letter forgiving you for something that
has happened in your past.What is something I need to let go of? Why am I
holding onto it?Write down three things that cause you anxiety. Brainstorm 1–2
ways you can combat these triggers when they come up.What does self-care mean to
you? How do practice this in your daily life?What is your best quality?Create a
list of 35 things that make you happy.What is something you are afraid to
accomplish?Where is this fear coming from?Create an itinerary for your “dream
day.”What are my strengths? What are my weaknesses? How can I work to improve on
these?What is something that I’ve struggled to follow through with? Why do I
think that is?Write a personal mission statement for who you want to be and how
you want to live your life.Am I facing real obstacles when it comes to
__________?Am I spending my time in a way that makes me feel happy?One thing I
will achieve this week/month/year is _________.What positive changes have I made
in the last year?List 15 things you’ve accomplished._________ derails my
productivity. I can take these steps: ______, _________, and _________ to change
that.How can I show others more love and positivity each day?List 5 things that
you’ve always wanted to do but are outside of your comfort zone.How can I feel
more fulfilled in my day to day life?Why is personal growth important to me?When
do I feel most confident?Create a list of the different types of person you want
to be. For example: a confident writer, a loyal friend, a thoughtful daughter,
etc.What unhealthy habits do I need to change?What healthy habit do I want to
start?Make a list of 20 things that inspire you.Create a list of 10 mantras you
can use as daily affirmations.Describe the last time you stepped out of your
comfort zone.Where in your life do you need to start saying no?What boundaries
do you need to put into place to live a happier life?Describe an activity you’ve
always wanted to try and why. Write down 5 things that make you incredibly happy
and describe why they make you feel this way.What do you fear the most? Why? Is
your fear rational?What qualities about yourself do you love the most?In the
next year, what are 5 improvements you would like to make regarding your life?
Write about the improvements and create a plan to accomplish each one.Write
about your one of your happiest memories?Write about the people in your life
that make you feel the most “at ease” and what they do to make you feel that
way.Write about a difficult memory and the coping mechanisms you used at the
time. Would you change the way you dealt? How?Write a poem (that DOESN’T HAVE TO
RHYME), describing the exact opposite of yourself.Write about the last time you
cried. What caused you to cry?Write about the last time you laughed really hard.
What was so funny?Write a letter to the future YOU.Write a letter to one of your
parents – even if you don’t actually give it to them.What has your anxiety
taught you about yourself?Write down a list of ‘regrets’. Either throw them away
or toss them into a fire. (Let go of past regrets & move on).In detail, describe
a perfect day.Write a letter to a person who has negatively impacted you.
(Again, you don’t actually have to send it out).Write a letter to a person who
has positively impacted you.Write about an incredibly difficult choice you’ve
had to make in your life.Write down all your coping mechanisms. Evaluate the
ones that are most helpful and the ones that are the most detrimental. Describe
what love means to you in detail.Write a letter of forgiveness to yourself.Write
down 3 of your favorite smells. Describe, in detail, how each one makes you
feel.Have you ever felt isolated? Write about it.Write about 5 songs that mean
the most to you. Why do the lyrics speak to you? How do you relate to these
songs? How do they make you feel when you hear them?Write down all the
compliments you can think of, that you’ve received. Write down compliments to
people in your life.Write a list of 10 things you want to remember during
difficult times. (Use this later if you’re feeling down). What risks do you want
to take? What’s holding you back?What element do you consider to be YOU? Write
about why. (Earth, Air, Fire, Water).What are some of the strongest emotions
you’ve ever felt? Write about how those emotions affected you and what caused
you to feel those emotions.Physically, how do you feel right now?What speaks to
you on an spiritual level? (Poetry, quote, song ect.) Write about it.What
items/objects do you find the most comforting? Why do you think that is? What is
comforting about them?Write a love letter to yourself.Write about something that
is frustrating to you.If you could be anywhere in the world at this very moment,
where would you want to be and why?What are 3 things that make you angry?
Why?What activities do you think would make you feel better? Make a plan to
carry out those activities.Write about something random you’ve seen that made
you smile.Describe your dream house.Who or what (or both), helps motivate you
the most? Why is that?What are you worried about? Why?What are some of your
favorite books? Why? Write about them.What makes you laugh?Write about what you
perceive to be the worst thing you’ve ever done.When is the last time you did
something for someone else? What did you do and how did it make you feel?What
secrets are you keeping? Are these secrets affecting your life or mental health?
Why or why not?Write about something that truly surprised you.Describe an outfit
that makes you feel completely comfortable in your own skin. If you weren’t
afraid, what are 5 things you would do? Are there any ways you can think of to
overcome the fear?Write a letter of forgiveness to someone who has caused you
pain. Old Man Days Past The Solstice Survival Scene Number ?
The winter of my heart (small ember barely orange needs blowing on, a thought i
somehow know I have to hold onto, need to find kindling to keep this heart
alive, might need to take it to somewhere else that provides more shelter and
wind protection)
Hypothermia sets in if the blood stops moving. It’s slowing to a crawl. These
snails in my veins are so out of shape that they have become resistant to the
idea of even inching along.
But did I have a choice? Do I have to keep punishing myself from the choices in
my past so much? Yes I am still hurting right now.
It takes everything I have just to reach down and blow. I trap it between a
couple of perfectly shaped rocks. Breathe in. Breathe out. It stirs a little. It
lightens a bit. I see a place around the bend where the wind doesn’t blow quite
so hard. I take a step. The pain increases, but I know I must take another. Blow
again. Reach down and dig beneath the snow. I dig and dig some more until
finally, I find a branch. Underneath the branch it’s dried or at least not as
wet. It’s worth a try. I peel and scrape but not too much, because of course I
have to blow more. Just to keep my little friend alive. The only hope I have
right now.
I’m almost to the clearing past the bend. I sit down underneath the largest of
many trees and I for some reason can breathe a little easier now. I feel Dr.
Grim’s hand upon my shoulder. I look behind me and nothing is there. Reap
somewhere else today my friend Dr. Grim will be back soon enough. I don’t have
time for such imaginings. I look away from the shapeshifting shadows.
Blow blow blow some more. Scrape and peel. Form a shape. Look around and utilize
what’s available in your environment. Breathe. I become even more aware that I
don’t know what the hell I’m doing. Or where the hell I am at. Much less, how
the hell did I get here. But somehow I start to have a feeling, a feeling I
haven’t felt in such a long long time. The warmth in my fingers begins to
tingle. It spreads a little. And now my hands don’t take as much out of me, just
to squeeze them. What I would give just to have someone else's hand to squeeze
right now. But it’s ok, my own will have to do.
(end of broadcast)
And now I hope you’re ready for the next idea. Because the storm in this brain
never ceases. Never calms. Only increases and spins out in more unpredictable
directions to wreak havoc. So I will break it down as much as I can. I have been
pondering a problem which has been bothering myself and a few clients for a bit
of time. And that is the concept of notes for a session. This is a benefit to
both myself as well as yourself. Having an audio transcript of the session, even
if it has a few errors here is something that I am currently aspiring to with
other clients on other platforms. So, I have a proposal whether modest I guess
you be the judge. And it is as follows. I have been experimenting with a
transcription automation program. And so far it is quite limited as far as the
trial period goes; but I wanted to put it out there for those of you who would
indeed enjoy your next audio transcribed please let me know. It’s one of the
benefits that I have discussed before of the chat sessions in that a record can
be saved and used between sessions or at the least be there to pick up with the
next session. Anyway, if you think this is something you’d like (I have about 10
hours left on the trial version) then I will do my best to make that happen.
Some of you might rather not have that put into the room for whatever reason you
determine; but as for those who would like that I believe you should have the
options. Betterhelp doesn’t require clinicians to put notes in the platform and
that is a limitation in some instances. Anyway, I have several reasons for the
motivation of this possibility with one of the main one’s being that I feel like
it is another value added service that might help at least a little bit to keep
me competitive. Looking forward to hearing what you might thnk about this and if
there’s enough of a demand I will for sure be subscribing to the full plan which
allows 6000 minutes per month (which actually isn’t even enough time for
everyone on my caseload to partake of this feature every week). Another thing
that I’m looking at is having a video feed as well for the sessions (not a video
chat but my own hybrid version of it and more details on this later). Ok, it’s
later, what do you think would be neat to have in your virtual therapy room?
Would you like to have a space to play to put on armor or try out a weapon where
you could virtually and symbolically destroy a fear or a past memory of trauma
or even better perhaps something that represents your self imposed perceived
limitations? These are just a few of the ideas I’m considering. There can also
be a video feed in there as well, maybe in one of the corners an object you
could click on to see what your therapist is up to (probably no good). There
could be a maze or escape room part and some thought provoking artworks that
serve as an interesting intervention. Maybe art works that ask you questions? Of
course there can be a music and meditation/mindfulness space. The only thing I
feel a bit weird about is having nature represented in virtual reality. How do
you feel about virtual trees, mountains, animals, and flowers? I think it would
be much better to just try to spend as much time in real nature as you can.
Rather, I would like to see this be a space that might even be possible for you
to reach into when you’re dreaming, like a pit stop on the astral highway, or at
least a place you can go in meditation. Maybe you need a guide for this. Maybe
you can be an even better guide to yourself when there’s no agenda and no right
way to turn and no treasure to find because it’s literally all around you. What
is around you is also an aspect of what’s inside of you. What would you put in
your virtual therapy healing space? PsychoBlast 3
Here it comes another psychobabble blast. Somewhere I read he who hesitates is
lost. And I’ve been hesitating / procrastinating on this all week. Then again I
read somewhere or heard that rather patience is a virtue. Like so much in life
it depends on the context. How well you receive the info might actually have
something to do with the mood you’re in when you read it. Or some other factor
entirely. Some of you might have received the earlier beginning of this version
(which I will also share at the end of this introduction) and if you did and you
misinterpreted it. I would like to say that I’m sorry. So this new and improved
version (I hope) will be all about misinterpretation among other things.f you
just started therapy in the last week, I’d like to thank you again for getting
started and for sticking with me with my first week “off” in quite some time.
There are a few things that I like to share every week as a role model for the
use of journaling. Today I want to talk a bit about humor, laughter, and
surprise. I believe that these three things have just as strong a place in the
process of therapy as promoting faith , hope, and courage. Maybe these can even
overlap a bit occasionally. Sometimes there’s not a good time and space in a
therapeutic session to tell or hear a good joke, but that doesn’t mean we can’t
give it a try every once in a while at least. Maybe this isn’t supposed to
happen that often in the first month or so of therapy but usually as we get to
know each other better, more times become not only possible but even probable.
Of course, this week wasn’t off in a traditional sense, since being off meant
being on a more than 4000 mile road trip for a family tragedy of one of my
wife’s nieces. Anyway, if I’m repeating myself for some of you, I apologize in
advance.But again, back to misinterpretation. I reread through my previous intro
and I’m still a little bit puzzled that it was misinterpreted so much by some.
It has made me question a bit just how good my communication skills actually
are. I think maybe if I would have just given it a title, then that would have
made a difference, but then again, I have my doubts as to how many of you
actually get through even a few paragraphs of this monstrosity. So now I will
insert the old one that some of you actually got already and then I will have a
few more things to say about misinterpretation and more generally perception. So
whether you are seeing a rabbit or a duck now I am not sure (insert illusion
image card here).
If the mistenterpeted shoe fits then wear it and maybe even feel like how it
might feel to be in another person’s shoes from time to time (as misinterpreted
as they might be as well).

If you don’t want or expect some confrontation in a therapy session, well then,
therapy with me might not be the best possible option for you. I cringe at
myself for even saying that. But then again, all of this is focused on healthy
boundaries and expectations. I have to practice what I preach. And the word “NO”
being the strongest word in our language. The opposite of is on and of course
sometimes this isn’t the train you need to be on or climbing aboard because it
isn’t going to give you the destination that you want then you might have to
just go ahead and jump off at the next stop or even right now before it even
leaves the station. If however, you have come to therapy for life changes, then
please step right up and find your perfect seat with a window view even and
enjoy a snack if you like. But if you just came here for noddings and mumblings
in agreement and even sometimes enabling types of behaviors or some sort of echo
chamber (not sure what else to call it , maybe I will think of something else
before this rant is over?); well, please go back to the station and switch
therapists. I take pride in what I do. Let’s play with a metaphor or two for a
minute. If your life is a house and it is crumbling or maybe not even crumbling
but it’s just not what you’d like it to be, then most likely you will have to do
some remodeling and renovations. And in order to do that you will probably have
to knock down a wall or two and maybe even replace a few worn out parts that are
no longer serving you in the best or even a proper way. So yes, that might be
painful. There might be a few memories and attachments that you have to let go
of to deal with in this process. It might hurt a little or a lot (again forgive
me for another metaphor) almost like getting a tooth extracted or drilling out a
cavity. This is no oracle at delphi; there are no hidden meanings or code words
for other words or ideas. I am as we say here where I am from, a pretty straight
shooter. There are plenty of other much more fancy and complicated therapists
than myself. They might even with more patience and more understanding and even
more experience than I have. Thanks for your time and patience and
understanding. I look forward to our next session and if not well I wish you all
the best as well in your therapeutic journey. Have a great rest of your week and
weekend!
So there it is for those of you that haven’t seen it before and maybe again for
those of you who already got this part before. Does it sound too harsh? Does it
sound like a therapist that is deep in the throes of burnout? Does it need a
trigger warning? Please know that if I offended you in just trying my best to be
more clear about the boundaries and expectations of a counseling session and the
therapeutic process; then I am truly sorry. Am I overreacting? Am I over
analyzing or overthinking it all? Maybe so. Maybe so. But I am doing my best to
not leave as much to chance, especially when I get feedback that I have not
expected. I don’t want to make any assumptions and I think it will be best for
you if you don’t make as many as well. Communication is the key to all
relationships whether with yourself or your partner or your boss or your child
or your best friend. It isn’t always as clear as we’d like for it to be. It’s
easy. You just speak your words and get the words back and respond in kind. But
then again, maybe it’s so easy that we take the whole delicacy and nuance of the
whole process way too much for granted way too many times. If you could and do
have to make just one assumption though, I would suggest that one of the best
ones you could make is that I have good intentions and that I am trying my best.
Thank you all so much for your messages and your sessions. Let’s do our best
this week to make sure we don’t make this beautiful two way street that we all
get to drive on to get to our destinations, only one way and end up in a
psychotherapeutic fender bender; no matter what kind of car you drive. And don’t
forget to watch out for motorcycles!
How are you feeling right now? Your brain has many jobs, but its most important
might be to answer this question. Perhaps you are hot, relaxed, hungry, in pain
– or something else? Your ability to sense the physical state of your body in
this way helps you survive. It helps you eat instead of starve. It tells you to
call the hospital if you feel you might be having a heart attack. But how do you
know how you feel?
Often, you can’t see, hear, touch, smell or taste information about the internal
state of your body. Instead, you use a sense known as ‘interoception’ (in
contrast to ‘exteroception’, which is how you sense the outside of the body via
vision, taste, smell, touch and hearing). The notion of interoception was
conceived more than 100 years ago when Charles Sherrington proposed the idea of
there being specialised receptors inside the body that send information from our
organ systems to the brain.
Of course, when I asked how you’re feeling right now, you might well have
answered differently – you might have said you are feeling sad, stressed,
excited, bored or some other emotional state. You don’t have an organ of boredom
that communicates this internal sensation to the brain. However, interpreting
your emotional feelings has a surprising amount in common with interpreting your
bodily states. One example is judging whether you are feeling stressed rather
than hungry. Both involve physical changes in the body: when you’re hungry, your
stomach rumbles, you might feel weak; when you’re stressed, your heart and
breathing rate increase, perhaps you even sweat or shiver. Perceiving and
interpreting these physical changes in both cases involves interoception.
The overlap between bodily and emotional feelings goes much further. If you are
feeling unwell, this often involves changes in both physical and mental health.
For example, both the flu and the COVID-19 vaccines temporarily raise
inflammation in the body, which can cause mild flu-like symptoms. Along with
feeling achy and tired, the increased inflammatory state from a vaccine can also
cause changes in mood. In a particularly extreme example, a medication called
interferon alpha that’s used to treat hepatitis C and other conditions, and
which increases inflammation, was found in one study to cause 40 per cent of
hep-C patients to develop major depression.
The same is true in the other direction. Mental health conditions can profoundly
change the sense of the physical condition of the body. In panic disorder, the
majority of symptoms are physical: feeling faint, chest pain, heart palpitations
and so on. Or consider eating disorders. For most people, hunger is aversive and
satiety is pleasant, yet people with anorexia report how much better it feels to
experience hunger rather than satiety. For them, satiety tends to arrive more
rapidly, and normal fullness can cause discomfort, bloating, and even
spontaneous vomiting. Bodily or ‘somatic’ symptoms are also commonly experienced
in depression (eg, loss of appetite and sex drive); in anxiety (eg,
gastrointestinal problems); and in post-traumatic stress disorder (eg, trembling
and feeling nauseous).
None of us has a direct line of communication with our body. Anything we feel is
a subjective sense, heavily influenced by other factorsWhen you close your eyes
and assess how your body feels, you are using interoception. This is not a
passive process – it’s not a simple case of unambiguous signals arising from
receptors inside your body. Sometimes, different bodily sensations can feel very
similar, making it hard to ascertain their origin. Do you feel hungry, or
nauseous? Are you sweating from heat, or nerves? To read this uncertain signal,
your brain uses clues from other factors: where you are, what you have recently
done, what sensations your body has experienced before, and so on. That means
that what you feel is a representation in the brain, only partly in response to
actual input from the body. You can see why this would be useful when the input
is so noisy, so hard to interpret. But the consequence is that even when you are
very sure your body feels one thing (uncomfortably full, for example), you can
never be certain, because none of us has a direct line of communication with our
body. Anything we feel is a subjective sense, heavily influenced by other
factors.
An important implication of this subjectivity is that the different bodily
experiences associated with certain mental health disorders might not come
directly from what’s happening in the stomach, heart or other internal organ,
but rather from how the brain interprets and processes the signals arising from
those organs. Indeed, interoception is experienced differently by people with
various mental health diagnoses, which has led scientists to theorise recently
that there might be a basic difference in how the brains of people with mental
health conditions process bodily sensations.
To test this possibility, researchers have conducted many studies to measure the
brain activity of people with mental health conditions during interoception. For
example, they’ve invited volunteers with mental health conditions to lie in a
brain scanner and count their heartbeats, or focus their attention on their
stomach or bladder, or to hold their breath. These studies have discovered many
brain regions that appear to function differently – being either over- or
underactive during interoception – compared with healthy volunteers’ brains,
including in the frontal, temporal and insular cortices, as well as in many
deeper, subcortical regions, such as the thalamus and amygdala.
Because of the variety of brain differences uncovered in that previous work, a
couple of years ago I started to wonder whether different mental health
disorders had any common changes – that is, shared differences in the brain
during interoception. To find out, I analysed previously collected neuroimaging
data from more than 1,000 volunteers engaged in interoception, half of whom were
patients with many different psychiatric diagnoses. I was looking for anywhere
specific in the brain’s interoceptive system that was different across
diagnoses, rather than for neural markers specific to one disorder or another. I
took this approach knowing that the biological correlates of different types of
mental health disorders often overlap. Moreover, mental health disorders are
highly comorbid – people who experience one disorder or diagnosis are at
increased vulnerability for other disorders. In other words, at a
neurobiological level, there appear to be common factors driving poor mental
health – and I reasoned that this might apply to interoception too. Still, I
wasn’t that hopeful of finding a single, uniform brain difference across
disorders. After all, different diagnoses could be driven by wholly different
interoceptive changes. And even if I did find a common difference, I thought it
was more likely that a whole bunch of regions would be implicated.
It could explain why, when you feel worse mentally, your physical pain might
worsen; and why inflammation in your body can make you depressedTo my surprise,
I found that, during interoception, patients with depression, bipolar disorder,
anxiety, anorexia and schizophrenia all showed ‘abnormal’ activity in one
specific brain region called the insula, compared with healthy control
volunteers. I cannot say from this study if activity in the patients’ insula was
overactive or underactive during interoception – it probably depends on the
nature of the interoceptive task, and perhaps on the specific diagnosis. For
example, when asked to focus on sensations from their stomach, people with
anorexia showed decreased activity in this region, while people with substance
use problems exhibited increased activity in this region during anticipation and
experience of soft touch. Nonetheless, my results suggest that this one key
region (other studies might discover more) shows an atypical amount of
activation during interoception across patients with different kinds of mental
health conditions, as compared with healthy controls.

The location of disrupted activation: the mid-insulaThe region I identified
won’t surprise interoception scientists. The insula is well known as a key
player in sensing the state of the body; it’s also involved in pain and emotion
processing. But there is more to the story. Different insula subregions are
involved in different functions, and the subregion where I found a difference in
mental health patients was specifically the mid-insula. The mid-insula is
distinctive anatomically because its cellular architecture is a hybrid:
somewhere between the cells that make up the front of the insula (anterior
insula) and the back of the insula (posterior insula). Moreover, this hybrid
structure is relevant to this subregion’s connections, which allow it to
communicate both with the more emotion-related anterior insula and the more
body-sensing-related posterior insula. Perhaps then, the area of the insula
affected in mental health disorders has a special role in a person’s subjective
feelings, integrating input from the body with expectations and emotions related
to the internal bodily state.
My study cannot tell us anything about why this region is commonly disrupted in
psychiatric disorders, just that it is; nor what causal role it might or might
not play in people’s symptoms. I hope to find out more in future experiments. If
it does play a causal role, another important and potentially exciting goal is
to find out whether mental health treatments could try to ‘normalise’ the
function of the insula as a way to alleviate people’s difficulties. In fact,
this might already be the basis for some established exercises and
interventions. Both mindfulness treatments generally and slow breathing
specifically are known to increase insula activation, and slowing the breath can
reduce the experience of pain and negative emotions. This tells us there are
therapeutic routes to target this brain region in mental health disorders.
Similar ways of targeting the insula could be particularly useful for patients
with more severely disrupted bodily experiences, such as people with panic
disorder or chronic pain.

