The Unseen Wounds of Dating Violence on Mental Health

Silent Scars

Dating violence is a pervasive issue that inflicts profound wounds on victims, both visible and hidden. The National Coalition Against Domestic Violence reports that 1 in 3 women and 1 in 4 men have experienced intimate partner physical violence such as slapping, injury and sexual abuse.[1] These issues can be difficult to notice from the outside of a relationship, allowing abuse to continue while mental scars shape victims' psychological and physical well-being. The connections between dating violence, abuse, and mental health shed light on the silent struggles endured by survivors.

The Spectrum of Abuse

Abuse in dating relationships takes on various forms - from physical violence to emotional manipulation, coercion, and even digital harassment. The dynamic that leads to violence in a relationship is a power imbalance when one person gains power and control over the other.[2] This may take the forms of threats, intimidation, financial abuse, stalking and isolation[3] and this multifaceted spectrum of dating violence can leave victims feeling trapped in a cycle of abuse. Dating violence shatters victims' sense of security, trust, and self-worth, planting the seeds for lasting mental health challenges. 

Examples of the warning signs of abusive behaviors include:[4]

• Using force or coercion to initiate sexual activity

• Attempting to isolate one from their family or friends

• Using threats

• Breaking objects, creating noise or yelling to establish intimidation 

• Having a history of abuse in past relationships 

• Expressing control financially (refusing for a partner to work)

• Expressing control over where a partner goes, what they wear, who they speak to...

• Frequent mood swings and shifts when in public compared to in private

• Constant jealousy 

Erosion of Emotional Well-being

The emotional toll inflicted by dating violence relates to poor mental health outcomes. Adolescent dating violence is particularly prevalent (i.e., 1 in 3 adolescents have experienced an abusive or unhealthy relationship) and is a predictor of partner violence as an adult.[5,6] Pérez-Marco et al. (2020) note that adolescents characterized dating violence as psychological, sexist, and verbal types of violence.[7] For example, blackmailing or damaging a partner’s dignity are examples of psychological violence.[8] Further, Piolanti et al. (2023) note that adolescent dating violence contributes to increased risk-taking behaviors such as marijuana and alcohol use, and negative mental health such as victimization, a common result of physical or emotional abuse.[9] These poor outcomes were more common among females when compared to males. Additionally, among 116 married women experiencing domestic abuse, Malik et al. (2021) found that abuse was associated positively with depression, anxiety and stress.[10] Domestic abuse was also related to a decreased quality of life.[11] The constant undercurrent of fear, anxiety, and uncertainty from degradation and physical attacks can erode victims' emotional well-being and even skew the perception of their relationship as being “normal” amidst high psychological distress.

Emotional abuse is related to:[12]

• Social anxiety

• Depression 

• Eating disorders

• Post Traumatic Stress Disorder (PTSD)

• Chronic pain

• Shame

• Self-doubt

• Low self-esteem

• Codependency 

Complex Trauma & Misconceptions of Dating Violence

Exposure to dating violence often inflicts complex trauma, or unique forms of psychological injury that can lead to enduring emotional and mental turmoil. The patterns of abuse – the relentless cycle of tension, explosion, and reconciliation – carve a pattern of fear in victims' minds. Complex trauma can manifest as post-traumatic stress disorder (PTSD), anxiety disorders and depression.[13] From an external perspective, relationship violence is commonly misunderstood as bystanders may question why a victim stays in their violent relationship if they are being abused. It is so easy to ask, “Why don’t they just leave?”[14] However, there is a deep manipulative aspect to dating violence that maintains a harmful cycle.

De Sousa et al. (2023) found that among participants ages 15-22 in relationships, control tactics were predominantly isolation, domination, and emotional manipulation.[15] These controlling dynamics establish heavy power imbalances that lead to both a bystander's and a victim's blindness to the harm of a relationship. For example, an abusive partner may conceal their violent tendencies when in public or around peers, but when in private with their partner, inflict abuse. The victim may even develop learned helplessness, in which they have repeatedly experienced violence and eventually stop resisting or trying to change the uncontrollable circumstance. Additionally, it is common for victims to find comfort in their abusive relationship, as they are manipulated to believe that they abuse because their partner “loves them,” as Shawn Guy writes for Genesis Women’s Shelter in an article about teen dating violence.[16] This occurrence is sometimes referred to as Stockholm syndrome, or the psychological response of a positive connection to an abuser.[17]

The Path to Recovery: Empowerment and Support

Victims of dating violence find it challenging to escape their abusers. Feelings of shame, guilt, and societal stigma can create barriers to seeking help. Additionally, financial dependence and isolation enforced by abusers can make it difficult for victims to end relationships.