There was no overlap between mid-insula activation (orange) and the change in
brain activation following antidepressant medication (blue) or psychological
therapy (not pictured)There is also the possibility of using interoception
training as a form of mental health treatment. For example, a study by Sarah
Garfinkel and Hugo Critchley in 2016 found heightened sensitivity to bodily
sensations among autistic people, coupled with poorer-than-usual interoceptive
accuracy (such as accurately counting one’s own heart-beat). Inspired by this,
they recently ran a trial led by Lisa Quadt at the University of Sussex that
involved training autistic volunteers with an anxiety disorder to detect their
own heartbeat. Typical anxiety disorder treatments are often ineffective for
this population, but Quadt’s team found that the heartbeat training improved
interoception, and, for nearly a third of the participants, it significantly
reduced their anxiety three months later, as compared with a control condition.
It’s increasingly apparent that interoception is essential for more than just
survival. It’s the very filter through which we feel mentally and physically
well, or unwell. My own research and that of others suggests that the brain
basis of interoception can help explain the interconnectedness of physical and
mental health – why, when you feel worse mentally, your physical pain might
worsen; and why inflammation in your body can make you depressed. Furthermore,
differences between people in their neural interoceptive processes could help to
explain why we all experience our bodily states differently, which in some cases
could drive worse mental health. These insights are shining a new light on
existing treatments, and helping to inspire cutting-edge ways to improve
interoception, raising the hope that we might be able to improve the treatment
of mental health for some of the people who need it most.
Alex, a 28-year-old paramedic, finds himself drinking more than he used to after
long days at work. He’s recently had a hard time coping with his feelings. He is
irritable most days and brings his frustration home to his girlfriend. Like many
people, he has blamed the COVID-19 pandemic for his increase in alcohol use and
overall bad mood. His drinking is just a way to unwind, he thinks. Is that true,
or is it possible that he has an addiction?
Zoe, a 44-year-old English teacher, has been drinking and smoking cannabis for
years. In the past, it was enjoyable, and she usually did it while socialising
after work. But since her divorce two years ago, she drinks and smokes at home
alone until she falls asleep on the couch with the TV on. She feels increasingly
disconnected from others. She has a sense that things have gotten out of hand
with her alcohol and drug use, and that it might be time to deal with it.
These specific cases are fictional, but they are based on the experiences of
people I have seen over the course of more than 20 years in my work as a
clinical psychologist. If you, too, have found yourself using substances more
than you used to, you might be wondering whether your behaviour is turning from
a casual pastime to an addiction. I have written this Guide to help you find an
answer to that question.
What is addiction?
Addiction can be defined as a persistent, compulsive need to use a substance,
despite the negative consequences to you or others.
Problematic or unhealthy drinking or drug use does not always signal an
addiction. For instance, binge drinking in college is troublesome, but it
doesn’t inherently amount to an addiction. Increased substance use on weekends
might indeed be an unhealthy way to cope with stress, but one that recedes after
new or different coping strategies are employed. It’s more likely to be an
addiction if you don’t care whether you are hurting yourself with your
behaviour, or if you are causing distress in your relationships. An addiction
can interfere with achieving your goals, and people who have an addiction have
often experienced other difficulties along the way. They might feel that ‘bad
things always find me’ because they are haunted by legal troubles, job problems,
school difficulties, family strife or significant health concerns.
If you are beginning to notice some negative consequences of using substances,
there is a good chance that your casual use has become chronic use. Another
important piece of the puzzle is an inability to stop or cut back on using the
substance – that is, you’ve tried to stop but it just doesn’t work. Someone with
an addiction needs more and more of that substance to get the same high that
they felt when they first started using drugs or drinking. This need for more is
called tolerance. When they stop using a drug or drinking alcohol, an addicted
person will most likely experience a physical and/or emotional crash. This crash
is called withdrawal, and it plays a role in motivating continued substance use.
Sign-up to our weekly newsletterIntriguing articles, practical know-how and
immersive films, straight to your inbox.
Your email addressSubscribeSee our newsletter privacy policyAddiction – which
falls under the formal medical category of substance use disorder – is a
prevalent problem. According to a report by the US Substance Abuse and Mental
Health Services Administration (SAMHSA), in 2020, more than 40 million people
aged 12 or older had met the criteria for a substance use disorder in the prior
year – that’s 14.5 per cent of the US population. These included more than 28
million people with an alcohol use disorder, and more than 18 million with an
illicit drug use disorder, involving the use of drugs such as cocaine, heroin,
hallucinogens, cannabis, methamphetamine or misused prescription drugs. The
stresses of the COVID-19 pandemic appear to have encouraged increases in various
types of substance use. Behaviours such as online gaming and gambling, central
concerns in what are called ‘behavioural addictions’, have also recently
increased. People often use alcohol and drugs or engage in other addictive
behaviours when they feel stressed, bored, depressed, angry or without control
over their circumstances. (This Guide focuses on drug and alcohol addictions,
though their symptoms – such as repeated, unsuccessful efforts to control the
behaviour – overlap to an extent with other conditions, such as gambling
disorder.)
Drinking and drug use often begin as a way to connect with others and have fun.
For many people, it might have started during the teen years. Because using
substances has become such a part of everyday life for so many, it can be hard
to know if you have crossed the line into addiction. But, together, we can start
to figure this out.
NEED TO KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSWhat to doAccept the
challenge of facing a possible addiction
If you find it difficult to think about the possibility that you might have an
addiction, you should know that this is incredibly common. There is still a
stigma around addiction, and it doesn’t feel good to think that a behaviour of
yours could be out of control. The idea of not having drugs or alcohol in one’s
life can feel overwhelming, too – many people in recovery from addiction have
commented that alcohol or drugs have been like their ‘best friends’, always
there to celebrate with and pick them up when they get low. There is a
psychological as well as a physical component involved in the repetition of
behaviours that are unhealthy for you.
Yet there is much to be gained by asking yourself if a habit is causing you
harm, or if it is causing harm to your loved ones. It requires honest
self-reflection – but you are worth the effort it takes to get a clearer picture
of what is going on. Many people who have given up their alcohol or drug use
have acknowledged that they feel better overall. Benefits such as waking up
without a hangover, remembering what you did the night before, being
clear-headed, and being able to have more honest connections with loved ones
cannot be underestimated. Facing a possible addiction brings with it incredible
opportunities to better know yourself and what you want your life to look like.
Learn the cornerstones of addiction
There are several cornerstones to consider if you are wondering whether you are
leaning into addiction. If you recognise these core components of the addiction
process in your own behaviour, it is more likely that it constitutes an
addiction. The first cornerstone is cravings. Cravings are feeling a strong need
to engage in the addictive behaviour.
The second cornerstone is triggers. Addiction triggers can include strong
emotional states – such as depression, anxiety, anger or grief – that might lead
you to gravitate back to your drug of choice to cope. Physical illness and pain
can also be triggers, and lead you down the road to using and overusing drugs or
alcohol to manage the discomfort. Even positive life events, such as a new
relationship, a new job or a promotion, might make you feel like you want to
celebrate with heavy drinking or drug use. Hanging out with people you have
tended to be with while drinking or using drugs, or visiting places where you
have done so, can also trigger your brain to think it’s time to engage in these
behaviours.
The third cornerstone is relapse. If you have made attempts to stop using drugs
or alcohol and been successful for a while, only to find yourself back at square
one, that is called relapse. Relapse is common among people who are recovering
from addiction, and many addiction professionals believe that it is part of the
recovery journey. (Indeed, I find that it’s more helpful to call any setback a
lapse, rather than a relapse.)
See if you detect the common signs
Let’s unpack some of the typical signs of addiction. As you read about them,
reflect on whether you have recently experienced any of the signs listed below
in your own life. While noticing any one sign is not necessarily a cause for
alarm, if you have experienced two or more of these 15 signs in recent weeks,
that might signify a problem that requires your attention.
It would be a good idea to track your behaviour in a notebook or on your
smartphone to determine whether you experience any of the signs. Note which
signs ring true for you, along with the dates on which they appear. Remember,
honestly tracking your behaviour is a great way to determine if your use has
become a problem for you.
Reflect on urges and motivations
Explore your motivations for using drugs or drinking alcohol, including whether
you are feeling intense urges to do so. You might also experience withdrawal
symptoms if you stop using drugs or drinking, which can make it difficult to
quit and can tend to feed into the motivation to use once again. Withdrawal
symptoms are different for different drugs but often include emotional symptoms
such as anxiety or depression, physical symptoms such as trouble getting to
sleep or staying asleep, and cognitive symptoms such as difficulty concentrating
or problems with memory.
Do you recognise your feelings and behaviour in any of the signs below?
You need an increasing amount of alcohol or drugs to feel a buzz or high.You
feel an urgency to get the first drink or drug of the day.You experience a loss
of interest in other activities and an increased desire to get ‘high’ or
‘buzzed’.You try to quit or cut down on the use of alcohol or drugs but
can’t.You will do almost anything to get the drug or alcohol.Think about social
settings and your relationships
Sometimes, taking a closer look at how you are interacting (or not interacting)
with other people in your life can help you determine if your use is sliding
into addiction. The way you engage in social settings and in your relationships
is linked to how you are feeling about yourself and your behaviour. Are you able
to be honest and transparent with others about your drinking or drug use? Ask
yourself if any of these signs apply to you:
You hide all evidence of your drug or alcohol use.You make excuses to others for
your drug or alcohol use.You are unable to talk about your alcohol or drug use
with others.You avoid family and friends, especially if they express concern
about your drug or alcohol use.You feel unable to enjoy social gatherings or
events without using drugs or alcohol.Identify any negative consequences of your
behaviour
If you are using drugs or drinking to excess, you might also be experiencing
adverse consequences in one or more areas of your life. For example, are you
going through significant difficulties at work? Have you recently had legal
problems related to substance use? Are you taking risks that could cause harm?
Take a look at the signs below and see if you agree with any of them:
You experience blackouts, or memory lapses, during or after excessive use of
alcohol or drugs.You neglect important family or work responsibilities in order
to use drugs or alcohol.You have financial, legal, medical, family and/or work
problems that have developed due to your alcohol or drug use.You are doing
things under the influence of drugs or alcohol that cause you shame or regret
later on.You take risks that could be harmful to you or to others, such as
having unsafe sex or driving while you are high or drunk.Consider the risk
factors of addiction
Along with understanding the basic mechanisms of addiction and its common signs,
it’s worthwhile to think about some of the biological and environmental factors
linked to an increased risk of addiction. One major risk factor is genetics.
People who have addiction in their family are at a much greater risk of
developing one than are people with no family history of addiction. Take a
moment to reflect on your family members – it might be helpful to draw a family
tree here. As far as you know, has anyone in your family struggled with
substance use problems? It could be useful to ask your parents or other close
relatives about their family members, too.
Another important risk factor is your environment growing up. A person who has
experienced early childhood trauma, bereavement or poverty might be at a higher
risk for overusing substances as a way to cope with re-experiencing difficult
situations as an adult. Be kind with yourself here, and reflect on whether an
adverse childhood experience is one of your potential risk factors.
Genetic and early environmental risk factors will sometimes emerge in the course
of treatment for an addiction. Someone who is working with a professional
therapist after struggling to control her drug use might reveal, for example,
that she was physically abused in childhood, and that one of her parents drank
excessively. A person does not need to have had these specific kinds of
experiences or other clear-cut risk factors to develop an addiction – but when
such factors are evident, it can help one gain a fuller understanding of their
behaviour.
If you reflect on your own life and notice some of the common signs of addiction
that I have described above, and perhaps one or more of the risk factors, this
could be a great opportunity to talk to a professional about how things are
going for you. Your doctor, a clinical psychologist or another qualified expert
can make an assessment using the formal criteria for substance use disorders and
can provide further guidance. In the Learn More section below, we’ll cover some
of the first steps toward change.
NEED TO KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSKey points – How to know
if you’re addictedIt can be difficult to know if you have developed an
addiction. Drinking or drug use that started out as a casual, social practice
can become more chronic and problematic over time.Not all unhealthy drinking or
drug use spells an addiction. Addiction can be thought of as a persistent,
compulsive need to use a substance despite the negative consequences.Accept the
challenge of facing a possible addiction. Thinking about whether you have an
addiction – and contemplating change – can be uncomfortable, if not
overwhelming. But the potential rewards for your wellbeing and your
relationships are well worth it.Learn the cornerstones of addiction. These
include cravings, a strong need to drink alcohol or use a drug; triggers,
feelings and circumstances that encourage use; and relapse, a return to using a
substance after trying to stop.Reflect on urges and motivations. Ask yourself
whether you need increasing amounts of a drug or alcohol to feel an effect, have
a diminished interest in other activities, or struggle to reduce your use. Do
physical and emotional crashes after not using make it harder to stop?Think
about social settings and your relationships. Are you open and honest about your
substance use, or do you conceal it, make excuses about it, or avoid discussing
it? Can you enjoy social activities without drinking or using a drug?Identify
any negative consequences of your behaviour. Honestly consider whether your use
has led to work-related, medical, legal or other substantial problems, or caused
you to be neglectful, take dangerous risks or do things you regret.Consider the
risk factors of addiction. People who have family members with addiction are at
greater risk of developing one themselves. Early adverse experiences, such as
childhood trauma, are also linked to increased risk of addiction.NEED TO
KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSLearn moreIf you think you might
have an addiction
If it does seem that you might have an addiction, you now get to decide what is
best for your mental, physical and spiritual health. You will be trying new
things here. Can you begin to imagine a new identity that might not include the
behaviour to which you have become attached? Envision that this new identity has
the ability to cope, in a reflective and self-compassionate way, with whatever
life deals out. Developing your self-compassion muscle – treating yourself how
your best friend would treat you – is one of the best ways for you to start
feeling better. Encouraging words go a long way if you’ve been beating yourself
up for your behaviour.
When someone decides to change a behaviour such as drinking or drug use, a
natural tendency is to resist the change. Instead of fighting with yourself,
invite in any resistance. See if you can determine why you might be struggling
against change. And begin to take small steps in the direction of your own
healing.
Explore your resources
A valuable step toward change is to explore your community for substance abuse
professionals and/or mental health professionals who focus on substance use
problems. Websites such as Psychology Today and SAMHSA offer ways to search for
a therapist in your area. If you have health insurance in the US, you can use
your insurance company’s website to find behavioural health professionals. Many
therapists worldwide are now providing online as well as in-person counselling.
If you are in college, you might access your school’s counselling centre.
When speaking with a professional, you can write down some of the concerns you
have about your behaviour and how it is impacting on your life and the lives of
your loved ones, and then bring it to the first appointment. Here is an example
of what the first conversation could look like: ‘I’m here to talk about my
alcohol use. I’ve been drinking socially for years but recently I noticed that I
have been drinking alone, I drink every day, and I’m drinking more over time.
I’m arguing with my partner all the time. I don’t know how to stop, and I’m not
sure I want to stop.’
There are multiple types of therapy that can be very effective in helping you
make good decisions about a future without addiction, and they are utilised by
many mental health professionals. One major example is cognitive behavioural
therapy (CBT), a short-term therapy that focuses on problem-solving and learning
how your thinking impacts on how you respond to situations. Another is
acceptance and commitment therapy (ACT), which teaches you skills to help you
behave in ways that are more aligned with your personal values, and helps you to
develop a flexible way of thinking about problems. Motivational enhancement
therapy (MET) is an additional expert-recommended approach that can help
facilitate change, especially if you are ambivalent about stopping.
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are free,
nonprofessional, multicultural groups available almost everywhere. AA and NA
groups are for anyone who wants to do something about their drinking or drug
use, respectively. Gamblers Anonymous also offers free groups and hotlines for
people who need help due to gambling. A recommendation here is to choose a few
different groups to attend (and when you first go, please just listen, don’t say
anything); it might take a few tries to find a group that you click with.
Self-Management and Recovery Training (SMART) is another option for you: these
free groups offer self-empowered recovery skills and support, and there are
opportunities to join any of these groups virtually, too. In addition to these
groups, keep in mind that your social supports – family and friends – will be
important too as you tease apart your behaviours and begin the process of making
healthier choices.
Re-engage with your mind
Mindfulness, consciously focusing on the present moment without judgment, can be
a quietly powerful way to calm down the mind after years of substance use. When
alcohol or drugs are removed from the brain, mindfulness is a compassionate
technique to bring the mind back into balance. Mindfulness meditation, spending
time (usually 10-20 minutes) each day allowing your mind to slow down and not
attach to any particular thought, is also helpful. Of course, at the beginning
it will feel like a storm has been kicked up in your head. Meditation enables
you to let your thoughts move like leaves down a stream. (See the Links & Books
section below for some resources on practising mindfulness and meditation.) Some
recovery centres have incorporated these techniques along with yoga, tai chi and
the arts to help heal the mind and develop alternative ways to cope. Why not try
one of these skills and see how it goes?
Take time to FLOAT
We’ve all heard of the fight-or-flight response to stressful situations. I want
to offer you a third choice when you get in a rough spot and have tough
decisions to make about your drug or alcohol use. It’s called FLOAT. Introduced
in The Mindfulness Workbook for Addiction (2012), which I co-wrote with Julie
Kraft, FLOAT is the idea of taking a moment to rise above the challenging
situation you are in and observe what’s going on, without judging the situation
or yourself. It’s an opportunity to quiet your inner critic (that voice in your
head that dispenses negative commentary about you). Here is how you do it:
Find your silent place. Even in the midst of crisis or conflict, there is a
quiet place where you can go in your mind. You can get to this place by
imagining yourself taking a step back from the conflict. Here, there is no rush
of emotion, there is just you observing without reacting. Going to this quiet
place allows you to breathe and regroup.Let go of judgment. Holding on to
judgment of yourself or others has a way of holding you back from being in the
present moment. If you are about to judge, take a moment to release the judging
thought. One way to do this is to acknowledge to yourself: I am judging, I now
allow myself to let go of the experience of judging. Be kind to yourself and
return to your calm mind.Observe your thoughts. An important thing to remember
about thoughts is that they are not permanent. Observe your thoughts and notice
that they come and go. Reminding yourself of the temporary nature of your
thoughts, including the difficult ones, empowers you to make choices based on a
clear, calm mind.Awareness of your environment. When you are feeling agitated,
angry or disappointed, take a moment to look around, notice your feet on the
ground, notice the space around you, and become aware of your body. This allows
you to slow down, be in the moment, and reassess the situation.Thankful for the
experience. In every experience, even the bad ones, there is a lesson to be
learned. Instead of berating yourself and dismissing the experience, take a
moment to be grateful for what life has put in your path as you choose a
healthier direction.The next time you are in the middle of a stressful
situation, try to FLOAT – and add this skill to your wellbeing toolbox. And as
you take the next steps toward a healthier life, remember to be kind and
compassionate towards yourself. You can feel better; your wellbeing is in your
hands.
NEED TO KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSLinks & booksThere are
plenty of terrific podcasts to jumpstart your thinking about whether you might
have an addiction, including The Addicted Mind, That Sober Guy Podcast, Seltzer
Squad and the Recovery Elevator. I recommend choosing one of these to start
with, to learn how others who have used drugs or alcohol engage in their daily
wellbeing.
The podcast Ten Percent Happier with Dan Harris brings together experts in the
field of mindfulness and meditation. Mindfulness meditation has been shown to
help with cravings and withdrawal from substances. I recommend this podcast for
new or seasoned meditators to add moments of calm into your day. Another podcast
that might be helpful if you want to explore meditation a bit more is Men
Talking Mindfulness, which offers both short meditation sessions (if you have
only 5 or 10 minutes) and longer interviews with experts.
Two hopeful documentaries give insight into the experiences of people who are
facing the struggles of recovery: A New High (2017) follows a group of people in
Seattle who undertake to climb a mountain as they wrestle with their addictions,
and Generation Found (2016) explores the lives of teenagers in Houston who are
caught in the addictive cycle and who find a path forward by attending a
‘recovery’ high school.
All journeys toward new behaviours are aided by companion books. Take a look at
the workbook I wrote with the marriage and family therapist Julie Kraft, The
Mindfulness Workbook for Addiction: A Guide to Coping with the Grief, Stress,
and Anger that Trigger Addictive Behaviors (2nd ed, March 2022). This workbook
offers more than 60 worksheets and exercises to explore your emotions, thoughts
and the reasons behind your behaviours.
Our book The Gift of Recovery: 52 Ways to Live Joyfully Beyond Addiction (2018)
is a pocket coach helping folks and their family members tackle the challenges
of early recovery with mindfulness skills and daily affirmations. It is also
available as an audiobook.
Other favourites of mine that focus on self-compassion in recovery are In the
Realm of Hungry Ghosts: Close Encounters with Addiction (2008) by the physician
Gabor Maté and Yoga for Addiction (2020) by the yoga teacher Katy Cryer. I’m a
big fan of reassessing and reengaging with what you value most in life: take a
look at Cravings and Addictions: Free Yourself from the Struggle of Addictive
Behavior with Acceptance and Commitment Therapy (2022) by the clinical
psychologists Maria Karekla and Megan M Kelly. And one of my favourite books on
developing a robust way to cope with stress is Resilient: How to Grow an
Unshakeable Core of Calm, Strength, and Happiness (2018) by the psychologist
Rick Hanson and his son, the writer Forrest Hanson.
If you have ever loved unrequitedly, then you know that living without any hope
for a future with your beloved is a bitter experience indeed. When in love, we
usually have a deep desire that our beloved love us back. If they don’t, it can
pain us very much. We might, in all likelihood, come to wish that we didn’t love
them, that we could stop loving them, or even that we had never loved them at
all. Even if you haven’t experienced this for yourself, then you can probably
imagine the agony involved.
No wonder that people employ all kinds of techniques to get over those who don’t
come to love them back. In George Eliot’s novel Daniel Deronda (1876), Rex
Gascoigne, after being rebuffed by the dynamic Gwendolen Harleth, begs his
father to allow him to defect from England to Canada. I too once toyed with the
idea of fleeing to the Canadian Rockies in the wake of heartbreak in Toronto.
Others might seek comfort in a weekend, or a few, of heavy drinking, or find
themselves set up on a series of uncomfortable blind dates by overbearing
sympathisers. Indeed, friends will offer us all sorts of concoctions and home
remedies. Those who have loved unrequitedly, however, know: though this friendly
advice is no doubt well meant, it is also misguided. For while the proposed
remedies might give us time and opportunity to heal from the hurt of the
disillusionment, they will not cause us to stop loving.
Why not? Because the fact that it would be better to stop loving is not itself
sufficient to stop us loving. Prudential reasons to fall out of love simply miss
the mark, given the nature and structure of love as arational. But the situation
is not entirely wretched. I hope to persuade you that, while unrequited love is
bitter, it can be made bittersweet, if you change your attitude toward it.
Rational love is love justified by reasons: for example, we might imagine Leo
Tolstoy’s character Anna Karenina loving Count Vronsky for the reasons that he
is charming, persistent and attentive. Arational love, by contrast, is love that
is not justified by such rationales. There are many reasons why I believe
romantic love has this arational form, one of which is a puzzle known to
philosophers of love as the ‘problem of particularity’. It goes like this: if
it’s true that love is rational, and that we love people for reasons such as
their charm, persistence and attentiveness, it’s not clear why we should love
any one particular charming person over any other. All sorts of people are
charming, persistent and attentive. Why love Vronsky?
If you are one of those who has loved unrequitedly, fear not, for there are
compelling reasons to embrace your predicamentSome commentators, such as the
philosopher Niko Kolodny, believe it is the shared history of a relationship
that solves the problem of particularity and provides a rational reason for
romantic love. After all, while there might be many charming people in the
world, only Count Vronsky first met Anna at that Moscow train station. In the
case of unrequited love, however, there is a strong reason to doubt that this is
correct. After all, doesn’t unrequited love sometimes blossom upon first sight
or develop over time for a near stranger? If love is possible in the absence of
a relationship, the relationship cannot serve as its reason.
So I say that love is arational. In consequence, though it may indeed be
‘better’ in a pragmatic sense for the heartbroken lover to move on, this
higher-order reason will not cause or persuade us to actually move on. Love is
not the sort of thing justified or undone by reasons.
Some might say, but what if this love is causing harm? If loving pains the
unrequited lover, surely this, if nothing else, gives them reason to stop
loving. Yet, I repeat once more, love is not the kind of thing that is swayed by
reasons, even this one. To borrow from William Shakespeare, once in love, we can
love someone ‘even to the edge of doom’. Take Charles Dickens’s character Sydney
Carton and his love for Lucie Manette in A Tale of Two Cities (1859): though she
did not love him – but loved another – still, he died for her sake, taking the
place at the guillotine of the man whom she did love. In this way, we might even
think of romantic love as not only arational, but also unconditional.
If you are one of those who has loved unrequitedly and you are persuaded by my
arguments that your love is arational and unconditional, and therefore immune to
rational or deliberate undoing, you might at this point be in some renewed
distress. But please fear not, for I believe there are compelling reasons to
embrace your predicament. (Note, I am not referring here to abusive
relationships in which one partner withholds love as a means of manipulation.) I
have already said that unrequited love can be deeply painful, and I stand by
this – but I hope you will forgive my saying that, if it is torture, it is
torture of the most sublime and exquisite kind. And I believe that an exquisite
torture is a torture worth bearing. The unrequited lover need not wish so
impatiently for their love to end. Instead, they might embrace their love, for
however long it persists. If you embrace your love, unrequited though it may be,
it need not hurt you so.
What does it mean to embrace love? Well, though love itself is arational, it
seems plausible that we can still take certain attitudes toward it, doing so for
reasons. If we reject our love, this can cause in us a kind of rift – we do not
endorse our love, and yet we can’t help but love. This results in a kind of
alienation contributing to our ultimate experience of bitterness. If instead,
however, you can adopt an attitude of affirmation, you need not be at odds with
yourself. This is what I mean by ‘embracing’ unrequited love: adopt an attitude
of affirmation toward it by telling yourself: ‘I’m in love, and that’s OK.’
You might worry that prudential reasons for embracing your unrequited love are
the ‘wrong kinds’ of reasons; that the notion ‘It would be better for me to
embrace my love’ does not give you the right kind of reason to actually do so.
Understandably, you might think that having certain attitudes requires having
certain beliefs. For instance, that having an attitude of affirmation toward
your love is not possible if you don’t really believe that it is OK that you are
in love. Fortunately, I can offer a powerful nonprudential reason for you to
embrace your unrequited love: it is sublime.
Love is not a choice, and yet it is still something you do, not something which
merely happens to youThat love is arational, and that we are capable of it, is
something to rejoice in. Small, trembling creatures though we may be, we are
capable of arational, unconditional love, which is the closest we may ever come
to the infinite or the eternal. I am thinking of something akin to Immanuel
Kant’s mathematical sublime, though I may be one of the only philosophers to
accuse his third Critique (1790) of being romantic. To paraphrase Kant, the fact
that we are capable, over and above reason, of feeling something so immense, so
overwhelmingly powerful, so beyond our control ‘indicates a faculty … which
surpasses every standard of sense’.
To love is to exhibit a capacity beyond the capacity of sense, and even beyond
that of reason. The depth of feeling of which we are capable is the ultimate
expression of our humanity, and our relative helplessness before it is perhaps
the essence of what makes us human. As W H Auden wrote: ‘If equal affection
cannot be, / Let the more loving one be me.’ If love is mathematically sublime,
however, then it is only metaphorically so; surely love needn’t be strictly
either mathematical or dynamic in order to be sublime. After all, the sublime
is, for Kant, the closest that one may ever get to peering over the edge, to
looking beyond the phenomenal (thinkable) world.
Love is, therefore, perhaps best thought of as sublime because it either is, or
at least gestures at, something that we cannot quite make sense of. Indeed, see
how we look for the reasons of love – we want love to be rational so that it may
be sensible! Yet love defies your sense-making strategies: love is not a choice,
and yet it is still something you do, not something which merely happens to you.
There is something incomprehensible about this, and this reflects a deep
incomprehensibility and essential mystery about the nature of agency, even of
our own agency over ourselves. Our experience of and attempts to analyse love
are perhaps the closest we can come to having an account of the self that is
outside of the limits of practical reason. Love is something that exists on the
maximal outer limit of our agency’s thinkability. Love is therefore sublime in
that it gives us a glimpse of the supersensible.
In short, love – including unrequited love – is exceptional. It can endure
anger, pain and grief, persisting against all odds, existing in the unlikeliest
of places and times. Though it may pain you that your beloved does not love you
back, take comfort – in loving, you are peering over Kant’s edge. The edge is
not something to be shied away from, though it is formidable. Rather, regard the
precipice with awe and rejoice in your proximity. Though this claim may not be
ultimately satisfactory to some, I mean it to be more than a salve. Romantic or
otherwise, returned or not, love is sublime and worthy of embrace because it
reveals in you, the lover, a unique and noble capacity.


New research has found that people with Attention Deficit/Hyperactivity Disorder
(ADHD) are significantly more likely to also exhibit hoarding behaviours, which
can have a serious impact on their quality of life.
The study, published in the Journal of Psychiatric Research and funded by
theBritish Academy and the Leverhulme Trust, found that almost one in five
people with ADHD exhibited clinically significant levels of hoarding, indicating
there could be a hidden population of adults struggling with hoarding and its
consequences.
Hoarding Disorder is a recognised condition that involves excessive
accumulation, difficulties discarding and excessive clutter. The disorder can
lead to distress or difficulties in everyday life and can contribute to
depression and anxiety.
Previous research into Hoarding Disorder has mainly focused on older females who
self-identify as hoarders and have sought help later in life. This new study,
led by Dr Sharon Morein of Anglia Ruskin University (ARU), recruited 88
participants from an adult ADHD clinic run by the Cambridge and Peterborough NHS
Foundation Trust.
The study found that 19% of this ADHD group displayed clinically significant
hoarding symptoms, were on average in their 30s, and there was an equal gender
split. Amongst the remaining 81%, the researchers found greater hoarding
severity, but not to a degree that significantly impaired their lives, compared
to the study's control group.
The researchers asked the same questions, about ADHD symptoms and impulsivity,
levels of hoarding and clutter, obsessive compulsive severity, perfectionism,
depression and anxiety, and everyday function, on a closely-matched group of 90
adults from the general population, without an ADHD diagnosis, and found only 2%
of this control group exhibited clinically significant hoarding symptoms.
They then replicated this with a larger online sample of 220 UK adults to see if
similar patterns were found, and similarly only 3% of this group exhibited
symptoms.
Dr Morein, Associate Professor in Psychology at Anglia Ruskin University (ARU),
said: "Hoarding Disorder is much more than simply collecting too many
possessions. People with diagnosed Hoarding Disorder have filled their living
areas with so many items and clutter that it impacts their day-to-day
functioning leading to a poorer quality of life, anxiety, and depression.
"Overall, we found that people who had been diagnosed with ADHD had a higher
likelihood of also having hoarding symptoms. This is important because it
demonstrates that hoarding doesn't just affect people later in life, who are
typically the focus of much of the research so far into Hoarding Disorder.
"Our findings also indicate that Hoarding Disorder should be routinely assessed
in individuals with ADHD, as they do not typically disclose associated
difficulties despite these potentially impairing their everyday lives. Likewise,
it is possible that many people who are currently being treated for Hoarding
Disorder might also have undiagnosed ADHD.
"Greater awareness amongst clinicians and people with ADHD about the link
between ADHD and hoarding could also lead to more effective long-term
management, as hoarding often gradually worsens with time."

A network of brain regions activated by the placebo effect overlaps with several
regions targeted by brain-stimulation therapy for depression, according to a new
analysis by a team that included several researchers from Massachusetts General
Hospital (MGH), who collaborated with colleagues at Sunnybrook Health Sciences
Centre at the University of Toronto. The findings of this study, published in
Molecular Psychiatry, will aid in understanding the neurobiology of placebo
effects and could influence how the results of clinical trials of brain
stimulation are interpreted. This work may also offer insights on how to harness
placebo effects for the treatment of a variety of conditions.
The placebo effect occurs when a patient's symptoms improve because he or she
expects a therapy to help (due to a variety of factors), but not from the
specific effects of the treatment itself. Recent research indicates that there
is a neurological basis for the placebo effect, with imaging studies identifying
a pattern of changes that happen in certain brain regions when a person
experiences this phenomenon.
The use of brain-stimulation techniques for patients with depression that
doesn't respond adequately to medication or psychotherapy has gained wider use
in recent years. Transcranial magnetic stimulation (TMS) is a non-invasive
treatment in which a clinician applies a coil to the patient's head and delivers
electromagnetic pulses to the brain. The effect of TMS on brain activity has
been established over the last three decades in animal and human research
studies, with several TMS devices approved by the Food and Drug Administration
for treating depression. What's more, there's growing research on the use of
deep brain stimulation (DBS, which requires an implanted device) for
hard-to-treat depression, too.
The senior author of the Molecular Psychiatry paper, Emiliano Santarnecchi, PhD,
director of the Precision Neuroscience & Neuromodulation Program at the Gordon
Center for Medical Imaging at MGH, saw studies of brain stimulation as a unique
opportunity to learn more about the neurobiology of the placebo effect.
Santarnecchi and his co-investigators conducted a meta-analysis and review of
neuroimaging studies involving healthy subjects and patients to create a "map"
of brain regions activated by the placebo effect. They also analyzed studies of
people treated with TMS and DBS for depression to identify brain regions
targeted by the therapies. The team found that several sites in the brain that
are activated by the placebo effect overlap with brain regions targeted by TMS
and DBS.
Santarnecchi and his colleagues believe that this overlap has critical
importance in interpreting the results of research on brain stimulation for
conditions such as depression. In clinical trials, a significant portion of
depression patients receiving brain stimulation improve -- but so do many
patients receiving placebo (sham) treatment, in which no stimulation is
administered, which has led to confusion over the therapy's benefits. A possible
explanation is "that there is a significant placebo effect when you do any form
of brain stimulation intervention," says Santarnecchi. Unlike taking a pill,
receiving TMS involves treatment in a surgery-like setting, with imaging
monitors and a clinician applying a coil to the patient's head. There are loud
clicks with each pulse delivered. "So the patient thinks, 'Wow, they are really
activating my brain', so you get a lot of expectation," says Santarnecchi.
Elevated placebo effects associated with brain stimulation may create problems
when studying the intervention, says the first author of the paper, cognitive
neurologist Matthew Burke, MD, of Sunnybrook Health Sciences Centre, in Toronto.
If brain stimulation and the placebo effect overlap in activating the same brain
regions, then those circuits could be maximally activated by placebo effects,
which could make it difficult to show any additional benefit from TMS or DBS,
says Burke. If that's true, this paper may help explain why clinical trials of
neurostimulation for depression and other conditions have had such variable
results. Separating the placebo component of brain stimulation interventions
from their direct impact on brain activity will help in designing studies where
the real potential of techniques such as TMS will be more easily quantified,
thus improving the effect of treatment protocols.
The findings from this study also suggest broad applications for the placebo
effect, says Santarnecchi. "We think this is an important starting point for
understanding the placebo effect in general, and learning how to modulate and
harness it, including using it as a potential therapeutic tool by intentionally
activating brain regions of the placebo network to elicit positive effects on
symptoms," he says. Santarnecchi and his colleagues are currently designing
trials that they hope will "disentangle" the effects of brain stimulation from
placebo effects and offer insights about how they can be leveraged in clinical
settings.

A study has uncovered new evidence linking higher levels of neuroticism and
anxiety with the ability to experience a deeply relaxing sensation known as the
Autonomous Sensory Meridian Response (ASMR). Charlotte Eid and colleagues at
Northumbria University, U.K., present these findings in the open-access journal
PLOS ONE on February 2, 2022.
During ASMR, a person experiences a tingling sensation beginning in the head and
neck that may spread throughout the body. Not everyone experiences ASMR, and
those who do have different triggers for it; for instance, receiving a massage
or listening to quiet sounds, such as whispering. Recent years have seen the
creation of numerous online videos featuring sounds and situations that may
trigger ASMR, and many viewers report relaxing benefits.
Previous research has suggested that people capable of experiencing ASMR may
have elevated levels of neuroticism. However, the precise link between ASMR and
personality traits has been unclear.
To help clarify, Eid and colleagues asked 36 volunteers who experience ASMR and
28 non-experiencers to watch a video meant to trigger ASMR. The participants
completed several questionnaires to evaluate their neuroticism, general tendency
to experience anxiety ("trait anxiety"), and moment-to-moment anxiety ("state
anxiety") before and after watching the video.
Statistical analysis of the participants' responses found that ASMR experiencers
had higher levels of neuroticism and trait anxiety, as well as higher levels of
state anxiety before watching the video -- however, this type of anxiety was
reduced after the video, and ASMR experiencers reported a greater level of
benefit from the video. In contrast, non-experiencers did not undergo a
reduction in state anxiety after the video.
Further analysis suggested that the differences in neuroticism and anxiety
between ASMR experiencers and non-experiencers statistically accounted for the
observed difference in the pre- and post-video change in anxiety, highlighting
the potential importance of these personality traits.
Overall, these findings suggest that ASMR experiencers may be characterized by
greater levels of neuroticism as well as anxiety disorders than
non-experiencers. They also suggest that ASMR could serve as an intervention for
individuals with elevated levels of neuroticism and/or anxiety in general.
However, the authors note, further research is needed to address the limitations
of this study and enhance understanding.
The authors add: "Our study found that watching an ASMR video reduced anxiety in
those who experience ASMR tingles even when previously not familiar with the
phenomenon. Personality characteristics which are linked with high anxiety were
also associated with these benefits, therefore ASMR may be a suitable
psychological intervention for anxious individuals in general."