Professional help through therapy can help survivors regain a sense of agency and control over their lives to minimize the long-term effects of abuse and trauma. For example, Karakurt et al. (2022) found that cognitive-behavioral therapy (CBT), mindfulness, motivational interviewing and expressive writing have led to successful results in increasing empowerment among women who had experienced intimate partner violence.[18] These modalities lowered stress and depressive symptoms, as well.[19]

Empowerment becomes a sign of hope as victims rebuild their self-worth as Pérez-Marco et al. found that empowerment skills were an effective resource to combat negative outcomes of abuse.[20] Treatment for perpetrators of domestic violence is less researched, but also integral to preventing relationship violence and subsequent mental health challenges. Taking into consideration social, societal and developmental contexts may be involved in methods to address high levels of violence exhibited by abusers as well as equitable access to treatment.[21,22]

Dating violence and abuse result in devastating impacts on victims' mental health, inflicting trauma that may never fully fade without proper intervention. By amplifying awareness, education, and access to mental health resources, society can stand against the silent scars left by dating violence and empower survivors on their journey toward recovery.

If one is experiencing any form of abuse or mental health challenges due to a relationship, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.

Contributed by: Phoebe Elliott

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 National Coalition Against Domestic Violence. National Statistics. https://ncadv.org/STATISTICS#:~:text=NATIONAL%20STATISTICS&text=On%20average%2C%20nearly%2020%20people,10%20million%20women%20and%20men.

2 Washington University in St. Louis. (2023). What is Relationship and Dating Violence? https://students.wustl.edu/relationship-dating-violence/

3 Ibid.

4 Ibid.

5 Liz Claiborne Inc and The Family Fund. Teen Dating Abuse 2009 Key Topline Findings. http://nomore.org/wp-content/uploads/2014/12/teen_dating_abuse_2009_key_topline_findings-1.pdf 

6 Piolanti, A., Waller, F., Schmid, I. E., & Foran, H. M. (2023). Long-term Adverse Outcomes Associated With Teen Dating Violence: A Systematic Review. Pediatrics, 151(6), e2022059654. https://doi.org/10.1542/peds.2022-059654 

7 Pérez-Marco, A., Soares, P., Davó-Blanes, M. C., & Vives-Cases, C. (2020). Identifying Types of Dating Violence and Protective Factors among Adolescents in Spain: A Qualitative Analysis of Lights4Violence Materials. International journal of environmental research and public health, 17(7), 2443. https://doi.org/10.3390/ijerph17072443

8 Ibid.

9 Polanti et al. (2023)

10 Malik, M., Munir, N., Ghani, M. U., & Ahmad, N. (2021). Domestic violence and its relationship with depression, anxiety and quality of life: A hidden dilemma of Pakistani women. Pakistan journal of medical sciences, 37(1), 191–194. https://doi.org/10.12669/pjms.37.1.2893

11 Ibid.

12 Telloian, C. (2023, March 23). What Are the Effects of Emotional Abuse? https://psychcentral.com/health/effects-of-emotional-abuse#relationship-impacts 

13 PTSDuk. (2023). Causes of PTSD: Domestic Abuse. https://www.ptsduk.org/what-is-ptsd/causes-of-ptsd/domestic-abuse/

14 Ibid.

15 De Sousa, D., Paradis, A., Fernet, M., Couture, S., & Fortin, A. (2023). "I felt imprisoned": A qualitative exploration of controlling behaviors in adolescent and emerging adult dating relationships. Journal of adolescence, 95(5), 907–921. https://doi.org/10.1002/jad.12163

16 Guy, S. (2020, October 19). When Love is Blind: What Teens Don’t See in an Abusive Relationship. https://www.genesisshelter.org/when-love-is-blind-what-teens-dont-see-in-an-abusive-relationship/

17 Cleveland Clinic. (2022, February 14). Stockholm Syndrome. https://my.clevelandclinic.org/health/diseases/22387-stockholm-syndrome

18 Karakurt, G., Koç, E., Katta, P., Jones, N., & Bolen, S. D. (2022). Treatments for Female Victims of Intimate Partner Violence: Systematic Review and Meta-Analysis. Frontiers in psychology, 13, 793021. https://doi.org/10.3389/fpsyg.2022.793021

19 Ibid.

20 Pérez-Marco, et al. (2020)

21 Oğuztüzün, Ç., Koyutürk, M., & Karakurt, G. (2023). Characterizing Disparities in the Treatment of Intimate Partner Violence. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2023, 408–417. 