Previous studies by Johns Hopkins Medicine researchers showed that psychedelic
treatment with psilocybin relieved major depressive disorder symptoms in adults
for up to a month. Now, in a follow-up study of those participants, the
researchers report that the substantial antidepressant effects of
psilocybin-assisted therapy, given with supportive psychotherapy, may last at
least a year for some patients.
A report on the new study was published on Feb. 15, 2022 in the Journal of
Psychopharmacology.
"Our findings add to evidence that, under carefully controlled conditions, this
is a promising therapeutic approach that can lead to significant and durable
improvements in depression," says Natalie Gukasyan, M.D., assistant professor of
psychiatry and behavioral sciences at the Johns Hopkins University School of
Medicine. She cautions, however, that "the results we see are in a research
setting and require quite a lot of preparation and structured support from
trained clinicians and therapists, and people should not attempt to try it on
their own."
Over the last 20 years, there has been a growing renaissance of research with
classic psychedelics -- the pharmacological class of compounds that include
psilocybin, an ingredient found in so-called magic mushrooms. According to the
National Institute on Drug Abuse, psilocybin can produce perceptual changes,
altering a person's awareness of their surroundings and of their thoughts and
feelings. Treatment with psilocybin has shown promise in research settings for
treating a range of mental health disorders and addictions.
For this study, the researchers recruited 27 participants with a long-term
history of depression, most of whom had been experiencing depressive symptoms
for approximately two years before recruitment. The average age of participants
was 40, 19 were women, and 25 identified as white, one as African American and
one as Asian. Eighty-eight percent of the participants had previously been
treated with standard antidepressant medications, and 58% reported using
antidepressants in their current depressive episodes.
After screening, participants were randomized into one of two groups in which
they received the intervention either immediately, or after an eight-week
waiting period. At the time of treatment, all participants were provided with
six to eight hours of preparatory meetings with two treatment facilitators.
Following preparation, participants received two doses of psilocybin, given
approximately two weeks apart between August 2017 and April 2019 at the
Behavioral Biology Research Center at Johns Hopkins Bayview Medical Center.
Participants returned for follow-up one day and one week after each session, and
then at one, three, six and 12 months following the second session; 24
participants completed both psilocybin sessions and all follow-up assessment
visits.
The researchers reported that psilocybin treatment in both groups produced large
decreases in depression, and that depression severity remained low one, three,
six and 12 months after treatment. Depressive symptoms were measured before and
after treatment using the GRID-Hamilton Depression Rating Scale, a standard
depression assessment tool, in which a score of 24 or more indicates severe
depression, 17-23 moderate depression, 8-16 mild depression and 7 or less no
depression. For most participants, scores for the overall treatment decreased
from 22.8 at pretreatment to 8.7 at one week, 8.9 at four weeks, 9.3 at three
months, 7 at six months and 7.7 at 12 months after treatment. Participants had
stable rates of response to the treatment and remission of symptoms throughout
the follow-up period, with 75% response and 58% remission at 12 months.
"Psilocybin not only produces significant and immediate effects, it also has a
long duration, which suggests that it may be a uniquely useful new treatment for
depression," says Roland Griffiths, Ph.D., the Oliver Lee McCabe III, Ph.D.,
Professor in the Neuropsychopharmacology of Consciousness at the Johns Hopkins
University School of Medicine, and founding director of the Johns Hopkins Center
for Psychedelic and Consciousness Research. "Compared to standard
antidepressants, which must be taken for long stretches of time, psilocybin has
the potential to enduringly relieve the symptoms of depression with one or two
treatments."
The researchers emphasize that further research is needed to explore the
possibility that the efficacy of psilocybin treatment may be substantially
longer than 12 months. Johns Hopkins is one of the sites of a national multisite
randomized, placebo-controlled trial of psilocybin for major depressive
disorder.
Other researchers who contributed to the study are Alan Davis, Frederick
Barrett, Mary Cosimano, Nathan Sepeda and Matthew Johnson from the Johns Hopkins
University School of Medicine.
The study was funded in part by a crowd-sourced campaign organized by Tim
Ferriss and by grants from the Riverstyx Foundation and Dave Morin. Support for
Alan Davis and Natalie Gukasyan was provided by a grant from the National
Institutes of Health (T32DA07209, National Institute on Drug Abuse). Support for
authors was also provided by the Center for Psychedelic and Consciousness
Research, which is funded by the Steven and Alexandra Cohen Foundation, Tim
Ferriss, Matt Mullenweg, Craig Nerenberg and Blake Mycoskie. The funders had no
role in study design, data collection and analysis, or in decision to publish or
manuscript preparation.
COI: Alan Davis is a board member of Source Research Foundation. Matthew Johnson
has received grant support from the Heffter Research Institute that is unrelated
to this study, and he is an advisor to the following companies: AJNA Labs, AWAKN
Life Sciences, Beckley Psytech, Entheon Biomedical, Field Trip Psychedelics,
Mind Medicine, Otsuka Pharmaceutical Development & Commercialization and Silo
Pharma. Roland Griffiths is a board member of the Heffter Research Institute and
has received grant support from the institute unrelated to this study. Griffiths
is site principal investigator, and Johnson and Gukasyan are co-investigators
for a multisite trial of psilocybin-assisted therapy for major depressive
disorder sponsored by Usona Institute.
Your friend is devastated. She’s just lost her job and looks like she’s about to
burst into tears in the middle of the busy coffee shop. You don’t know what to
do. You want to help her, but what do you say in this horrible situation? How do
you make her feel better right now, and how can you help her get through the
tough time to come?
We’ve all been in situations like this, both big and small and everything in
between: from a friend burning the food at their dinner party, to struggling
with the loss of a loved one; from missing the bus to work, to enduring a
marriage breakdown. Common wisdom suggests that a problem shared is a problem
halved. We really want to help, yet we don’t quite have the words or the
tactics. You might have felt yourself freeze in these moments, paralysed by the
thought that anything you say or do could be a little awkward, or even make
things worse.
Being supportive isn’t easy
Research shows that many people don’t really know what works best to help their
friends effectively. Moreover, the support we do provide, such as giving advice,
is often ineffective. Part of the challenge is that there are just so many
possible ways to intervene. A survey of the methods that people used to manage
their friends’ emotions identified 378 distinct strategies, including allowing
the other person to vent their emotions, acting silly to make the other person
laugh, and helping to rationalise the other person’s decisions. Given this large
variety of strategies, it’s no wonder that deciding what to do when you have a
friend in tears can be a little overwhelming.
Sign-up to our weekly newsletterIntriguing articles, practical know-how and
immersive films, straight to your inbox.
Your email addressSubscribeSee our newsletter privacy policyProviding support is
a skill that can be learned
The good news is that there are evidence-based support strategies you can learn
that will help you provide more effective support to your friends. What’s more,
providing support to your friends is good both for them and for you. Receiving
social support from friends has benefits: in general, people who are supported
tend to be more mentally and physically healthy. This might be because support
from our friends and family is a strong buffer against the stress caused by
tough times. Giving social support to friends also has benefits: when we support
another person, it helps to strengthen our relationship with that person, and it
makes us feel better (with the benefits being even greater when we feel like
we’ve done a good job helping).
In this Guide, I will take you through five strategies to help you provide more
effective emotional support to those who are struggling. For each strategy, I’ll
give an example to help you see what this might look like in practice. These
five strategies are broadly applicable but, later in the Guide, I’ll also cover
some caveats to keep in mind.
NEED TO KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSWhat to doResist the urge
to downplay your friend’s problems
Your friend Alex messages you, upset that he received a B in a college class.
Your first impulse is to ignore the message – you think Alex is overreacting. He
can handle this non-event on his own, and you don’t get why he is so upset.
After a while, you figure you should respond. You write: ‘You’ll be fine, I
don’t know why you’re worrying! Getting a B is pretty good and not the end of
the world.’
When we think that someone is catastrophising something that (to us) is not a
big deal, it can be tempting to ignore them, downplay them or be dismissive, but
that would be a mistake and will likely end badly. Whatever your own take on
your friend’s dilemma, it’s important to be responsive to their requests, and to
prioritise trying to understand how they feel. Some studies suggest that being
supportive is helpful only when we are responsive in this way. Moreover, being
responsive to other people – trying to understand them, valuing their opinions
and abilities, and making them feel cared for – is a cornerstone of good
relationships.
So, in the above scenario with Alex, you might send a more thoughtful response,
showing that you’re trying to understand how he feels: ‘I get why you’re upset,
that sucks. I know you’re a hardworking and smart person, and I bet you’ll be
able to get an A next time.’
In the longer term, a way to work on being more responsive and less dismissive
is through setting compassionate goals. These involve focusing on supporting
others, being constructive in interactions, and being understanding of others’
weaknesses. In a study with college students, people who reported setting goals
that were more compassionate and less selfish had roommates who felt more
supported by them. Cultivating a compassionate mindset is a useful background
for all the remaining steps in this Guide.
Ask questions and really listen
You have coffee with your friend Jamie, who has just had a big argument with his
partner. Your knee-jerk reaction is to think to yourself ‘Oh no, not another
argument,’ to infer that Jamie is ready to leave the relationship (after all,
that’s how you’d feel if you were him) and to show him that you’re on his side.
You’re inclined to tell Jamie straight up that you get why he is angry, and that
you agree it’s probably time to let the relationship go.
Just as playing down a friend’s problem is unwise, so too is trying to empathise
too quickly, including jumping in with rapid advice. While this impulse is
understandable and quite normal, it is also likely to go wrong. Although we tend
to assume that we can tell how other people are thinking using our empathy,
research has shown that we’re actually really bad at taking other people’s
perspectives. One study, led by Tal Eyal at Ben-Gurion University of the Negev,
involved researchers asking people to put themselves in another’s shoes in 25
different contexts, including taking other people’s perspectives on movies, on
activities, on social issues, and even on whether jokes were funny. In all these
experiments, trying to take another person’s perspective didn’t work, and
sometimes it even backfired.
So how might you best address the situation instead? In the research by Eyal and
her colleagues, directly asking was the only thing that helped one person
understand how another person felt. This suggests that in the above scenario it
would be better to slow down and start by asking directly how Jamie is feeling,
rather than thinking about how you might feel in a similar situation. In short,
we’re not as good as we think at intuiting other people’s feelings, and it is
better to ask questions and listen to the answers.
Listening well can also be a challenge, but again there is psychology research
that can help. To be a more effective listener, you can begin with two easy
tactics. First, be attentive to the other person, and signal that you’re
listening carefully by using nonverbal signals (such as nodding and smiling) and
brief phrases (such as ‘Mmhmm’ or ‘Oh really?’) Second, provide ‘scaffolding’
questions that help your friend to elaborate on their story or their feelings,
such as: ‘And what happened next?’ or ‘How did you feel after that?’ This can
help them feel supported and heard. These skills may seem self-evident, but
they’re particularly easy to forget in the moment, as we get distracted by our
phones, or inclined to hurry our friends along to get to the point of their
stories.
A related technique to try is active listening, which is commonly used by
therapists, and relatively simple to implement. One form of active listening
involves paraphrasing what your friend is saying in your own words, which can
help them feel better. For example, your friend might spend some time explaining
a series of stressful events across their week, describing arguments with their
spouse, a mounting workload and some worries about debt, and you might
paraphrase by saying that it sounds like they are overwhelmed both at home and
at work right now.
Give emotional support first, cognitive support second
Your friend Casey comes to you upset that she has lost a big client at work. You
want to jump straight in and help Casey think more positively about things. You
know that this client was taking up a lot of Casey’s time. So, now that client
is out of the picture, Casey can do less overtime, and spend more time on new,
exciting clients. This kind of reframing is likely to be helpful for Casey in
the long term, but it’s not the best place to start your support.
In contrast to downplaying a friend’s problem – the first pitfall I mentioned
above – helping a friend see a situation in a positive light (known as
reframing) is a supportive strategy. However, it’s important that you don’t jump
straight to it. In the situation with Casey, it would have been better to start
things off by validating her feelings, which is a form of emotional support.
Casey has come to you feeling awful, and jumping straight to discussing the
bright side might leave her feeling as if you aren’t getting it. That doesn’t
mean you shouldn’t have tried to find a silver lining for Casey at all – but,
rather than beginning there, better to validate and comfort Casey as she talked
through the situation. Once you’d shown that you get how she feels, then you
could have helped her find the bright side, which is a form of cognitive support
in the sense that you’re helping your friend to think differently.
It’s important to provide both emotional and cognitive support because, although
people prefer to receive and provide emotional support (and to avoid cognitive
support), emotional support alone is often ineffective at making people feel
better over the long term. Using emotional support first and cognitive support
second makes people feel better, reaping the benefits of both approaches.
One additional concern with cognitive support is making sure that the reframe
you suggest doesn’t slip into invalidating or downplaying your friend’s
feelings. The dividing line here can be difficult to navigate. The key is to
ensure your reframe doesn’t negate your friend’s feelings that the initial
situation was upsetting. Instead, focus your reframing on unexpected upsides not
yet considered, or future avenues to move past the initial problem. In the
example with Casey, the aim wouldn’t be to convince her that losing her client
wasn’t hard, but rather to help her find other parts of the situation that might
soften that blow.
More generally, adopting the one-two punch approach of always beginning with
validation is likely to help with this problem: if you begin from a perspective
of validating, it’ll become more obvious to you when the reframes you provide
are contradicting that validation.
Don’t take charge
Your friend Jay has a terrible boss. Jay has been struggling to deal with this
for a while, and they’ve been constantly unhappy. You think Jay should quit and
find another job with a better mentor, and you tell them as much.
Although you had good intentions, telling Jay straight up to quit would be a
mistake. Very direct and obvious help can sometimes make people feel as if they
are helpless. In research, people who received obvious and visible social
support – rather than subtle, invisible social support – felt more stressed
about an upcoming negative event. If your support is too directive and
take-charge, it might make your friend feel like they aren’t able to handle
things on their own, like a kid who needs their parent’s help to manage their
problems.
Instead, it would have been better to ask Jay what they want, and how they might
be able to change this situation, and then listen to them talk through their
options one by one. In doing this, you provide a sounding board for Jay to take
control of the situation on their own. Your aim should be to facilitate the
other person’s choices, rather than dominating them. This will help them
organise their thoughts and come to some solutions, without feeling like you did
it for them.
Avoid venting together
Your housemate Jordan calls you to complain about your other housemate Kirby.
Kirby hasn’t been doing her share of the chores, and Jordan is at the end of his
patience. You too are annoyed at Kirby and, after a while, you realise that you
and Jordan have been going back and forth complaining about Kirby for 10
minutes, and now you’re both feeling pretty upset.
Sympathising with a friend’s dilemma and venting together might seem like a
supportive strategy that shows you’re both in the same boat and you’re happy to
talk it over at length. However, this approach can go too far. In the above
scenario, it’s likely to pull you and Jordan into a downward spiral of
negativity.
Although I’ve discussed ways in which talking about problems with your friends
can help, if taken to an extreme, it can become a problematic issue called
co-rumination. This involves talking excessively with other people about
problems, and constantly dwelling on those problems together without looking for
solutions. Such behaviour results in both people feeling worse, with
co-ruminating associated with increases in anxiety and depression over time.
How might you stop that downward spiral? The good news is that, according to
researchers, simply knowing that co-rumination exists might help people avoid
these kinds of negative spirals, although this has not yet been directly
examined in a study. So, begin by being on the lookout. In the scenario above,
once you’d identified the venting spiral, you could have pointed it out to
Jordan. Distraction can interrupt that feeling of being stuck in a problem so,
next, you and Jordan could have agreed to stop the discussion for a few hours,
and do something that distracts you both, before coming back to figure out how
to deal with the issue. At this point, you could have considered enacting the
validate-and-reframe pattern I mentioned earlier (supporting such an approach,
there is evidence that reframing can interrupt spirals of rumination).
NEED TO KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSKey points – How to
support a struggling friendBeing supportive isn’t easy. Many people struggle to
know the right thing to say or do to help.Providing support is a skill you can
learn. There are evidence-based strategies you can use. What’s more, providing
the right kind of support is good both for your friends and for you.Resist the
urge to downplay your friend’s problems. Instead, aim to be compassionate and
responsive to how your friend is feeling.Ask questions and really listen. Most
of us aren’t as good at empathy as we think – so find out how your friend feels
and show you’re paying attention.Give emotional support first, cognitive support
second. Validate your friend’s feelings, and only then help them to see things
in a more positive light.Don’t take charge. Avoid being directive about your
opinions; instead, encourage your friend to come up with potential solutions so
they feel in control of the problem.Avoid venting together. Dwelling on problems
with your friend without looking for a solution is known as co-rumination. Use
distraction to break out of these negative spirals.NEED TO KNOWWHAT TO DOKEY
POINTSLEARN MORELINKS & BOOKSLearn moreTailoring your support
Not all supportive strategies will work in the same way for all people, cultures
and situations. Now that we have good information about what works overall,
researchers are starting to investigate how the optimal way to give support
might vary depending on the who, where and when of the situation. Here are some
of the most important findings to date:
Who: a relevant factor is the personality of the person being supported and in
particular their self-esteem. In a series of studies, Denise Marigold at the
University of Waterloo and her colleagues found that people with lower
self-esteem benefited less from reframing and other forms of cognitive social
support. As I discussed in the What to Do section above, this is the kind of
support that involves positively reframing a friend’s experience (eg, ‘That
terrible job interview was good practice for jobs you’ll care more about in the
future’). People with lower self-esteem found this reframing cognitive support
less helpful, and the people who provided the support felt worse about the
interaction, themselves and their friendships more broadly. However, people with
lower self-esteem were responsive to emotional support that validated their
personal experiences. These findings indicate how important it is to think
carefully about the personality of your friend and their preferences as you
provide support.
Where: other research has investigated the role of culture in effective support.
For instance, while much of the research I have discussed so far focuses on
participants in Europe or the United States, crosscultural studies have
demonstrated different dynamics among Asian and Asian American people. People
with these backgrounds tend to request less support than Europeans and Americans
because they fear that requesting too much support will strain their
relationships. Perhaps as a result, whenever Asian and Asian American people
have to ask for social support, they tend to find it less beneficial than any
unsolicited support they receive. This suggests that, when giving support to
Asian and Asian American people, it might be better to offer the support in a
more subtle way, without waiting to be prompted.
Furthermore, research has demonstrated that social support may be more effective
in some cultures, depending on people’s values. For instance, a study
investigating Latino culture in the US found that this is characterised by
familism, which values positive emotions, readily accessible social support from
family, and a sense of shared obligation among community members. Among Latino
participants, but not European or Asian participants, those people who more
strongly endorsed familism tended to enjoy greater social support and better
relationships. Related research suggests that among Latinos specifically,
endorsement of familism is associated with deriving more health benefits from
social support. Taken together, this work suggests that providing effective
support may be particularly important in Latino communities that strongly
endorse familism.
When: the role of situation in social support provision is another focus of
research. One key distinction has been whether the support is given online (eg,
through social media or messages) or in person. Despite the challenges involved
in online interactions, studies in young people have found that providing
support online can be helpful, especially for those who have less support
available in person. Indeed, studies with young adults have found that support
received digitally (eg, through messages and video calls) was just as helpful as
face-to-face support. There tends to be some scepticism around the benefits of
digital social support, but this research suggests that it may be a promising
avenue, at least in young people. It’s unclear how well such studies will
generalise across all age groups, but it does indicate that, if offering digital
support is an available option (as is so often the case), then it is an avenue
worth using. Many of the strategies discussed in this Guide are equally
applicable in digital settings and can be used to support friends from afar.
NEED TO KNOWWHAT TO DOKEY POINTSLEARN MORELINKS & BOOKSLinks & booksIn this New
York Times guide, the columnist Tara Parker-Pope discusses the research on how
to be a better friend, including how to make friendships last, how to listen
more effectively, and how to have better arguments.
The Psychology Podcast hosted by the cognitive scientist Scott Barry Kaufman has
several episodes that are helpful to being a better friend, including one on
developing emotion skills, with Marc Brackett of the Yale Center for Emotional
Intelligence, and another on fostering positive relationships, with the social
psychologist Sara Algoe.
The Ten Percent Happier podcast hosted by the journalist Dan Harris also has
some relevant episodes, including one on making and keeping friends, with the
evolutionary psychologist Robin Dunbar of the University of Oxford, and another
that makes the case for kindness, with Dacher Keltner of the Greater Good
Science Centre at the University of California, Berkeley.
In her TED talk ‘Helping Others Makes Us Happier – But It Matters How We Do It’
(2019), the psychologist Elizabeth Dunn of the University of British Columbia
discusses the benefits we get from helping others, demonstrating that supporting
our friends also has personal benefits.
The book The War for Kindness (2019) by the psychologist Jamil Zaki of Stanford
University is excellent on the psychology of empathy. Zaki demonstrates that
empathy is a skill we can develop, in order to be kinder and more supportive
people.

Decades of research has shown that limits on calorie intake by flies, worms, and
mice can enhance life span in laboratory conditions. But whether such calorie
restriction can do the same for humans remains unclear. Now a new study led by
Yale researchers confirms the health benefits of moderate calorie restrictions
in humans -- and identifies a key protein that could be harnessed to extend
health in humans.
The findings were published Feb. 10 in Science.
The research was based on results from the Comprehensive Assessment of Long-term
Effects of Reducing Intake of Energy (CALERIE) clinical trial, the first
controlled study of calorie restriction in healthy humans. For the trial,
researchers first established baseline calorie intake among more than 200 study
participants. The researchers then asked a share of those participants to reduce
their calorie intake by 14% while the rest continued to eat as usual, and
analyzed the long-term health effects of calorie restriction over the next two
years.
The overall aim of the clinical trial was to see if calorie restriction is as
beneficial for humans as it is for lab animals, said Vishwa Deep Dixit, the
Waldemar Von Zedtwitz Professor of Pathology, Immunobiology, and Comparative
Medicine, and senior author of the study. And if it is, he said, researchers
wanted to better understand what calorie restriction does to the body
specifically that leads to improved health.
Since previous research has shown that calorie restriction in mice can increase
infections, Dixit also wanted to determine how calorie restriction might be
linked to inflammation and the immune response.
"Because we know that chronic low-grade inflammation in humans is a major
trigger of many chronic diseases and, therefore, has a negative effect on life
span," said Dixit, who is also director of the Yale Center for Research on
Aging. "Here we're asking: What is calorie restriction doing to the immune and
metabolic systems and if it is indeed beneficial, how can we harness the
endogenous pathways that mimic its effects in humans?"
Dixit and his team started by analyzing the thymus, a gland that sits above the
heart and produces T cells, a type of white blood cell and an essential part of
the immune system. The thymus ages at a faster rate than other organs. By the
time healthy adults reach the age of 40, said Dixit, 70% of the thymus is
already fatty and nonfunctional. And as it ages, the thymus produces fewer T
cells. "As we get older, we begin to feel the absence of new T cells because the
ones we have left aren't great at fighting new pathogens," said Dixit. "That's
one of the reasons why elderly people are at greater risk for illness."
For the study, the research team used magnetic resonance imaging (MRI) to
determine if there were functional differences between the thymus glands of
those who were restricting calories and those who were not. They found that the
thymus glands in participants with limited calorie intake had less fat and
greater functional volume after two years of calorie restriction, meaning they
were producing more T cells than they were at the start of the study. But
participants who weren't restricting their calories had no change in functional
volume.
"The fact that this organ can be rejuvenated is, in my view, stunning because
there is very little evidence of that happening in humans," said Dixit. "That
this is even possible is very exciting."
With such a dramatic effect on the thymus, Dixit and his colleagues expected to
also find effects on the immune cells that the thymus was producing, changes
that might underlie the overall benefits of calorie restriction. But when they
sequenced the genes in those cells, they found there were no changes in gene
expression after two years of calorie restriction.
This observation required the researchers to take a closer look, which revealed
a surprising finding: "It turns out that the action was really in the tissue
microenvironment not the blood T cells," Dixit said.
Dixit and his team had studied adipose tissue, or body fat, of participants
undergoing calorie restriction at three time points: at the beginning of the
study, after one year, and after two. Body fat is very important, Dixit said,
because it hosts a robust immune system. There are several types of immune cells
in fat, and when they are aberrantly activated, they become a source of
inflammation, he explained.
"We found remarkable changes in the gene expression of adipose tissue after one
year that were sustained through year two," said Dixit. "This revealed some
genes that were implicated in extending life in animals but also unique calorie
restriction-mimicking targets that may improve metabolic and anti-inflammatory
response in humans."
Recognizing this, the researchers then set out to see if any of the genes they
identified in their analysis might be driving some of the beneficial effects of
calorie restriction. They honed in on the gene for PLA2G7 -- or group VII A
platelet activating factor acetylhydrolase -- which was one of the genes
significantly inhibited following calorie restriction. PLA2G7 is a protein
produced by immune cells known as macrophages.
This change in PLA2G7 gene expression observed in participants who were limiting
their calorie intake suggested the protein might be linked to the effects of
calorie restriction. To better understand if PLA2G7 caused some of the effects
observed with calorie restriction, the researchers also tracked what happened
when the protein was reduced in mice in a laboratory experiment.
"We found that reducing PLA2G7 in mice yielded benefits that were similar to
what we saw with calorie restriction in humans," said Olga Spadaro, a former
research scientist at the Yale School of Medicine and lead author of the study.
Specifically, the thymus glands of these mice were functional for a longer time,
the mice were protected from diet-induced weight gain, and they were protected
from age-related inflammation.
These effects occurred because PLA2G7 targets a specific mechanism of
inflammation called the NLRP3 inflammasome, researchers said. Lowering PLA2G7
protected aged mice from inflammation.
"These findings demonstrate that PLA2G7 is one of the drivers of the effects of
calorie restriction," said Dixit. "Identifying these drivers helps us understand
how the metabolic system and the immune system talk to each other, which can
point us to potential targets that can improve immune function, reduce
inflammation, and potentially even enhance healthy lifespan."
For instance, it might be possible to manipulate PLA2G7 and get the benefits of
calorie restriction without having to actually restrict calories, which can be
harmful for some people, he said.
"There's so much debate about what type of diet is better -- low carbohydrates
or fat, increased protein, intermittent fasting, etc. -- and I think time will
tell which of these are important," said Dixit. "But CALERIE is a very
well-controlled study that shows a simple reduction in calories, and no specific
diet, has a remarkable effect in terms of biology and shifting the
immuno-metabolic state in a direction that's protective of human health. So from
a public health standpoint, I think it gives hope." PsychoBlast 4 A few things
first for everyone that’s starting new with me and the platform, some of you
might be newer than others, but this is not to worry about. But first, a mantra
or two.
All I have to give is all I have. All the good I am is good enough.

A lot of times people start with the platform and don’t have any expectations
and not that I think that is bad in any way; but that in itself can be somewhat
anxiety provoking to say the least.
So just a few things.
Just a couple of more things I wanted to share with you if you get some time to
do some journaling or explore some of the worksheets that you’d like for me to
send. I also wanted to role model my own journal and ask a few things that I
didn’t get to in our first session. Once again I appreciate you taking this
first step in therapy and I’m deeply honored to work with you.As much as I know
about you so far and you know about me, I want you to know first off that I’d
like to get to know you better. In our sessions together I do my best to try and
get right to the point but I also don’t want you to ever feel rushed or
pressured in any way. Honestly, I’m afraid that I have lost some clients due to
them not really letting me know some things that would have been very helpful
for them to have gotten off their chest. I’m looking at this as just as much my
own fault as theirs, because the response of the communication is my
responsibility. Not only would the deeper confession have helped them but also
me to help them. I’m not trying to put any pressure or attempt to control
anything but just thought that bringing this to your awareness might give you an
opportunity to shift somehow or reevaluate how you best spend your phone, chat,
or video session time. So if it's a different agenda, then feel free to set it.
Some more structure can be good as I’ve found out with a couple of you as of
recently putting in some boundaries as to what you wanted the topic of the
session to be. Thank you again for knowing what you want and what you need to
make it a better session for you.So, if I think about you my client, I develop
an overall picture of you. I’m not sure how accurate it is, but probably at
least some of it is. Sure my perception and judgment both good and bad adds some
variety to that. I would say I even project other things about you just based on
what you have already told me. For example, if you like spicy asian food , then
I might assume (which is wrong on so many levels and you and I both know this)
that you probably have enjoyed spicy food of other cultures as well. So yeah,
that’s just a small example but makes the point I believe, this could go into
other areas that might be very valuable to know in the process of therapy.I
guess in other words, or another way for me to ask this is for you to think a
bit about some of the things that either I don’t know about you or also possibly
other stuff that you’ve told me that you are afraid that maybe I’ve forgotten
about you and take this opportunity in your journal or with a message to refresh
my memory. I look forward to hearing about a few of these things. Let me tell
you a little secret about me. I feel kind of strange revealing too much of
myself sometimes and this is probably a fault at times, but I also know that our
counseling relationship is all about YOU and not me (even though I certainly
self disclose too much perhaps). And that’s just the thing, there’s no
guarantees, I mean it’s obviously too late to take it back afterwards if I get
the vibe and I think damn they didn’t really want to know you love to paint your
toenails every Sunday afternoon and if you don’t get the chance then you throw a
fit which could only be rivaled by a three year old not getting their needs
met.If you chuckled there (and also if you’ve made it this far) then thank you
so much. That brings up another topic worthy of exploring and that’s the subject
of humor and entertainment. Surely, it’s not good to expect that we all have the
same sense of humor. And especially when it only involves text without any of
the subtleties that verbal / audio communication can provide. I know without a
doubt that humor and the ability to have some humor here and there in the
process of therapy is very important. Still though, therein lies a risk, it’s if
I share a different perspective that results in a laugh or even the possibility
of laughing at oneself; it’s never with the intention of not honoring or
respecting you, my client. I am quite aware that I have the huge splinter in my
eye, but then again, let’s not forget the power of looking the mirror from time
to time; especially when it comes to our own immediate gut reactions, sure
sometimes these are perfectly truthful, honorable, valid, and good; but other
times, tempering those reactions with just a touch or even as little as a
sprinkle of thought could help reduce any misunderstandings. And after all isn’t
that what therapy is about at the core? To think about our reactions and
perceptions and see them from different perspectives and with a new light of
understanding?Yes, I know that was a bit of a run on sentence that packed quite
a punch. I promise the punch only had the best of intentions, but even now you
have to trust me enough to take my word on that :)So now here’s a few things,
and maybe I will start to integrate this list with all of my new clients on
betterhelp or only after a bit of getting to know a new client, anyway not sure
on that yet. Some of these questions I might already know about you, but then
again how can I be sure unless you tell me? Of course, if you don’t want to let
me know anything (or more likely some of the questions) in this list then I
understand completely. I don’t ever want there to be any pressure. So without
further ado, here’s the list. Thanks again for being my client and I hope to
learn a lot more about you.
Favorite stores, websites, activities that aren’t connected to workThings that
inspire youFavorite foodsBest and worst childhood memoriesNeatest toy you had as
a child or other activity you enjoyedBest friend now and best friend in the
pastPerson you trusted the most as a child and as an adultThing you hate to do
the mostThing you love to do the mostBest vacation or trip you ever took , most
fun travel you are looking forward toYour favorite entertainmentThings that
impress you about others or when they do them for youHow you show your
appreciation to someoneThe funnest time in your lifeThe most fun you’ve had this
year (I know this is a tough one)Things you’d like to learn more aboutThings you
wish you could change about yourself or others or the world Also, feel free to
just tell me a random fact about you or someone you love.










Part 2

Content About Contentment
I’m so glad that some of you have asked for me to do this. Sometimes we are
guilty of thinking that other people are thinking as much about us as we think
that they are. But for those of you that wanted to know here’s my response to
the prompts I gave you guys.So here it goes I am going to share a few things
about me. Take a deep breath and relax and don’t worry it won’t be long because
there’s a few secrets that I want to keep under lock and key probably forever
(but rather that get into a wild rant about boundaries which I’m sure you can
read in one of my other posts I will just stick to the idea here). Taking a
little bit of my own medicine, bitter pills that I have to swallow at times.
Here’s some random facts about some of my family members. I will start with my
wife, she is a workaholic; but also one of the sweetest yet stubbornest people
you will ever meet. It seems like an impossibility probably but that’s not only
my opinion of her. It has been confirmed by other people that knew her way
longer than me even! Next , I will tell you about my youngest daughter and that
she likes to draw and do animations and bake or cook with her grandmother. Ok,
next my mom, she’s really into crosswords, mahjong, and gardening. My other
daughters are very different, one being really into music and documentaries and
other “real life” dramas. Whereas, the other one is totally into scifi and
fantasy types of stories and not really as much into music. The former was and
still is really into athletics both as a participant and a fan and the latter
could care less for any of that and is more into photography/aesthetics/etc. One
of them works overnights for a large retail chain and the other works in a
printshop/tshirt/tourist gift shop. One of them went to college on an academic
scholarship and dropped out. The other one went on an athletic scholarship and
dropped out, so I guess you can't blame me for loving them both the same LOL.As
far as best friends go, my best friend now is a guy that I’ve grown to a
friendship with that used to be just a colleague of mine. He is also a
therapist, but really likes motorcycles as well so that’s probably what took us
past the “colleague zone”. He is also about to retire so it’s been neat to watch
him transition into another stage of life. One of my best friends in the past is
no longer a friend or even someone that I talk to anymore. This has been
puzzling to me. In fact, it’s the only time I’ve ever truly been ghosted in my
life. Sometimes I think about him and how close we were and it still hurts, so
many good times, but I’ve also given up on trying to understand and even though
it’s painful, it’s definitely been good for my ego and character building in a
way. I don’t ever think I took him for granted, but then again maybe I was
wrong, so I will do even better in the future. That’s the only bright spot at
the end of that dark obsessive ruminating on the past tunnel.The person I
trusted the most as a child was my paternal grandfather. I look back on the time
that I had with him and I’m so glad that I was able to have that. It was
probably the closest I’ve had to unconditional love actually. As an adult, the
most trust has been given to my wife, even when it was very difficult to do so.
It’s been a two way street and I can only hope to be blessed for it to stay that
way. She has made me a better person and I’ve allowed myself to be vulnerable in
ways that I never thought I’d be able to as a younger man.The thing I hate to do
the most. I think what I hate to do the most is be honest with myself. Even when
I know I’m not doing it, I still persist in my stubborn nature. This has cost me
dearly in my life many times. I don’t know where it comes from. I think a lot of
it has to do with not accepting the uncomfortable aspects of myself, all the
ugly parts. Yeah, ok, enough on that for now.The thing I love to do the most?
Hmmmm, there’s so many things, it’s hard to pinpoint. I do like being creative
with visual arts like painting and photography mixed with some writing in there
every once in awhile and riding my motorcycle the most probably. Also camping
out and spending time in nature, which can be integrated with everything else in
all kinds of ways usually.The best vacation trip I have to say was my trip to
Micronesia to meet my wife’s (yes I know they are technically my family as well
now) family for the first time. I do look forward to ANY kind of travel at this
point, but can’t wait to take my youngest daughter back there to see what a
different world of adventure it is and hopefully even scuba dive with her on the
reefs.My favorite entertainment is a split between visual arts and music, so
even better if they go together in some way. I am as at home in a concert as I
am in an art gallery or just looking at photos. The surreal or slightly strange
has always been fascinating such as movements in art like surrealism and
dada.What really impresses me is when people do things out of the pure goodness
of it with no thought of anything in return and not necessarily financial
things, although that’s impressive as well. But just those random acts of
kindness, especially when they are anonymous in doing it. I like to show my
appreciation to them by complimenting people as well as doing my best to make
them laugh.Funnest times I’d have to say are still ongoing. I try to make it a
priority actually. I think it’s even starting to become one of my most important
values as I get older. One thing that for sure about these times is that they
always involve having some other people around that you love and care about. A
jump scare of my kid and just being goofy with her. Dressing up for halloween so
well that even my wife or daughters didn’t recognize me. Yup a great memory for
sure.I’d like to learn more about cultures, languages, and ancient history as
well as get more time to play guitar. But more than anything, more time to
travel with my family (really hope that we all get to travel more really soon).
Keeping my fingers and toes crossed. Thanks for taking the time to read my
journal.


Update to this for 2022 February 8

Still haven’t gotten to travel nearly as much as I or the family would like. Mom
has had more problems with her health. My wife and two of my daughters have had
covid (and I suspect my youngest daughter had it in Dec. of 2019 as well). Have
been doing a lot more hiking that borders on mountain climbing at times (pushing
past comfort zones). Had some losses in the family both mine and my wifes. My
daughter continues to amaze me and be the thing that brightens my life more than
anything (same for my wife). We have a new indoor cat/kitten. (stopping the
thought train to add to this later)

Just a few housekeeping things to go through. I am opening up some times for
next week toward the end of the week. I hope that those of you that haven’t been
able to get a session in the last week through no fault of your own (therapist
cancellation) will be able to get the time that you want. Remember that the
flexibility of the application in using voice messages as well as live chat
sessions if being able to have a phone session isn’t possible. Thank you for
your flexibility and for the opportunity to work with you. Anyway, now onto the
rest of the journal keeping. I will do my best to make up another session or
two. If I need to have two sessions in a week then maybe we’d be even then (or
getting closer to that point).
As always, 45 minutes is the time allotted for sessions. Sometimes we go over a
bit. But not too much. Sometimes I’m a bit late to the beginning of a session
even in spite of this due to reasons not nearly as much as in my control as I’d
like for them to be. I also have two other jobs besides this platform and life
circumstances that at times can make a cancellation/reschedule necessary. I do
my best to allot alternative times for this. Sometimes I fail. If you are
unfortunate and this happens to you, I do my best to make it up with two
sessions the next week (if that is allowed based upon your plan which I don’t
know and don’t have access to). Both of my other jobs compete really well
compared to this one in the area of compensation so that is also a factor.
Thanks in advance for your understanding regarding this difficulty at
times.Nothing is promised. Each day is a gift. You deserve to go a little easier
on yourself and those you care about. Life is tough but it can be tougher I
think when you try your best to “out tough it”. Because life has been so hard
that doesn’t mean that you have to take the approach of you being harder than
life itself. This is an impossibility. However far you go in your “tough”
approach/mentality. Life will present you an opportunity that can truly bring
you to your knees. Or at least it should. Being on your knees is the place to
see life as it truly is and not in a religious sense necessarily. More about
being humble. More about being in awe of this whole thing we call life and being
a part of it. A part that is alive. A part that can do things and even sometimes
make a few things happen for ourselves or some other part of humanity that we
care about or even nature itself. It’s a bit ironic and paradoxical. But it
sometimes seems that the only way to have any true power is to embrace your
weakness. To truly and completely admit just how little of a piece of the puzzle
you are. Just how small your impact. Just how quickly life would adjust and move
on even if you weren’t as big of a part of it anymore becoming nothing but dust
and memories. That doesn’t have to depress you. That doesn’t have to damage your
ego. That is enough. I think you get the idea. Some people though totally
embrace their suffering and make it their point to increase the suffering of
others. If you are around these types of people I hope you take some time to
reevaluate the value that they bring to your life. The time is always right for
making a huge earth shattering turn around that could truly be way better than
you might have actually even thought. You always at least have the choice to try
and see things from a different perspective. Even if you can’t make the move
right now. Or if you’re paralyzed but what the “right” move might be. Hold onto
the possibility that tomorrow you still have the “right” to change how you are
seeing things. Guess what, it's never going to be alright. But don’t worry it’s
not alright for anybody else either. And you’re in very fine company!So the
first few research studies are about something very related to human
interactions. It’s on the concept of cooperation. Whether it’s families or in
the workplace or even in society in general I know that I need to learn more and
think about how I could do a better job in this area. The last two are about
depression and sleep and depression and eating.
Institute of Science and Technology Austria
Cooperation plays a crucial role in evolution. A team of scientists has now
created a new model that shows how different kinds of cooperative strategies
among humans develop. Using their unified framework, they show how an
individual's experience and the reputation of others influence the emergence of
successful cooperation.
Cooperation as a successful strategy has evolved in both nature and human
society, but understanding its emergence can be a difficult task. Researchers
have to abstract interactions between individuals into mathematical formulas to
be able to create a model that can be used for predictions and simulations.
In the field of evolutionary game theory, they often investigate strategies of
players in a simple game of giving and receiving benefits. Such strategies tell
players how to behave in a given interaction. The scientists' findings counter
the narrative that only the strongest and most selfish flourish and survive.
Instead, they show how cooperation can be a successful and stable strategy.
Researchers, spearheaded by Laura Schmid from the Chatterjee group at IST
Austria, have created a new mathematical framework that combines so far
incompatible descriptions of cooperation. In their simulations of many
interactions between players, they show how prior experiences with and
reputation of a potential partner affect the willingness of a players to
cooperate with them.
Scratched Backs and Flawless Reputation
The central concept in the researchers' work is that of interactions based on
direct and indirect reciprocity. "An interaction based on direct reciprocity
simply means 'I'll scratch your back if you scratch mine'," Laura Schmid
explains, "It can be found both among humans and several animal species."
On the other hand, indirect reciprocity is based on the reputation of an
individual. "This means that if they behave well towards others, I will
cooperate with them, even if I have not interacted with that individual before,"
Schmid continues, "So far this has conclusively only been shown among humans."
Resolving conflicts that arise when these two kinds of reciprocity lead to
competing suggestions is not straightforward. Should the player cooperate with a
person who behaves well towards others, even if they have treated them unfairly
in the past? The strategies adopted by the players then answer this kind of
question.
One of the key insights the researchers gained from their unified model of both
direct and indirect reciprocity was that the evolution of strategies, the amount
of cooperation, as well as which kind of reciprocity individuals prefer all
depend on the environment: factors like how often players interact and whether
they know the truth about their partner's reputation.
Stabilized Cooperation
This model can help researchers understand the fundamental dynamics of how
cooperative strategies evolve and stabilize. "Using mathematical tools that were
developed only recently, we explored which strategies of direct or indirect
reciprocity give rise to a Nash equilibrium," Schmid points out. "Once the
evolving population of players in our simulation adopts such strategies, none of
them has an incentive to divert."
These findings shed some light on how the evolution of cooperation in early
human societies could have been influenced by their social norms based on
experience and reputation. A more current application would be the modeling of
rating systems of online stores based on both a buyer's personal experience and
the reputation of a seller.
Bridging different fields such as game theory and evolutionary modeling has been
a topic for Laura Schmid for some time. Growing up in Vienna, she first studied
physics at TU Wien as well as piano at the Music and Arts University of the City
of Vienna before joining the Chatterjee group at IST Austria for her PhD. After
completing her degree later this year, she plans to continue her research career
abroad.
In her future work, Laura Schmid wants to look into how many players in a group
have to use a strategy based on indirect reciprocity for it to become
successful. With this, she will be able to investigate the effect of the spread
of social norms within a society.
Story Source:
Materials provided by Institute of Science and Technology Austria. Note: Content
may be edited for style and length.