22 Wexler D. B. (1999). The broken mirror. A self psychological treatment perspective for relationship violence. The Journal of psychotherapy practice and research, 8(2), 129–141. 

The Role of Gratitude in Improving Mental Health

Focusing on the Good 

Gratitude has its foundational roots in the humanities, from ancient philosophical studies, to religious conceptualizations, and evolutionary theories. Though gratitude has traditionally been understood and studied in this way, novel insights, questions, and understandings are being developed under the lens of contemporary scientific research today. In the past few decades gratitude has been studied in increasingly precise contexts, from early childhood education, to prosocial behavior in the workplace and potential for chronic disease treatment. Nevertheless, gratitude is still quite difficult to define. Is it an emotion, a virtue or a behavior? The APA gives a general description of gratitude as part of a wider outlook on life that involves noticing and appreciating the positive aspects of life.[1] Though there are many conceptualizations of gratitude, Emmons & McCullough (2003) defined gratitude in two parts: 1) recognizing that one has obtained a positive outcome and 2) recognizing that there is an external source for this positive outcome.[2]

In general, gratitude has been shown to present a plethora of benefits for one’s mental and physical health. It may foster a more positive mood, induce better sleep, and even lower disease markers and inflammation in the body.[3] Additionally, depressive symptoms, substance abuse, anxiety, chronic pain, and risk of disease may be lowered with the implementation of daily gratitude practices.[4] Cultivating feelings of gratitude through practices of mindfulness and daily journaling can fortify relationships with others as well as increase empathy and prosocial behavior. Overall, expressions and practices of gratitude have been extensively studied for its ability to increase well-being, longevity, and happiness. 

The origins of gratitude 

Though gratitude has often been thought of as merely an intuitive emotion or feeling, there have been key developments in various fields that have led to our increased understanding of gratitude and the ways it can be qualitatively and quantitatively measured. 

Evolutionary: 

The questions surrounding gratitude and its origins can be traced back centuries to evolutionist Darwin. In The Descent of Man (1871), he offers the possibility that humans and other animals share collective emotions, “even the more complex ones such as jealousy, suspicion, emulation, gratitude, and magnanimity.”[5] With this, gratitude may have played a unique role in human social evolution. It has been posited that gratitude is an adaptation for what Robert Trivers first coined as “Reciprocal Altruism” in 1971, or the sequential exchange of costly benefits between non relatives.[6] This is supported by a series of studies by prominent gratitude researchers Mccullough et al. (2008) which explain that a positive feeling of gratitude can alert us to the benefits we’ve received from others and inspire us to show appreciation, which will in turn make others more likely to help us again in the future.[7] The evolutionary advantage is that we become more interconnected and collectively stronger as a society, as strangers become friends and new allyships are created. 

Neurobiological: 

There have also been more recent studies which incorporate systematic ways of studying and measuring the biological origins of gratitude. In one key fMRI based study by Fox et al. (2015), higher ratings of gratitude correlated with increased brain activity in participants’ anterior cingulate cortex and medial prefrontal cortex. Activity in these regions has been linked to moral cognitive processes, social reward and interpersonal bonding, as well as emotion perception and theory of mind. Previously, it was unknown how the brain generated the range of feelings associated with gratitude; however, this study provides a window into gratitudes origins, as well as its relationship to mental health and resilience.[8]   

Factors that contribute to gratitude

Multiple studies have honed in on certain individual factors that may contribute to increased or decreased expressions of gratitude including personality, cognitive factors, and gender. 

1. Personality Traits: Recently, Szcześniak et al. (2020) studied the interaction among personality traits, emotional intelligence, and a grateful disposition. They found that both gratitude and emotional intelligence correlated positively and significantly with extraversion, openness to experience, agreeableness, and conscientiousness. Conversely, gratitude and emotional intelligence correlated negatively and significantly with neuroticism.[9]

2. Cognitive Factors: Certain cognitive factors may also influence the amount of gratitude one feels in a particular situation. Some examples include the perceived intention of the benefactor, the apparent cost to the benefactor, or the value of the gift which vary based on the situation.[10] This differs based on personal experience and background, perception of the situation, and even some larger cultural norms.   

3. Gender: In particular, Kashdan et al. (2009) hypothesized that women possess an advantage over men in experiencing and benefiting from gratitude. In this comparative study of reaction to gift appraisals, women viewed gratitude expression to be exciting and interesting while men were less likely to feel and express gratitude, made more critical evaluations of gratitude, and derived fewer benefits.[11]   

Along with the numerous individual factors which show variance in either lending to or inhibiting expressions of gratitude, there is also a wider discussion on gratitude as it relates to the complex interplay of religion, culture, and social norms. 

1. Religion: Gratitude has often been associated with and studied in conjunction with religion and spirituality. Specifically looking at the United States, a study by Krause (2009) found that more frequent church attendance and stronger God-mediated control beliefs are associated with positive changes in gratitude over time.[12] In accordance with these findings, a more generalized study of intergroup differences conducted by Ferenczi et al. (2021) examined religiousness, gratitude, and well-being over time and found that religiousness is linked to higher gratitude and moreover, an increase in gratitude can result in an increase in subjective well-being.[13] 

2. Culture: Cross cultural research often looks at the difference between individualist and collectivist cultures in the context of behavior, values, practices, and more. Srirangarajan et al. (2020) found evidence that across East Asian and Western cultures, being grateful generally seems to have a similar relationship with a wide variety of psychological variables including but not limited to life-satisfaction, stress and social anxiety, and anger.[14] Another more recent study carried out by Freitas et al. (2022) sampled a participant pool with diverse cultural backgrounds ranging from countries such as China, Brazil, Russia, and Turkey to investigate gratitude as a moral virtue. The main findings indicated that despite the broad array of cultures represented, gratitude as a virtue develops during childhood and is influenced by one's cultural group.[15] 

3. Parenting Style: As gratitude has been shown to have developmental roots, parenting styles and gratitude in children has also been examined. Obeldobel & Kerns (2021) conducted a literature review that showed how children’s gratitude was higher when parents modeled gratitude, there was a more secure parent–child attachment, and parents employed more supportive, autonomy granting, and warm parenting styles. These findings align with attachment theory, social learning and emotion socialization theories, and the find-remind-and-bind theory.[16] 

Individual Benefits 

Researchers have been interested in gratitude particularly in regard to its potential for improving one’s mental and emotional health for decades. Many key mechanisms and rationales for significant findings have been identified and discussed throughout the existing literature. More recent studies, though, have also begun to incorporate physical health and well-being into experimental design. 

1. Improving Physical Health: UCLA Health notes that gratitude supports heart health through the improvement of depression symptoms, increased sleep, improved diet and more frequent exercise - which all reduce the risk of heart disease.[17] Additionally, several studies show that a grateful mindset positively affects biomarkers associated with the risk for heart disease. One recent study by Jans-Beken et al. (2021) sought to provide an updated overview of the literature on the connection of gratitude to human health, specifically focusing on experimental study findings. The researchers state that gratitude interventions appear to positively affect a number of cardiovascular and inflammatory parameters, (e.g., a decrease in diastolic blood pressure with daily gratitude journaling) as well as improving sleep quality.[18] In addition, not only has gratitude journaling been shown to lessen depressive symptoms related to chronic illness, but has been shown to lessen inflammatory chronic disease biomarkers such as HbA1c (which is involved in blood sugar control). This is especially important given that high levels of HbA1c have been associated with chronic kidney disease, a number of cancers, and diabetes.[19] 

2. Improving Well-being: In addition to the evidence of improvements to physical health, many more studies support the idea that a grateful disposition is associated with greater life satisfaction, optimism, subjective well-being, positive affect, and overall happiness.[20] Some mechanisms by which gratitude can positively intervene in one’s life to improve general well-being include counteracting materialism and protecting against burnout. Specifically looking at student culture, Tsang et al. (2014) found that undergraduate students reported less life satisfaction, which could be explained by their lowered levels of gratitude. The study concluded that gratitude played an important mediating role for the negative relationship between materialism and life satisfaction. Grateful people may be less materialistic because they feel more satisfied with their lives - and thus, don’t feel much of a need to acquire new things in order to feel more satisfied.[21] 

3. Treating Mental Illness: While there is clearly strong evidence for gratitude’s role in improving both mental and physical health, several more studies are concentrating on gratitude interventions for specific psychological challenges and the related mechanisms by which these may elicit significant positive changes. 