University of Chicago Press JournalsWhat is morality? And to what extent does it
vary around the world? The theory of 'morality-as-cooperation' argues that
morality consists of a collection of biological and cultural solutions to the
problems of cooperation recurrent in human social life. These solutions or
cooperative behaviors are plausible candidates for universal moral rules, and
that morality-as-cooperation could provide the unified theory of morality that
anthropology has hitherto lacked.Anthropologists at the University of Oxford
have discovered what they believe to be seven universal moral rules.The rules:
help your family, help your group, return favors, be brave, defer to superiors,
divide resources fairly, and respect others' property, were found in a survey of
60 cultures from all around the world.Previous studies have looked at some of
these rules in some places -- but none has looked at all of them in a large
representative sample of societies. The present study, published in volume 60,
no. 1 issue of Current Anthropology, by Oliver Scott Curry, Daniel Austin
Mullins, and Harvey Whitehouse, is the largest and most comprehensive
cross-cultural survey of morals ever conducted.The team from Oxford's Institute
of Cognitive & Evolutionary Anthropology (part of the School of Anthropology &
Museum Ethnography) analyzed ethnographic accounts of ethics from 60 societies,
comprising over 600,000 words from over 600 sources. Dr Oliver Scott Curry, lead
author and senior researcher at the Institute for Cognitive and Evolutionary
Anthropology, said: "The debate between moral universalists and moral
relativists has raged for centuries, but now we have some answers. People
everywhere face a similar set of social problems and use a similar set of moral
rules to solve them. As predicted, these seven moral rules appear to be
universal across cultures. Everyone everywhere shares a common moral code. All
agree that cooperating, promoting the common good, is the right thing to do."The
study tested the theory that morality evolved to promote cooperation, and that
-- because there are many types of cooperation -- there are many types of
morality. According to this theory of 'morality as cooperation', kin selection
explains why we feel a special duty of care for our families, and why we abhor
incest. Mutualism explains why we form groups and coalitions (there is strength
and safety in numbers), and hence why we value unity, solidarity, and loyalty.
Social exchange explains why we trust others, reciprocate favors, feel guilt and
gratitude, make amends, and forgive. And conflict resolution explains why we
engage in costly displays of prowess such as bravery and generosity, why we
defer to our superiors, why we divide disputed resources fairly, and why we
recognize prior possession.The research found, first, that these seven
cooperative behaviors were always considered morally good. Second, examples of
most of these morals were found in most societies. Crucially, there were no
counter-examples -- no societies in which any of these behaviors were considered
morally bad. And third, these morals were observed with equal frequency across
continents; they were not the exclusive preserve of 'the West' or any other
region. Among the Amhara of Ethiopia, "flouting kinship obligation is regarded
as a shameful deviation, indicating an evil character." In Korea, there exists
an "egalitarian community ethic [of] mutual assistance and cooperation among
neighbors [and] strong in-group solidarity." "Reciprocity is observed in every
stage of Garo life [and] has a very high place in the Garo social structure of
values." Among the Maasai, "Those who cling to warrior virtues are still highly
respected," and "the uncompromising ideal of supreme warriorhood [involves]
ascetic commitment to self-sacrifice...in the heat of battle, as a supreme
display of courageous loyalty." The Bemba exhibit "a deep sense of respect for
elders' authority." The Kapauku "idea of justice" is called "uta-uta,
half-half... [the meaning of which] comes very close to what we call equity."
And among the Tarahumara, "respect for the property of others is the keystone of
all interpersonal relations."The study also detected 'variation on a theme' --
although all societies seemed to agree on the seven basic moral rules, they
varied in how they prioritized or ranked them. The team has now developed a new
moral values questionnaire to gather data on modern moral values, and is
investigating whether cross-cultural variation in moral values reflects
variation in the value of cooperation under different social conditions.
According to co-author Professor Harvey Whitehouse, anthropologists are uniquely
placed to answer long-standing questions about moral universals and moral
relativism. "Our study was based on historical descriptions of cultures from
around the world; this data was collected prior to, and independently of, the
development of the theories that we were testing. Future work will be able to
test more fine-grained predictions of the theory by gathering new data, even
more systematically, out in the field.""We hope that this research helps to
promote mutual understanding between people of different cultures; an
appreciation of what we have in common, and how and why we differ," added
Curry.Materials provided by University of Chicago Press Journals. Note: Content
may be edited for style and length.In models that explore how humans act when
their reputation is at stake, usually assumptions were made that are at odds
with reality. In a new, more realistic model, scientists explore what happens
when information is incomplete and people make mistakes. In their model,
previously successful strategies do not lead to sustained cooperation, and in
most cases do not evolve at all. Indirect reciprocity is a model that explores
how humans act when their reputation is at stake, and which social norms people
use to evaluate the actions of others. A key question in this area is: which
social norms lead to cooperation in a society? Previous studies have always
assumed that everyone in the population has all the relevant information and
that everyone agrees who is good and bad -- assumptions at odds with the reality
we live in. In a new, more realistic model, Christian Hilbe, Laura Schmid, Josef
Tkadlec, and Professor Krishnendu Chatterjee at the Institute of Science and
Technology Austria (IST Austria), together with Professor Martin Nowak of
Harvard University, explore what happens when information is incomplete and
people make mistakes. In their model, previously successful strategies do not
lead to sustained cooperation, and in most cases do not evolve at all. Their
results will be published today in the journal PNAS.In the world of game theory,
indirect reciprocity is played out using two randomly selected individuals in a
population: one donor, one recipient. The donor then needs to decide whether or
not to help the recipient based on their social norms. The donor's decision may
depend on the reputations of the two individuals, and on the social norm the
donor employs (for example, they might only help recipients with a good
reputation). Meanwhile, the rest of the population is watching: after the
donor's decision, they update their opinions of him or her based on their own
social norms. Past models were based on the assumptions that everyone agreed on
the reputations of everyone else, and that everyone witnesses all interactions.
These studies showed that there are eight "leading" social norms or "strategies"
that lead to stable cooperation in a population. But what happens when people
make mistakes, and differences of opinion develop? "We wanted to explore how the
leading eight strategies fared when faced with incomplete, noisy information,"
explains Laura Schmid, a PhD student in the Chatterjee group. What they found
surprised them: none of the strategies led to high levels of cooperation, and
many were unstable or did not evolve at all.Modeling these interactions is
mathematically demanding, and the previous assumptions made the analysis easier.
"When you consider all the details, you need to rely on simulations, and those
just take a lot of time" says postdoc Christian Hilbe. Still, even a single
difference of opinion in the population could have drastic effects. If the donor
thinks the recipient is bad, but the rest of the population thinks the recipient
is good, the donor's decision not to give causes his or her reputation to drop,
resulting in a ripple effect throughout the population. Josef Tkadlec, another
PhD student working with Professor Chatterjee, described mathematically how
differences of opinion spread and divide a population. "For some strategies,
even a single disagreement could lead to populations that were split into two
polarized subgroups," Tkadlec says. "Other strategies could recover, but it
might take them a long time."The team has additional modifications already in
mind: for instance, in the populations in previous simulations, everyone was
connected with everyone else. What would happen when the population had a
particular network structure? Moreover, individuals in populations were
independent in forming their opinions. What would happen if they could
communicate? The team has already found some numerical evidence that suggests
that communication among individuals reduces errors and increases cooperation.
"Seen from this angle," concludes postdoc Christian Hilbe, "our findings
highlight the importance of communication and coordination for building and
maintaining cooperation in a society."Materials provided by Institute of Science
and Technology Austria. Note: Content may be edited for style and length.New
tools to systematically build cooperation: Theory of repeated games Institute of
Science and Technology AustriaSocial dilemmas occur when individual desires
clash with group needs. How can people be encouraged to cooperate when they have
reason not to? Scientists show that if the social dilemma that individuals face
are dependent on if they work together, cooperation can triumph. This finding
resulted from a new framework that they introduced, which extends the entire
theory of repeated games. Moreover, their work provides tools to systematically
build cooperation. When what we want as individuals clashes with what is best
for the group, we have a social dilemma. How can we overcome these dilemmas, and
encourage people to cooperate, even if they have reason not to? In a paper
released today in Nature, Christian Hilbe and Krishnendu Chatterjee of the
Institute of Science and Technology Austria (IST Austria), together with Martin
Nowak of Harvard and Stepan Simsa of Charles University, have shown that if the
social dilemma that individuals face is dependent on whether or not they work
together, cooperation can triumph. This finding was the result of a new type of
framework that they introduced -- one that extends the entire theory of repeated
games. Moreover, as their work pinpoints the ideal conditions for fostering
cooperation, they have provided tools to systematically build cooperation.The
tragedy of the commons: if we can (ab)use a public good without seeing negative
consequences, we will -- without consideration of others or the future. We see
examples of this in our daily lives, from climate change and forest depletion
down to the stack of dirty dishes in the office kitchen. In game theory,
scientists have used repeated games -- repeated interactions where individuals
face the same social dilemma each time -- to understand when individuals choose
to cooperate, i.e. their strategies. However, these games have always kept the
value of the public resource constant, no matter how players acted in the
previous round -- something that does not reflect reality of the situation.In
their new framework, Hilbe, Simsa, Chatterjee, and Nowak consider repeated games
in which cooperation does not only affect the players' present payoffs, but also
which game they face in the next round. "Repeated games have been studied
intensely for over 40 years, and significant new developments are rare --
especially such simple ones," says Martin Nowak. "This addition actually extends
the whole theory of repeated games, as a fixed environment is a special case of
our new framework."When they explored the new model, the scientists found that
this dependence on players' actions could greatly increase the chance that
players cooperate -- provided the right conditions were in place. "Our framework
shows which kinds of feedback are most likely to lead to cooperation," says
first author Christian Hilbe. These include, for instance, how quickly the
resource degrades or how easy it is to return to a more valuable state. "Using
this knowledge, you can design systems that maximize cooperation, or create an
environment that encourages people to work together," he adds. For example,
these ideas could even be implemented by a business or corporation, to create a
work community that encourages working together.The new research project also
demonstrates how cooperations between fields of research can yield valuable
results. "Working with computer scientists has been extremely rewarding for me
as a biologist," adds Nowak. "The tools and perspectives they bring with them
have had and will have a significant impact on what we can do."Materials
provided by Institute of Science and Technology Austria. Note: Content may be
edited for style and length. Moral systems are key to distinguishing between
"good" and "bad" and are essential to the establishment of social orders. For
instance, a rule of thumb for maintaining cooperation within a sizable group is
to help those who have a good reputation and avoid those who seem bad. However,
the moral standard for what is good and what is bad is not necessarily unique
and often diverges across societies."What moral standards best promote
cooperation among those who are willing to freeload on others' efforts?" Sasaki
asks. "There is no definitive consensus on the question, and it remains unclear
even how those who refuse to help the bad should be assessed."To address these
issues, Tatsuya Sasaki collaborated with colleagues Isamu Okada from Soka
University and Yutaka Nakai from the Shibaura Institute of Technology in Japan.
These researchers adopted a new approach, one that is different from the
traditional assessment rules that are based on compulsory moral assessment.Their
results unveil a new champion of moral assessment rules, referred to as
"Staying." Sasaki and colleagues examined the Staying rule by applying the
helping game of two persons (a mover and a receiver). They consider two
different types for the person on the moving end, "freeloading" that is to
refuse to help, whoever the opponent, and "cooperation" that is to help when the
opponent has a good reputation or to refuse to help when the opponent has a bad
reputation.They define the moral assessment rule for "Staying," as follows. When
the person on the receiving end has a good reputation, the Staying rule assesses
the person on the moving end, who either helps or refuses to help, as good or
bad, respectively. This is necessary to stabilize cooperation once it has been
established.In striking contrast to more traditional rules, "under Staying," if
the potential receiver has a bad reputation, the reputation of the person who
helps remains the same as in the prior assessment. In this case, a choice about
whether or not to render aid to the potential receiver does not affect the
reputation of the potential mover.A game-theoretical analysis demonstrates --
for the first time -- that the Staying rule, in which the assessment system
avoids making moral assessments in specific cases, is more effective in
establishing cooperation as compared to traditional assessment rules. Indeed,
under the Staying rule, good cooperators can proliferate no matter how many
freeloaders surround them, so long as the error rate is sufficiently small.This
study suggests that the practice of avoiding moral assessments can be the best
policy when assessing those who refuse to help ("punish") wrongdoers.
"Reputation-seeking punishment, described as I'll punish your bad behavior to
make me look good,' may not be the best way to subvert a population of
freeloaders," says Sasaki.This study has important implications for various
contemporary issues, including the potential applications of artificial
intelligence (AI) in terms of decision-making. "The results of future work that
examines whether AI can learn to avoid making moral judgements will be
fascinating," says Sasaki.Materials provided by University of Vienna. Note:
Content may be edited for style and length.The tragedy of the commons, a concept
described by ecologist Garrett Hardin, paints a grim view of human nature. The
theory goes that, if a resource is shared, individuals will act in their own
self-interest, but against the interest of the group, by depleting that
resource.Yet examples of cooperation and sharing abound in nature, from human
societies down to single-celled bacteria.In a new paper, published in the
journal Scientific Reports, University of Pennsylvania researchers use game
theory to demonstrate the complex set of traits that can promote the evolution
of cooperation. Their analysis showed that smaller groups in which actors had
longer memories of their fellow group members' actions were more likely to
evolve cooperative strategies.The work suggests one possible advantage of the
human's powerful memory capacity: it has fed our ability as a society to
cooperate."In the past we've looked at the interactions of two players to
determine the most robust evolutionary strategies," said Joshua B. Plotkin, a
professor in Penn's Department of Biology in the School of Arts & Sciences. "Our
new analysis allows for scenarios in which players can react to the behaviors
and strategies of multiple other players at once. It gives us a picture of a
much richer set of social interactions, a picture that is likely more
representative of the complexities of human behavior."Plotkin collaborated with
Alexander J. Stewart, then his postdoctoral researcher and now a Royal Society
research fellow at University College London, on the work, which builds on years
of game theory examinations by the pair.In their earlier works, they used the
Iterated Prisoner's Dilemma scenario, in which two players face off and can
choose to either cooperate or not, to understand what circumstances promote the
rise of generosity versus selfishness.In the new paper, they added two levels of
complexity. First, they used a different scenario, known as a public-goods game,
which allows players to interact with more than one other player at a time. The
set-up also enabled the researchers to vary the number of players in a given
game. In the public-goods game, a player can contribute a certain amount of a
personal resource to a public pool, which is then divided equally among all
players. The greatest shared benefit comes when all players contribute
generously, but that also puts generous players at risk of losing resources to
selfish players, a tragedy of the commons scenario.The second added level of
complexity was imbuing players with the capacity for long memories. That is,
players could use the actions of their opponents from multiple earlier rounds of
the game to inform their strategies for subsequent rounds. If a player
repeatedly encountered a player in a group that frequently behaved selfishly,
for example, they may be more likely to "punish" that defector by withholding
resources in future rounds.In addition, the populations of players were
permitted to "evolve," such that more successful players, those that achieve
greater payoffs, are more likely to pass their strategies on to the next
generation of players.Stewart and Plotkin found that the more players in a game
the less likely that cooperative strategies could win out. Instead, the majority
of robust strategies in large groups favored defection."This makes intuitive
sense," Plotkin said. "As a group size increases, the prospects for sustained
cooperation go down. The temptation to defect and become a freeloader goes
up."Conversely, their findings showed that giving players a longer memory, the
ability to remember and base decisions on as many as 10 previous rounds of their
opponents' actions, led to a greater relative volume of robust cooperative
strategies. Part of the reason for this, the researchers said, was because
greater memories allowed players to develop a broader array of more nuanced
strategies, including ones that could punish individuals for defecting
strategies and ensure they didn't take over the population"A stronger memory
allowed players to weed out the rare defector," Plotkin said.In a final set of
experiments, Stewart and Plotkin used computer simulations that allowed the
memory capacity of players to evolve alongside the strategies themselves. They
found that not only were longer memories favored, but the evolution of longer
memories led to an increase in cooperation."I think a fascinating takeaway from
our study," Stewart said, "is that you can get a set of circumstances where
there is a kind of runaway feedback loop. Longer memories promote more
cooperation and more cooperation promotes longer memories. That kind of
situation, where you go from a simpler system to one that is more complex, is a
great example of what evolution does, it leads to more and more complexity."As a
next step, Stewart and Plotkin would like to use human subjects to evaluate
their mathematical findings."We have all these results about what kinds of
strategies are successful that take into account different features of players'
actions," Stewart said. "We'd like to run an experiment with people to figure
out what they are actually paying attention to when they're playing. Is it their
payoffs? Is it their opponents' payoffs? And see how those strategies match up
to those we see in our analyses." Materials provided by University of
Pennsylvania. Note: Content may be edited for style and length. Ok, sorry just a
couple of more that are in the area of depression, that I think you might find
very interesting. One about sleep and one about eating and just a couple of
things to shift there that could make a big difference.Waking up just one hour
earlier could reduce a person's risk of major depression by 23%, suggests a
sweeping new genetic study published May 26 in the journal JAMA Psychiatry.The
study of 840,000 people, by researchers at University of Colorado Boulder and
the Broad Institute of MIT and Harvard, represents some of the strongest
evidence yet that chronotype -- a person's propensity to sleep at a certain time
-- influences depression risk.It's also among the first studies to quantify just
how much, or little, change is required to influence mental health.As people
emerge, post-pandemic, from working and attending school remotely -- a trend
that has led many to shift to a later sleep schedule -- the findings could have
important implications."We have known for some time that there is a relationship
between sleep timing and mood, but a question we often hear from clinicians is:
How much earlier do we need to shift people to see a benefit?" said senior
author Celine Vetter, assistant professor of integrative physiology at CU
Boulder. "We found that even one-hour earlier sleep timing is associated with
significantly lower risk of depression."Previous observational studies have
shown that night owls are as much as twice as likely to suffer from depression
as early risers, regardless of how long they sleep. But because mood disorders
themselves can disrupt sleep patterns, researchers have had a hard time
deciphering what causes what.Other studies have had small sample sizes, relied
on questionnaires from a single time point, or didn't account for environmental
factors which can influence both sleep timing and mood, potentially confounding
results.In 2018, Vetter published a large, long term study of 32,000 nurses
showing that "early risers" were up to 27% less likely to develop depression
over the course of four years, but that begged the question: What does it mean
to be an early riser?To get a clearer sense of whether shifting sleep time
earlier is truly protective, and how much shift is required, lead author Iyas
Daghlas, M.D., turned to data from the DNA testing company 23 and Me and the
biomedical database UK Biobank. Daghlas then used a method called "Mendelian
randomization" that leverages genetic associations to help decipher cause and
effect."Our genetics are set at birth so some of the biases that affect other
kinds of epidemiological research tend not to affect genetic studies," said
Daghlas, who graduated in May from Harvard Medical School.More than 340 common
genetic variants, including variants in the so-called "clock gene" PER2, are
known to influence a person's chronotype, and genetics collectively explains
12-42% of our sleep timing preference.The researchers assessed deidentified
genetic data on these variants from up to 850,000 individuals, including data
from 85,000 who had worn wearable sleep trackers for 7 days and 250,000 who had
filled out sleep-preference questionnaires. This gave them a more granular
picture, down to the hour, of how variants in genes influence when we sleep and
wake up.In the largest of these samples, about a third of surveyed subjects
self-identified as morning larks, 9% were night owls and the rest were in the
middle. Overall, the average sleep mid-point was 3 a.m., meaning they went to
bed at 11 p.m. and got up at 6 a.m.With this information in hand, the
researchers turned to a different sample which included genetic information
along with anonymized medical and prescription records and surveys about
diagnoses of major depressive disorder.Using novel statistical techniques, they
asked: Do those with genetic variants which predispose them to be early risers
also have lower risk of depression?The answer is a firm yes.Each one-hour
earlier sleep midpoint (halfway between bedtime and wake time) corresponded with
a 23% lower risk of major depressive disorder.This suggests that if someone who
normally goes to bed at 1 a.m. goes to bed at midnight instead and sleeps the
same duration, they could cut their risk by 23%; if they go to bed at 11 p.m.,
they could cut it by about 40%.It's unclear from the study whether those who are
already early risers could benefit from getting up even earlier. But for those
in the intermediate range or evening range, shifting to an earlier bedtime would
likely be helpful.What could explain this effect?Some research suggests that
getting greater light exposure during the day, which early-risers tend to get,
results in a cascade of hormonal impacts that can influence mood.Others note
that having a biological clock, or circadian rhythm, that trends differently
than most peoples' can in itself be depressing."We live in a society that is
designed for morning people, and evening people often feel as if they are in a
constant state of misalignment with that societal clock," said Daghlas.He
stresses that a large randomized clinical trial is necessary to determine
definitively whether going to bed early can reduce depression. "But this study
definitely shifts the weight of evidence toward supporting a causal effect of
sleep timing on depression."For those wanting to shift themselves to an earlier
sleep schedule, Vetter offers this advice:"Keep your days bright and your nights
dark," she says. "Have your morning coffee on the porch. Walk or ride your bike
to work if you can, and dim those electronics in the evening."Story
Source:Materials provided by University of Colorado at Boulder. Original written
by Lisa Marshall. Note: Content may be edited for style and length. Eating a
diet rich in fruit and vegetables is associated with less stress, according to
new research from Edith Cowan University (ECU).The study examined the link
between fruit and vegetable intake and stress levels of more than 8,600
Australians aged between 25 and 91 participating in the Australian Diabetes,
Obesity and Lifestyle (AusDiab) Study from Baker Heart and Diabetes
Institute.The findings revealed people who ate at least 470 grams of fruit and
vegetables daily had 10 per cent lower stress levels than those who consumed
less than 230 grams. The World Health Organization (WHO) recommends eating at
least 400 grams of fruit and vegetables per day.Lead researcher, PhD candidate
Simone Radavelli-Bagatini from ECU's Institute for Nutrition Research, said the
study strengthens the link between diets rich in fruit and vegetables and mental
wellbeing."We found that people who have higher fruit and veggie intakes are
less stressed than those with lower intakes, which suggests diet plays a key
role in mental wellbeing," said Ms Radavelli-Bagatini.A growing issueMental
health conditions are an increasing problem in Australia and around the world.
Around one in two Australians will experience a mental health issue in their
lifetime. Globally, approximately 1 in 10 people live with a mental health
disorder.According to Ms Radavelli-Bagatini, some stress is considered normal,
but long-term exposure can significantly impact mental health."Long-term and
unmanaged stress can lead to a range of health problems including heart disease,
diabetes, depression and anxiety so we need to find ways to prevent and possibly
alleviate mental health problems in the future," said Ms Radavelli-Bagatini.The
benefits of a healthy diet are well known, but only 1 in 2 Australians eat the
recommended two serves of fruit per day and fewer than 1 in 10 eat the
recommended five serves of vegetables each day."Previous studies have shown the
link between fruit and vegetable consumption and stress in younger adults, but
this is the first time we're seeing similar results across adults of all ages,"
said Ms Radavelli-Bagatini."The study's findings emphasise that it's important
for people to have a diet rich in fruit and vegetables to potentially minimise
stress."Food and moodWhile the mechanisms behind how fruit and vegetable
consumption influences stress are still unclear, Ms Radavelli-Bagatini said key
nutrients could be a factor."Vegetables and fruits contain important nutrients
such as vitamins, minerals, flavonoids and carotenoids that can reduce
inflammation and oxidative stress, and therefore improve mental wellbeing," she
said."Inflammation and oxidative stress in the body are recognised factors that
can lead to increased stress, anxiety and lower mood.""These findings encourage
more research into diet and specifically what fruits and vegetables provide the
most benefits for mental health."The research is part of ECU's recently launched
Institute for Nutrition Research, which aims to investigate how nutrition can
help prevent and treat chronic health conditions.'Fruit and vegetable intake is
inversely associated with perceived stress across the adult lifespan' was
published in Clinical Nutrition.Story Source:Materials provided by Edith Cowan
University. Note: Content may be edited for style and length. Thank you for
reading and as always I love hearing your feedback in regards to these research
articles. Thanks again for your journals, messages, and other things you’ve
shared. I look forward to talking to you again soon within the next week I hope.
NEW RESEARCH: Imagery rehearsal therapy (IRT) is a cognitive-behavioral
treatment for reducing the number and intensity of nightmares, such as those
experienced by people with posttraumatic stress disorder (PTSD).1 Nightmares or
terrifying dreams are among the most common PTSD symptoms. IRT focuses directly
on helping to make nightmares less intense for people with PTSD.If you've ever
had a nightmare, you probably woke up just at the moment when it felt most
frightening. That's because, as you probably know, the intensity of a nightmare
usually builds until the sleeper is too terrified to continue--and wakes up.In
IRT treatment, you're helped to reimagine your nightmares with different, less
frightening outcomes.1 The goal is to "reprogram" your nightmares to be less
terrifying if and when they occur again.How Imagery Rehearsal Therapy WorksIn
IRT, your therapist first provides you with background information on sleep and
nightmares to "set the scene" for learning to manage them. Then, working with
your therapist, you:2Create detailed, nonfrightening endings for nightmares
you've had repeatedlyWrite down and rehearse the nightmares with the new
endingsLearn how to monitor your nightmares so you know how well your IRT
treatment is workingOften a person with PTSD has already thought about whether
it might help to reimagine and "defuse" nightmares so they're less frightening.
That can help make starting IRT feel more comfortable and hopeful, but it isn't
necessary for the technique to be successful. PTSD: Coping, Support, and Living
WellCould This Therapy Be Upsetting?Your therapist will likely ask you to begin
your IRT with one or more of your less-frightening nightmares. Why? To build
your confidence and help keep you from being frightened by the nightmares again
as you bring them into your waking hours.The goal is not to trigger emotional
responses. Instead, it's to help you view your nightmares with as little emotion
as possible.1 Typically, the therapist will start the rehearsal process by
saying something to help you stay calm, such as, "Now, we'll rehearse the
dream--not the nightmare." Think of it as a "crawl before you walk" approach.
PTSD Triggers and Coping StrategiesHow Long Does It Last?It's important to be
aware that IRT is not an open-ended therapy. It lasts for a specific length of
time because it's focused only on nightmares, which are just one symptom of
PTSD. If you are having a number of PTSD symptoms, consider looking into more
broad-based treatments, such as exposure therapy.3 What Is Exposure Therapy for
PTSD?Is This Approach Right for You?You can work with IRT alone with your
therapist or as part of group therapy.Although the usual goal of IRT is
achieving less frightening endings to nightmares, different people with PTSD may
have different ideas about what they want from it. For example, you may want to
change an entire nightmare, or a large portion of it, while someone else wants
to reimagine only a few small details. A therapist will work with you to choose
the IRT approach that best fits your needs.The 55 themes identified with dreams
are: (not necessarily related to troubling dreams that would be tackled in IRT
therapy).school, teachers, and studyingbeing chased or pursuedsexual
experiencesfallingarriving too latea living person being deada person now dead
being aliveflying or soaring through the airfailing an examinationbeing on the
verge of fallingbeing frozen with frightbeing physically attackedbeing
nudeeating delicious foodswimmingbeing locked upinsects or spidersbeing
killedlosing teethbeing tied up, restrained, or unable to movebeing
inappropriately dressedbeing a child againtrying to complete a task
successfullybeing unable to find toilet, or embarrassment about losing
onediscovering a new room at homehaving superior knowledge or mental
abilitylosing control of a vehiclefirewild, violent beastsseeing a face very
close to yousnakeshaving magical powersvividly sensing, but not necessarily
seeing or hearing, a presence in the roomfinding moneyfloods or tidal
waveskilling someoneseeing yourself as deadbeing half-awake and paralyzed in
bedpeople behaving in a menacing wayseeing yourself in a mirrorbeing a member of
the opposite sexbeing smothered, unable to breatheencountering God in some
formseeing a flying object crashearthquakesseeing an angelpart animal, part
human creaturestornadoes or strong windsbeing at the movieseeing
extra-terrestrialstraveling to another planetbeing an animalseeing a UFOsomeone
having an abortionbeing an objectSome dream themes appear to change over
time.For example, from 1956 to 2000, there was an increase in the
percentageTrusted Source of people who reported flying in dreams. This could
reflect the increase in air travel.What do they mean?Relationships: Some have
hypothesized that one cluster of typical dreams, including being an object in
danger, falling, or being chased, is related to interpersonal conflicts.Sexual
concepts: Another cluster that includes flying, sexual experiences, finding
money, and eating delicious food is associated with libidinal and sexual
motivations.Fear of embarrassment: A third group, containing dreams that involve
being nude, failing an examination, arriving too late, losing teeth, and being
inappropriately dressed, is associated with social concerns and a fear of
embarrassment.Brain activity and dream typesIn neuroimaging studies of brain
activity during REM sleep, scientists found that the distribution of brain
activity might also be linked to specific dream features.Several bizarre
features of normal dreams have similaritiesTrusted Source with well-known
neuropsychological syndromes that occur after brain damage, such as delusional
misidentifications for faces and places.Dreams and the sensesDreams were
evaluated in people experiencing different types of headache. Results showed
people with migraine had increased frequency of dreams involving taste and
smell.This may suggest that the role of some cerebral structures, such as
amygdala and hypothalamus, are involved in migraine mechanisms as well as in the
biology of sleep and dreaming.