   Through various meta-analysis and literature review studies, it is now commonly accepted that gratitude can play a key role in improving depressive symptoms. One recent development, though, comes from a study carried out by Tomczyk et al. (2022), examining gratitude and acceptance of illness for women who were at risk for clinical depression. They identified that women with elevated depressive symptoms who were more grateful (compared to those who were less grateful) were more accepting of their condition, which was related to increased well-being and decreased feelings of depression and anxiety.[22] 

   Gratitude can help promote long-term recovery from substance misuse. In particular, the Narcotic Anonymous (NA) program has adopted gratitude as a key component of recovery and urges members to practice gratitude on a daily basis on their journey toward successful recovery.[23] 

   Several more studies have been conducted under the topic of gratitude’s effect on mitigating stress and anxiety disorders, PTSD, and suicidal ideation. For example, Vieselmeyer et al. (2017) looked at the role that gratitude and resilience played in post-traumatic stress. Particularly relevant to contemporary events and the dramatic increase in the prevalence of community trauma like school shootings, these researchers found that people with high trait gratitude four months following the 2014 Seattle Pacific University shooting showed a stronger relationship between post-traumatic stress and post-traumatic growth, implying that very grateful people are also more resilient and willing to adopt a growth mindset post-trauma.[24] Another study by Li et al. (2015) examined the relationship between suicide ideation and gratitude, finding that the odds of suicidal ideation and suicide attempts were lower among adolescents who scored higher on gratitude, and furthermore, these results were mediated by both prevalence of stressful life events and self-esteem.[25]

   Perhaps one of the most widely studied and supported topics related to mental health and gratitude, though, is its effect on stress and depression. A comprehensive study by Wood et al. 2008 examined the direction of the relationships between trait gratitude, perceived social support, stress, and depression during a life transition. The key findings from this study is that gratitude seems to directly foster social support, and to protect people from stress and depression, which has major implications for clinical interventions.[26] 

4. Child/Adolescent Health: The Anxiety and Depression Association of America outlines the mental health benefits of gratitude for kids and teens including improving mood, increasing social connection, reducing suicide risk, and improving sleep. Many of the existing studies on child/adolescent gratitude and mental health examine a specific type of intervention (e.g., gratitude journaling) and its longitudinal effects. For example, one study by Tara et al. (2016) sought out to promote positive psychology evidence-based interventions for use in schools. They found that students who completed the gratitude intervention demonstrated enhanced school belonging and gratitude relative to the control group. Thus, a link was established between gratitude, sense of belonging and well-being for school-aged children.[27] The generalizability of this result, however, may not be definitive. In one gratitude article featured in the Journal of Positive Psychology, Hussong et al. (2018) states that children and adolescents often display wider variance in ways of expressing gratitude. In other words, there are different aspects of gratitude moments (i.e., awareness, thoughts, feelings, and actions) and the way that these facets appear in children.[28]

Social Benefits

A major implication of gratitude is in its social benefits. Studies have looked at how gratitude improves relationships between individuals, enhances productivity in the workplace, boosts well-being among students, and stimulates more helping behavior within collective spaces. Especially relevant to the demanding and highly stressful work environment of healthcare since the Covid-19 pandemic, Kersten et al. (2021) was motivated to investigate the effect of gratitude in mitigating and alleviating the effects of burnout in the workplace. They carried out a study, surveying an international sample of employees, showing a clear negative relationship between work-specific gratitude and disengagement, mediated by Interpersonal Helping Behavior (IHB).[29] 

Similarly, other studies have been interested in the relationship between gratitude and prosocial behavior. Prosocial behavior refers to a range of positive behaviors including positive interactions (e.g., friendly play or peaceful conflict resolutions), altruism (e.g., sharing, offering help), and behaviors that reduce stereotypes.[30]

Zhang (2022) was able to identify a positive relationship between gratitude and adolescents’ prosocial behavior as well as further clarify the mechanism by which the effect operates. Two factors in particular were identified as important to cultivating greater prosocial behavior: the sense of meaning in life and self-esteem. Researchers rationalized that the sense of meaning in life generally refers to an awareness of life goals, tasks, and missions, and hence is intertwined with positive physical and mental health, improved mood, and life satisfaction to promote gratitude and prosocial behavior. Moreover, higher self-esteem is recognized as a key factor in adolescents being more attuned to the behavior of others to then form a positive cognition of themself and others.[31]

Gratitude interventions 

It’s clear that gratitude has been conceptualized in many different ways throughout history and utilized within various disciplines and subfields of psychological study. Because of its applicability, gratitude is extremely well-studied and universally accepted as an intervention which can aid mental health struggles and increase life-satisfaction. From maintaining and improving relationships, fostering a more secure sense of self and well-being, as well as being more attuned to others around us, gratitude is an economical, effective, and comprehensive intervention. What are some ways, then, to cultivate a gratitude practice? 