Dopamine is a chemical messenger in your brain. It’s essential for motivation,
movement, memory, mood, sleep, and behavior regulation. Dopamine is also at the
center of how the brain’s reward system works. Dopamine rewards you whenever you
engage in a beneficial behavior and motivates you to repeat the behavior.Every
time we do something enjoyable, like eating a nice meal, having sex, or going
for a run, a little bit of dopamine is released in our brain. However, engaging
in vices like alcohol or recreational drugs also causes dopamine to be released
into the brain. This is why the chemical messenger has been closely linked to
addiction. Low dopamine levels have been linked to several medical conditions
like depression, addiction, schizophrenia, and Parkinson’s disease. Low dopamine
levels can make you feel less motivated, apathetic, listless and affect your
ability to concentrate.Some symptoms of low dopamine levels include: Low libido
Muscle stiffness Insomnia Lack of motivation Fatigue
InattentionApathyListlessness What Is the Chemistry Behind Depression?How
Dopamine Works Most of the dopamine produced by your body is made in the
midbrain after which it is distributed to different areas in your brain. Despite
decades of research, scientists are still baffled by the exact mechanism of
dopamine in the brain.There are four major pathways for dopamine in your brain.
Each one controls a different process in your body. Three of these pathways are
your rewards pathways and their function is to release dopamine into your brain
when you engage in a rewarding activity.1What Causes Low Dopamine Levels? Many
things could cause low dopamine levels. Some of them include: Medical
conditions: Some medical conditions have been linked to low dopamine levels.
Conditions like schizophrenia, Parkinson’s diseases, depression, substance
abuse, and bipolar disorder are common culprits of low dopamine levels. Poor
diet: Eating a diet that doesn’t contain adequate nutrients for optimal brain
health could cause low dopamine levels—especially a diet that’s lacking in
tyrosine. Substance abuse: Abuse of alcohol and recreational drug use can, in
the long term, cause your body to reduce its natural production of dopamine.
This, in turn, causes you to rely on the substance you are abusing. Certain
medication: Some medications like antidepressants and antipsychotic drugs work
by binding to dopamine receptors. This blocks the natural activity of dopamine
in your brain. How to Increase Your Dopamine Levels Naturally Treating dopamine
loss aims to cause the production of more dopamine, slow down the breakdown of
dopamine that is being produced, create more dopamine receptors, and repair
existing dopamine receptors so that they can work better.There are several
supplements and medications available for people who have low dopamine levels.
Medication is often used in cases where your depleted dopamine levels is caused
by a condition such as depression or schizophrenia. However, there are some
techniques you could also use to increase your dopamine levels naturally.2Get
Enough SleepGetting an adequate amount of sleep every night is necessary for
maintaining our health. The Center for Disease Control and Prevention (CDC)
recommends that adults get an average of seven or more hours of sleep every
night.3When you don’t get enough sleep, dopamine receptors in your body can be
adversely affected. Research has linked sleep deprivation to the suppression of
some dopamine receptors in your body.4Listen to Some MusicMake a playlist of
some of your favorite music and listen to it when you are feeling listless,
unmotivated, or experiencing other symptoms that indicate your dopamine levels
are low.In a 2011 study, researchers found that when you listen to music you
find pleasurable it can lead to a release of dopamine in your brain.5Maintain a
Healthy DietEating a healthy diet has several benefits for both your body and
mind and increasing your dopamine levels is part of this. Foods that are rich in
tyrosine like almonds, egg fish, and chicken are especially good for boosting
dopamine levels.Tyrosine is an amino acid that is naturally produced by the
body. Dopamine is made from this amino acid and can be found in protein-rich
foods. Foods that contain natural probiotics such as yogurt and kefir may also
increase dopamine production.Drinks like coffee also boost your dopamine, but
keep in mind that as your dopamine levels drop after drinking it, this could
cause a caffeine addiction. Exercise MoreExercising regularly has been proven to
be very important for your brain’s health. It can also help you boost your
dopamine levels. Whenever you exercise your brain releases some dopamine.6While
more research needs to be conducted into the exact mechanism that leads the
brain to produce dopamine when we exercise, you are probably familiar with the
feeling you get after a workout.Frequent runners also report experiencing
something called a runner’s high. This is described as a feeling of relaxation
and elation and is a result of the release of dopamine by the brain.
MeditateMeditating has a positive effect on a host of mental health conditions.
Research also shows that meditation has the ability to increase your dopamine
levels.7Cut Down on Processed SugarsConsuming processed sugars like candy and
soda have the ability to increase your dopamine levels, but this increase is
only temporary and artificial. Like with alcohol and recreational drugs, sugar
can give you temporary boosts of dopamine while affecting the rate at which your
body produces it naturally.When you consume a large amount of sugar in a short
time, you may notice that you feel a rush of elation. This is a sugar high. It
is typically very temporary and followed by a crash that leaves you feeling
down. Remove Stressors From Your LifeStress is a precursor to many medical
conditions, it also causes low dopamine levels. We aren’t always in control of
the things that bring stress into our lives, but you can eliminate stressors
that you have some control over.For instance, if a long commute to work is
causing stress, you might consider moving closer to work. You can also engage in
activities that reduce stress like meditating, exercising, or getting a massage.
There is still a fairly heated controversy in the field of psychology about
whether or not repressed memories can or should be recovered, as well as whether
or not they are accurate. The clearest divide appears to be between mental
health practitioners and researchers.In one study, clinicians had a much greater
tendency to believe that people repress memories that can be recovered in
therapy than the researchers did.1 The general public, too, has a belief in
repressed memory. Clearly, more research is needed in the area of memory. Trauma
Can Be ForgottenMost people remember the bad things that happen to them, but
sometimes extreme trauma is forgotten. Scientists are studying this, and we are
beginning to understand how this occurs.When this forgetting becomes extreme, a
dissociative disorder sometimes develops, such as dissociative amnesia,
dissociative fugue, depersonalization disorder, and dissociative identity
disorder.2 These disorders and their relationship to trauma are still being
studied. Childhood Trauma and DissociationHow Memory WorksMemory is not like a
tape recorder. The brain processes information and stores it in different ways.
Most of us have had some mildly traumatic experiences, and these experiences
sometimes seem to be burned into our brains with a high degree of
detail.Scientists are studying the relationship between two parts of the brain,
the amygdala and the hippocampus, to understand why this is. Here's what we know
at this time:Moderate trauma can enhance long-term memory.3 This is the
common-sense experience that most of us have, and it makes it difficult to
understand how the memory of horrible events can be forgotten.Extreme trauma can
disrupt long-term storage and leave memories stored as emotions or sensations
rather than as memories. Research suggests that it can take up to several days
to fully store an event in long-term memory.4Sensory triggers in the present
can cause forgotten material to surface. This is because the material is
associated with the trigger through a process known as "state-dependent memory,
learning, and behavior."5"False memories" of mildly traumatic events have been
created in the laboratory.6 It is unclear to what extent this occurs in other
settings.Studies have documented that people who live through extreme trauma
sometimes forget the trauma.7 The memory of the trauma can return later in
life, usually beginning in the form of sensations or emotions, sometimes
involving "flashbacks" during which the person feels like they are reliving the
memory. This material gradually becomes more integrated until it resembles other
memories.Debate Over Recovered MemoriesAre recovered memories necessarily true?
There is much debate surrounding this question. Some therapists who work with
trauma survivors believe that the memories are true because they are accompanied
by such extreme emotions.Other therapists have reported that some of their
patients have recovered memories that could not have been true (a memory of
being decapitated, for example). Some groups have claimed that therapists are
"implanting memories" or causing false memories in vulnerable patients by
suggesting that they are victims of abuse when no abuse occurred.Some therapists
do seem to have persuaded patients that their symptoms were due to abuse when
they did not know this to be true. This was never considered good therapeutic
practice, and most therapists are careful not to suggest a cause for a symptom
unless the patient reports the cause.There is some research suggesting that
false memories for mild trauma can be created in the laboratory. In one study,
suggestions were made that children had been lost in a shopping mall. Many of
the children later came to believe that this was a real memory.8 It is
important to note that it is not ethical to suggest memories of severe trauma in
a laboratory setting.If you have been feeling sad for a prolonged period of time
and you cannot shake it off – or perhaps you know someone in this situation –
you or your friend or relative might have considered asking your family doctor
for a prescription for antidepressants. It’s not an easy decision to make.
Antidepressants are arguably the most controversial drug treatment in medicine,
with print and social media coverage tending to be biased against them. If you
believed everything you read or heard, you could come away thinking these drugs
are: glorified placebos, highly effective, dangerously addictive, remarkably
well tolerated, wildly overprescribed for a range of social ills, or even
underprescribed, given the supposed ‘epidemic’ of depression in society.
Obviously, these contradictory statements cannot all be true.In this Guide, I’ve
attempted to give you a balanced account of the pros and cons of
antidepressants.Depression is more than everyday sadnessAntidepressants are for
the treatment of clinical depression and related problems, not the everyday
sadness we all feel from time to time, especially if we’ve been having a hard
time. Depression as a psychiatric diagnosis, or what is sometimes called
‘clinical depression’ or ‘major depression’, is defined as being sad most or all
of the time and being in this state for at least two weeks. Also, to count as
depression, a number of other symptoms besides sadness need to be present (see
the acronym below, adapted from this mnemonic), and the patient has to find
their symptoms distressing and/or disabling.DEPRESSION, an acronym:Depressed
mood – most or all of the time, for at least two weeksEnergy – lackingPleasure –
no more in previously pleasurable activities (‘anhedonia’)Reduced movement
(‘retardation’ – or can be increased, in ‘agitation’)Eating disturbance – loss
of appetite (or overeating, or comfort eating)Sleep disturbance – insomnia (or
occasionally too much sleep)Suicidal thoughtsIndecision – or reduced
concentrationOut of confidenceNegative thoughts – about the self, the world, the
futureThere are two different definitions of depression – one used by the
American Psychiatric Association as laid out in its diagnostic manual (the
latest version being the DSM-5) and the other devised by the World Health
Organization for the rest of the world (the latest version, ICD-11, came into
effect in January 2022). The two approaches have in common that five or more of
10 depression-related symptoms must be present most of the day for at least two
weeks to diagnose major depression. Hopelessness about the future is a listed
symptom in the ICD-11, but not the DSM-5.It is a pain that the DSM-5 and ICD-11
definitions of depression differ, but this reminds us that these definitions are
guides or indexes – they are not the final word on whether depression should be
diagnosed, much less whether it is what you are experiencing.One advantage of
formal diagnostic criteria is that they allow for estimates about the prevalence
of different conditions, with the latest figures suggesting 5 per cent of adults
worldwide have a diagnosable depressive illness at any point in time.As you may
already know or have experienced first-hand, anxiety is a very common
accompaniment to depression – indeed, around 50 per cent of people with one
diagnosis will have significant levels of the other. Complicating matters is the
fact that depression can cause secondary anxiety, or vice-versa, and that the
symptoms of the two diagnoses overlap.Antidepressants work, so why are they
controversial?Antidepressants were first discovered as possibly helpful for
depression in 1951 and introduced into medical practice in 1957. Since then,
they have been shown to work, again and again, in randomised, double-blind,
placebo-controlled clinical trials. Despite what some commentators say, overall
the evidence that they work for many people is very strong.Over the years,
antidepressants have also been found in clinical trials to be useful treatments
for anxiety, pain and other problems. That is why drugs such as imipramine are
categorised as antidepressants but used for the treatment of other conditions as
well.All currently licensed antidepressants increase the levels of some of the
chemical neurotransmitters – especially serotonin and/or norepinephrine – by
which nerve cells in the brain communicate with each other across a gap known as
a synapse. At the psychological level, soon after taking antidepressants, people
who are depressed will typically begin to process information more positively,
such as finding it easier to recall happy memories. At a slower, molecular
level, antidepressants seem to stimulate synaptic plasticity and nerve cell
growth, thus helping reverse the harmful effects of stress on these processes.
Note that these pharmacological, psychological and molecular changes may all
work hand in hand to promote recovery from depression.Given their effectiveness,
why are antidepressants so controversial? There is a lot of stigma attached to
mental illness and this undoubtedly influences many people’s attitudes to
antidepressants. Particularly relevant is the widely held, ill-informed belief
that depression is ‘just some sort of sadness’, that it is ‘mental’ rather than
physical and therefore not a ‘real’ medical condition that requires treatment.
At the other extreme is the view that depression is ‘hopeless’ and either
untreatable or requiring of lifelong treatment. Any which way, people who take
antidepressants are regularly ‘pill-shamed’ on social media. Partly as a result,
people often seem reluctant to mention taking them and how they have contributed
to their recovery. Yet, for many people, the drugs are beneficial and in some
cases literally a life-saver.This Guide is not a substitute for first-hand
professional medical advice but, if you are considering whether to begin taking
antidepressants, it will help you to make a careful, informed decision.What to
doIf you are depressed or anxious, and are considering getting some help or
treatment including starting antidepressants, a sensible way to proceed is to
ask yourself a series of questions about your experiences and circumstances. To
help you, here are some important questions to ask yourself, either alone or
with a friend, a relative or a doctor, and some factors to consider in each
case:Do I need or want any treatment at all?Most cases of depression and anxiety
are mild, and most will resolve with time – as people say, time is a great
healer. The diagnostic manual of US psychiatry, the DSM-5, states that recovery
from major depression begins within three months for 40 per cent of people and
within a year for 80 per cent of people.If there is a particular trigger for
your chronic feelings of sadness, such as a stressful life event, you might be
better off focusing your efforts on getting relevant practical help, such as
extra educational, financial or housing support. Similarly, relationship
problems might be best addressed by some form of couples therapy. One tell-tale
sign that your main problem is stressful circumstances and not depression per se
is to think about whether you are preoccupied by the stressful situation rather
than with any symptoms related to depression or anxiety.Having said that, when
the stress of life circumstances feels overwhelming, antidepressants can still
offer valuable help by providing you with much-needed relief from
depression-related symptoms such as insomnia and fatigue. This is particularly
true if you have a history of depression that needed antidepressants before, or
if the symptoms persist.Would I be better off with a talking therapy?Mild to
moderate depression and anxiety are often best treated with cognitive
behavioural therapy (CBT) or some other evidence-based, structured
psychotherapy, such as interpersonal therapy (IPT). CBT tends to focus on ways
to address patterns of negative thinking, whereas IPT focuses more on
difficulties you might be having with other people. Indeed, in England in 2021,
the National Institute for Health and Care Excellence, which provides
independent, evidence-based guidance to the government, issued a renewed draft
guideline for treating depression in adults, which stressed that talking-based
treatments should be the first choice for addressing mild to moderate
depression.The problem is finding a trained therapist with the time to treat
you. In Edinburgh in Scotland where I work, and where services are relatively
good by international standards, there are only a small number of clinical
psychologists, nurses or other health professionals who are trained to provide
CBT or IPT. Clearly, they could not treat all the estimated 50,000 people with
depression/anxiety each year (of a population of roughly 500,000) who might
benefit. In fact, each typically treats 10-20 people a week for about 3-6 months
– ie, a maximum of about 100 people a year.Wherever you live in the world, the
chances are high that, if you are seeking psychotherapy for mild to moderate
depression, you will likely have to find private psychotherapy, if you can
afford it. In my experience, most private therapists provide counselling, or
what might best be called generic or supportive psychotherapy, often with a
psychodynamic orientation. This can still help, especially in those who cannot
engage with CBT, but arguably most of the benefit comes from non-specific
factors such as ‘a problem shared is a problem halved’, general support, and the
inculcation of hope. In my experience, they are less likely to offer structured
psychotherapies, such as CBT and IPT, which have been shown in multiple clinical
trials to have benefits over these non-specific therapeutic factors, as have
antidepressants.There is some evidence that CBT or IPT may provide some greater
longer-term benefits than antidepressants. This isn’t surprising if one
considers that these approaches give people ways of dealing with depression or
anxiety that they can invoke again if they need to. However, it is important not
to overstate the reach and benefits of psychotherapy. For instance, my patients
with severe depression often find that the effects of psychotherapy tend to fade
over time and that they require top-up or ‘booster’ sessions or perhaps a whole
new course of therapy.This ongoing desire for therapy flies in the face of the
common (mis)perception that psychotherapy somehow gets to the ‘root of the
problem’ of depression in a way that drug treatments cannot. Perhaps this same
sentiment feeds the harmful myth that taking antidepressants is ‘the wimp’s way
out’ because the person is not facing up to their problems. It’s true that there
can be historical roots to many people’s depression, such as childhood sexual or
physical abuse, but psychotherapy usually helps rather than ‘cures’ these
issues. Psychotherapy can be helpful for those with moderate to severe
depression, but that may depend on a high level of therapist experience and
expertise.You should also bear in mind that 30-40 per cent of people do not
benefit from psychotherapy, which is about the same as the proportion of
patients for whom antidepressants do not help (but, fortunately, most people
respond to one or the other or both). And, as with any intervention, talking
treatments can do harm as well as good. This is a neglected area of
psychotherapy research but, for some perspective, consider data from a recent
study of hundreds of people who received therapy for depression or anxiety via
the NHS in England, which found that just over 14 per cent of clients reported
that they had been made worse in the long term. The risk of harm has long been
recognised in the psychodynamic community. Simply put, there are some
unfortunate people who have been too damaged by traumatic upbringings to be able
to tolerate, let alone benefit from, talking about it. A previous Psyche Guide
takes you through the different therapists available and what to discuss in your
first session to maximise the chances of a positive outcome.So, when should I
take an antidepressant?If your depression or anxiety is mild to moderate, and if
time and a talking treatment have not helped, and especially if things are
getting worse, then you should consider taking an antidepressant. Moreover, if
your depression or anxiety is moderate to severe, you should consider taking an
antidepressant combined with CBT as your first form of treatment.This raises the
question: how do you know if you are moderately or severely depressed? You could
count your symptoms from the acronym in the Need to Know section above, though
this is best done by a trained clinician. Or you could fill in a free
questionnaire, such as this patient health questionnaire (while this too is
designed to be administered by professionals, you can still score it
yourself).In general, the more depressed you are, the more likely you are to
benefit from antidepressants. Other markers of a more severe depression include
a complete lack of pleasure, feeling emotionally numb or ‘cut off’, agitated, or
being markedly slower than usual in your thoughts and movements. I was taught
that if a person has the so-called biological or melancholic features of
depression – such as disturbances in sleep or appetite, and especially waking
early in the morning and feeling at your worst early in the day – then
antidepressants are more likely to help. This is a useful rule of thumb, but
caution is required because the research evidence for these associations is
sparse.Obviously, if you are too ill to be able to think clearly and comply with
the demands of psychotherapy, or would simply prefer an antidepressant, then
these are more reasons why you should take one.Yet another consideration is if
you need or want to get better quickly – for example, this might be the case if
a person is feeling suicidal, or if their depression is causing urgent
employment or relationship issues. Psychotherapy can sometimes work relatively
quickly but it tends to take months for a meaningful benefit, whereas
antidepressants usually lead to a significant beneficial response in weeks.Which
antidepressant should I take?This is a decision you need to make carefully with
your doctor. However, it might be helpful to go into these discussions with some
basic background information on the various options, provided below. Worth
remembering is that all the antidepressants that are currently licensed for
depression or anxiety have been shown in clinical trials to help more people get
better than an inert placebo pill.The drugs that current evidence suggests are
the most effective for depression are the older drugs, such as amitriptyline (a
so-called ‘tricyclic’ based on its chemical structure) and escitalopram and
paroxetine (known as ‘selective serotonin reuptake inhibitors’, or SSRIs, based
on their chemical effects in the brain); and newer drugs, such as mirtazapine
(known as an ‘atypical antidepressant’ because it works differently than most
others) and venlafaxine (a ‘serotonin-norepinephrine reuptake inhibitor’, or
SNRI, again based on its chemical effects in the brain). Other SSRIs, such
fluoxetine and sertraline, are slightly less effective, but also tend to cause
fewer side-effects.For anxiety, duloxetine and venlafaxine (both SNRIs) and
escitalopram (an SSRI) are all similarly efficacious, and most people take them
without problems. Other options, including mirtazapine, sertraline and
fluoxetine, cause few problems and are also effective, although these findings
are limited by smaller sample sizes. The sedative antipsychotic drug quetiapine
can also be helpful for anxiety and depression, but weight gain can be a
problem.What adverse effects should I expect?You’ll have noticed I already
referred to side-effects or problems a few times. There are many potential
side-effects of antidepressants, but most are rare. Some, however, are classed
as ‘very common’ (affecting more than 10 per cent of people who take them) or
‘common’ (impacting 1-10 per cent of people). Because of this, people prescribed
antidepressants should receive regular medical review, especially in the early
stages of treatment, to check that they are not feeling worse on the drugs.For
the SSRIs, these common side-effects include reduced appetite, nausea, ‘tummy
upset’ and sexual dysfunction that many, but not most, of the patients I have
treated over 30 years told me they have suffered from. My experience is that
most people find these problems are usually mild and tend to fade away after the
first couple of weeks. SSRIs can also make you feel agitated or ‘wired’ when
first consumed, which is why they are usually best taken in the morning with
food.I have found that forewarning patients of these common adverse effects and
how to deal with them helps my patients to tolerate the drugs – and perhaps even
increases their effectiveness! I suspect, but do not know, that people think I
am a better doctor if I tell them what will happen in the first couple of weeks
and then it does. If I also tell them, as I typically do, that they are likely
to feel better in 2-4 weeks, then perhaps that is also more likely to occur. One
could think of this as part of the placebo response, but I think it is one of
the non-specific elements of treatment that is part of being a good doctor or
therapist, which includes sharing problems and inculcating hope. I also tell my
patients with depression and/or anxiety that they will get better, that it is
just a matter of time and finding the right treatment – and, thankfully, nearly
all of them do recover.The side-effects profile is quite different for so-called
‘sedative antidepressants’, such as mirtazapine and duloxetine, amitriptyline
and clomipramine, which can cause sleepiness. Sedation can actually be a good
thing if you are struggling to sleep; if, however, you are left feeling
‘hungover’ the following day, the dose can usually be split into 6pm and 10pm
doses to be tolerable, which is an option worth discussing with your doctor.
Less easy to deal with is that these sedative antidepressant drugs also tend to
increase your desire for ‘fizzy pop’, biscuits, cakes and sweets. However, this
is usually manageable if you drink water and eat fruit instead, dull as that may
sound.Will antidepressants interfere with therapy?Far from it – there is strong
evidence from clinical trials that both drug and talking treatments work better
when they are combined than either does alone. Although that evidence is for CBT
and IPT in particular, I suspect that the general principle holds for all
combinations of pharmacological therapy and psychotherapy.When you think about
it, this is not that surprising – even to be expected. Psychotherapy presumably
works by changing the way we think about things – what is sometimes called a
‘top-down’ approach. Drugs, on the other hand, impact first on neurobiology in a
‘bottom-up’ fashion. Indeed, as the British neuroscientist Camilla Nord
described in a Psyche Idea, her research into brain activation before and after
treatment with antidepressant medication or psychotherapy uncovered striking
results – there was no overlap between the brain changes, suggesting that the
two approaches work differently, yet complementarily.As far as I am aware, there
is no evidence that antidepressants will impair your ability to deal with any
psychosocial issues that might have contributed to or been caused by your
depression or anxiety. There used to be a theoretical concern that they might
interfere with the natural healing process after bereavement, but that does not
seem to be the case – and that accords with my clinical experience, too.Rather,
I am all too aware that people are often so overwhelmed by stress, or so
exhausted by insomnia, or in such a rut with depression, that taking an
antidepressant actually helps them have the energy and motivation required to
comply with psychotherapeutic demands.What should I do if I don’t respond to my
antidepressant medication?Upon beginning treatment for depression or anxiety
with an antidepressant, you might experience immediate symptomatic relief, and
after a couple of weeks, it is usual to feel a little better. However, getting
the full benefits typically takes two to three months for depression and can
take even longer for anxiety. So, if at first you don’t respond, it is often
worth waiting longer (so long as the side-effects are tolerable).If you still
don’t find any benefit, the next best and easiest thing is to try a higher dose
of the same drug you’re taking already, which is something to discuss with your
doctor. To give you some context, a family doctor will often start a patient on
20mg of fluoxetine or 50mg of sertraline, which can and often does work but, for
the patients I see in a psychiatry clinic who have moderate to severe problems,
a higher dose is usually required.If a higher dose of the same drug does not
work, or seems unlikely to, your doctor might propose trying another
antidepressant of a different type. Based on my personal experience and some
limited data, I’d say around 10 per cent of patients find they need to try a
third or even fourth antidepressant before they find the one that suits them.
This is also a good time to add in a structured psychotherapy, such as CBT or
IPT, if you haven’t already.Most people will respond to these manoeuvres. If you
are still showing no signs of recovery, all the mental health professionals
you’ve been consulting should review the situation and reconsider your
diagnosis. Perhaps there is an ongoing stressor or unaddressed psychosocial
issue that is still problematic. One issue to consider is that ‘self-medicating’
with alcohol or illicit drugs can prolong depression and interfere with the
potential benefits of antidepressants.How and when should I stop taking
antidepressants?Nobody likes taking pills or wants to do so for any longer than
necessary. But, if you respond to an antidepressant, there is a lot of evidence
that staying on them for a year or more will significantly reduce the chances of
relapsing and becoming unwell again.In a systematic review of 31 randomised
controlled trials involving 4,410 participants, 41 per cent of people taking a
placebo became depressed again, on average, compared with 18 per cent of people
taking an antidepressant. In other words, staying on antidepressants more than
halves the risk of relapse.However, most people want to stop their
antidepressant pills as soon as possible after getting well. They feel better
and believe it should be safe to stop the pills – but that is often not the
case, especially with moderate to severe depression because of the major risk of
relapse.Some of my patients opt to stay on antidepressants for years rather than
risk becoming depressed again. As I tell them, there are no known adverse
physical effects of staying on antidepressants in the long term. And, as they
tell me, it provides assurance and reassurance that they will remain well. As
one patient of mine put it:I never want to feel as disgusting as depression
makes me feel. Never again. So I’ll keep taking the pills.When the time does
come that you and your doctor are agreed that it is safe to stop taking the
pills, be prepared that you might experience an ‘antidepressant withdrawal
syndrome’. Do not be alarmed – this is not the same as ‘dependence’ or
‘addiction’ and is not unique to antidepressants. There are several drugs for
‘physical’ illnesses, such as the beta-blocker propranolol and the steroid
prednisolone that also need to be withdrawn slowly, but no-one ever says
patients are addicted to them. Usually, any withdrawal effects from
antidepressants are mild and last only a few days. If they persist, it can be
difficult to distinguish them from symptoms of a relapse of depression or
anxiety.You should review your experiences with your doctor, but my clinical
rule of thumb is that if you start to feel as you did before treatment in terms
of your mood and other symptoms, that is probably because you’ve stopped taking
an effective drug treatment; on the other hand, if you feel differently than you
did before, and in particular have symptoms commonly associated with drug
withdrawal rather than anxiety or depression (such as ‘electric shock’
sensations, flu-like symptoms or sweating) then you are probably experiencing a
withdrawal reaction that will soon pass.If you have been on an antidepressant
for months or years, then your doctor will advise that you need to reduce the
dose slowly. How you do that should be discussed with your doctor, but halving
the dose every couple of months and then reviewing things to check it’s OK to
halve again usually works well in my experience. This is particularly true if
you are on paroxetine or venlafaxine, which are more likely to cause withdrawal
reactions than the other antidepressants. I also advise my patients to phase out
antidepressants at a relatively good, stress-free time in their lives, perhaps
at a time of year such as the spring or summer, when everyone tends to feel a
bit brighter.How should I deal with antidepressant stigma and pill-shaming?Many
ill-informed people seem to think that antidepressant use stems from emotional
weakness, or an inability to deal with problems, and that people with depression
should somehow ‘snap out of it’. Such mistaken ideas sometimes co-occur with a
lack of belief in the therapeutic efficacy of antidepressants, despite
overwhelming evidence to the contrary.Although it is increasingly well
recognised that people on antidepressants may face judgmental remarks from
friends, family and colleagues, I am not aware of any good guides on how to deal
with this. My advice would be to explain calmly that your depression is
distressing and disabling, that the drugs do work, the side-effects can be
managed, and that you won’t be taking the pills forever because you will phase
them out once you are well again.To my mind, the stigma of antidepressants is
closely related to the broader stigma of depression and of all mental illness.
The more people can be open about their illness and how they benefited from drug
treatment, the less stigmatised depression and antidepressants will be. People
who have written and spoken openly about their use of antidepressants include
the eminent biologist Lewis Wolpert in Malignant Sadness (1999); the writer
Andrew Solomon in The Noonday Demon (2001) and, more recently, the science
writer Alex Riley in A Cure for Darkness (2021). Celebrities who have spoken
about their positive experiences of antidepressants include the Canadian actress
Annie Murphy and the US singer and actress Selena Gomez.Besides therapy and
pills, what else can I do to help?I’m sure there are many things you have tried
already. Comments such as ‘Just pull yer socks up’ and ‘Try a bit harder’ are
part of the harmful, stereotypical blaming that occurs too often in the context
of depression and anxiety. If you could somehow make yourself better, you would
have! Indeed, most folks I’ve treated have tried to try harder, but have come up
against the limitations of their condition. Usually, what you need to do, as
difficult as it can be, is to disengage from your depression or anxiety,
distract yourself from thinking about it too much, and do other things.As I tell
all my patients, there are ‘good common sense’ changes that just about everyone
can adopt to promote recovery. We humans are creatures of habit and social
animals, and among the daily routines that can help are: getting up at a regular
time, getting out of the house for some exercise, even if just once around the
block, and meeting up with someone for a chat.More formal evidence-based
approaches for depression include physical activity and mental exercises, such
as meditation; and, for anxiety, there are various relaxation and other worry
management approaches. Mindfulness meditation may have a particular role to play
in reducing people’s chances of becoming depressed again. Physical exercise has
a moderate treatment effect and a small preventative effect for depression. Yoga
and tai chi are also worth considering, but I suspect that any form of exercise
is the key rather than any particular approach.NEED TO KNOWWHAT TO DOKEY
POINTSLEARN MORELINKS & BOOKSKey points – How to decide whether to take
antidepressantsDepression is more than everyday sadness. If you’ve been feeling
down most of the time for more than two weeks, you might be
depressed.Antidepressants are controversial but they work. Despite what you
might have heard, the research evidence for the effectiveness of antidepressants
is very strong.Decide whether you need any treatment at all. If you’re dealing
with a lot of stress, it’s worth considering whether your priority should be to
seek practical support.Consider talking therapy first if your depression is mild
to moderate. The challenge is finding an available, suitable therapist who is
trained in CBT or a similar approach.Try antidepressants if therapy didn’t help
or your depression is moderate to severe. The more serious your depression
(online questionnaires can help you assess this), the more likely that
antidepressants will help.Familiarise yourself with the antidepressants that are
available. The options available vary in their reported effectiveness and
likelihood of provoking side-effects.Understand the possible side-effects. Most
side-effects are rare. Common ones, such as nausea, are usually mild and soon
pass.Antidepressants do not interfere with therapy. Far from it – there’s
evidence that therapy and pills both work more effectively in combination.Don’t
expect an instant benefit. The full beneficial effects usually take a few weeks
or months to manifest.Don’t rush to stop taking the pills. Relapse is a risk, as
are withdrawal symptoms. If you’ve been on the drugs for months or years, reduce
your dose slowly.Prepare to deal with pill shaming. Explain calmly that your
depression is distressing and disabling, and that the drugs do help.Use
lifestyle changes to further aid your recovery. I’m sure there are many things
you have tried already, but remember that regular exercise and socialising are
good for mental health.Learn moreAdvice for specific demographic groupsThe
advice above applies to most people, but there are a few special considerations
for those of you who are young, pregnant, old or physically ill.Children and
young peopleAll doctors are rightly reluctant to prescribe any medicine, and
especially psychoactive drugs, to the young. For children who suffer from
depression, which does happen, albeit more rarely than in adolescents and
adults, there is some evidence that treatments involving the whole family are
more effective than individual therapy for the child. For depressed adolescents,
studies generally show that CBT and IPT are more effective than control
treatments such as generic, supportive psychotherapy. If antidepressants are
required, as they sometimes are, fluoxetine is the antidepressant with the
greatest evidence for effectiveness. Any treatment usually reduces suicidality,
but it’s important to be aware that, in a minority of young people (up to the
age of 25), SSRIs may increase their thoughts of suicide and their likelihood of
self-harming. If a youth is prescribed an antidepressant, it is vital that they
are monitored to ensure this is not happening and to take suitable action if it
is.Pregnancy and breastfeedingBecoming pregnant and giving birth are usually
happy events but are somewhat idealised in human societies. Medical
complications during pregnancy and childbirth are common but, even when they
don’t occur, many women become depressed or anxious during pregnancy and in the
months afterwards. No one wants to expose pregnant women and unborn children to
any drug, but sometimes it is necessary. About 10 per cent of women suffer from
postnatal depression in the weeks following birth that is severe enough to
potentially hinder bonding with the child or harm the child’s subsequent
development – and therefore merits treatment. The usual way of making a balanced
decision is that treatment is justified when the risks of doing so are fewer
than the risks (to mother and foetus) of not treating.There is some evidence
that taking SSRIs early in pregnancy very slightly increases the risk of your
baby developing heart defects, spina bifida or cleft lip. If you are in this
situation, be reassured that most antidepressants are safe for both mothers and
babies, especially after the first three months or so of pregnancy. Babies who
have been exposed to SSRIs in the womb can be a bit ‘jittery’ for a few days
after birth, but that doesn’t cause any long-term problems. Similarly,
breastfeeding is thought to be safe while on citalopram or sertraline, and is
known to be safe while on paroxetine or amitriptyline/clomipramine because too
little drug is present in breastmilk to be harmful.The elderly and infirmFamily
doctors have long been in the habit of prescribing low doses of the older
tricyclic antidepressants, especially amitriptyline, to help older people with
various problems such as musculoskeletal pain. Although the use of lower doses
of antidepressants in this way is not strongly supported by clinical trials,
they will help you sleep and might reduce your pain sensitivity. However, if you
are elderly or have a physical illness, you should be particularly careful about
taking antidepressants and especially tricyclics, such as amitriptyline, because
they can cause more adverse effects and/or interact with other medications you
might be taking. Other rare side-effects of antidepressants to discuss with your
doctor if you are elderly or physically frail include low blood pressure and
other cardiovascular effects, which might increase your risk of falls.A book
ideaIt can be very difficult for people who have not had severe depression to
appreciate just how awful it is. My favorite such memoir is the book Darkness
Visible: A Memoir of Madness (1989) by the Pulitzer Prize-winning US novelist
William Styron. For those who have felt this depressed, it can be comforting to
read about other people’s experiences and recovery from depression.







Hello there, I hope you are doing very well. I was just dropping a couple of
lines to let you know about a program that one of the companies I work with is
doing to help support access to behavioral health services. Basically, the
program gives a free month of therapy to anyone. It is through betterhelp.com
and through the sistersites of that company. All the person has to do is go to
betterhelp.com/voucher and enter the code of “sharethecare”. Some of the other
sites focused on more specific client populations are as follows:
regain.us/voucherpridecounseling.com/voucherfaithfulcounseling.com/voucherteencounseling.com/voucher
Also, please feel free to direct them to my site on the platform at:
betterhelp.com/jason-huber/If they'd like to request to use me as their
therapist, shortly after the survey is completed, then the process of matching
or requesting a therapist can begin. Thank you for your time and support of
those with behavioral health needs. There are many benefits of online therapy
including easier accessibility and affordability as well as convenience and
effectiveness.Respectfully and Professionally,Jason Huber, MS, LPC



J. HUBER, MS, LPC


BEHAVIORAL HEALTH COUNSELING, CONSULTING, COACHING, & TRAINING

580 591 1609

SOLUTION FOCUSED STRATEGIES FOR ACHIEVING HEALTHY OUCOMES FOR ORGANIZATIONS,
INDIVIDUALS, & COUPLES





HOW CAN I HELP YOU?

Specializing in trauma, depression, anxiety, anger, relationship issues, and
many more.


PSYCHOBLAST JOURNALS

PREVENTION ART GALLERY

SCRIPTS FOR HEALING & MEDITATION

THERAPEUTIC STORIES

EXPERIENCE

TESTIMONIALS

COUNSELING/THERAPY

COACHING

CONSULTING

TRAINING

New CLIENTS


THERE'S NO TIME BUT NOW...

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Request an Appointment




ABOUT


25 + YEARS OF EXPERIENCE



CRISIS/TRAUMA RESPONSE?

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porincididunt ut labore et dolore.


THERAPEUTIC NEEDS?

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porincididunt ut labore et dolore.


COACHING OR CONSULTING?

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ONLINE TRAINING OPTIONS?

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Reviews


CLIENT SATISFACTION

 * “GREAT PLACE FOR PHYSICAL THERAPY – THEY ARE A WONDERFUL GROUP OF
   HIGHLY-TRAINED PHYSICAL THERAPISTS THAT ELIMINATE PAIN AND GIVE YOU THE TOOLS
   YOU NEED TO REMAIN PAIN-FREE.”
   
   ERIK SCHNEIDER
   
   Physical Therapy Patient

 * “GREAT PLACE FOR PHYSICAL THERAPY – THEY ARE A WONDERFUL GROUP OF
   HIGHLY-TRAINED PHYSICAL THERAPISTS THAT ELIMINATE PAIN AND GIVE YOU THE TOOLS
   YOU NEED TO REMAIN PAIN-FREE.”
   
   ERIK SCHNEIDER
   
   Physical Therapy Patient

 * “GREAT PLACE FOR PHYSICAL THERAPY – THEY ARE A WONDERFUL GROUP OF
   HIGHLY-TRAINED PHYSICAL THERAPISTS THAT ELIMINATE PAIN AND GIVE YOU THE TOOLS
   YOU NEED TO REMAIN PAIN-FREE.”
   
   ERIK SCHNEIDER
   
   Physical Therapy Patient

 * 
 * 
 * 



CONTACT DETAILS

580 591 1609
Mon - Fri: 9:00 AM — 7:00 PMSat 10:00 AM — 5:00 PM

PO Box 1018, Fletcher, OK 73541

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