1. Noting the Positive: One relatively simple practice is “counting blessings” or gratitude journaling (e.g., writing down things one is grateful for either daily or weekly). Another gratitude practice under the same paradigm as journaling is,“mental subtraction.” This activity involves imagining what life would be like if a positive event had not occurred and has been shown to greatly improve mood.[32] 

2. Mindfulness: According to Ochsner Health, mindfulness is defined as paying attention, on purpose, in the present moment, non-judgmentally. To practice mindfulness is simply to invite yourself to where you already are and to experience and acknowledge that moment without judgment or expectation.[33] Mindfulness has been shown to bring emotional regulation, steady attention, and physical healing over the past few decades with the emergence of modern neuroscience and numerous evidence-based studies.[34] While gratitude is central to happiness, mindfulness can help us cultivate it as it enables us to be present with the feelings and sensations of goodness in our life. Like gratitude, mindfulness is a practice which can be practiced daily and refined over time. 

3. Acceptance and Commitment Therapy (ACT): This psychotherapeutic intervention integrates the principles of both acceptance and mindfulness in order to increase flexibility in thinking and outcomes. In addition, this therapy hones in on defusion, engagement with emotions, articulation of life values, self-compassion, mindful gratitude, and stepwise movement in accord with one’s life values.[35] An article from positivepsychology.com states “gratitude is about feeling the right way, about the right things, and at the right time. It is inseparably linked with self-discipline and motivation.” Commitment to action and mindful behavior are both tenets of ACT and will also contribute to a stronger, more consistent gratitude practice.[36] 

Though both mindfulness and ACT are well studied and relatively easy to implement in daily life, there are some factors and limitations that have hindered one’s willingness to adopt practices and express gratitude. These include narcissism, gratitude turning into indebtedness or obligation, and cultural differences and cultural contexts which all affect the way we may experience and perceive gratitude. Generally though, gratitude has been posited as social glue which fortifies relationships. At its most effective, gratitude interventions have been shown to elicit positive changes behaviorally, mentally, and physically. It provides a wealth of benefits to those who commit to this principle as a daily practice and lens through which to view life rather than a short term solution. 

If you or someone you know would like to learn more about how to incorporate gratitude in daily life, learn about mindfulness and ACT, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for additional guidance and support.  

Contributed by: Kaylin Ong

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 American Psychological Association. (2015, April 9). A grateful heart is a healthier heart [Press release]. https://www.apa.org/news/press/releases/2015/04/grateful-heart 

2 Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389. https://doi.org/10.1037/0022-3514.84.2.377 

3 APA (2015) 

4 American Psychological Association. (2012, August 5). Growing up grateful gives teens multiple mental health benefits, new research shows [Press release]. https://www.apa.org/news/press/releases/2012/08/health-benefits 

5 Trivers, R. L. (1971). The Evolution of Reciprocal Altruism. The Quarterly Review of Biology, 46(1), 35–57. http://www.jstor.org/stable/2822435 

6 McCullough, M. E., Kimeldorf, M. B., & Cohen, A. D. (2008). An Adaptation for Altruism: The Social Causes, Social Effects, and Social Evolution of Gratitude. Current Directions in Psychological Science, 17(4), 281–285. https://doi.org/10.1111/j.1467-8721.2008.00590.x

7 Suchak, M. (2017, February 1). The Evolution of Gratitude [Review of The Evolution of Gratitude]. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/the_evolution_of_gratitude 

8 Fox, G. R., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of gratitude. Frontiers in psychology, 6, 1491. https://doi.org/10.3389/fpsyg.2015.01491 

9 Szcześniak, M., Rodzeń, W., Malinowska, A., & Kroplewski, Z. (2020). Big Five Personality Traits and Gratitude: The Role of Emotional Intelligence. Psychology Research and Behavior Management, Volume 13, 977–988. https://doi.org/10.2147/prbm.s268643 

10 Allen, S. (2018). The Science of Gratitude. https://ggsc.berkeley.edu/images/uploads/GGSC-JTF_White_Paper-Gratitude-FINAL.pdf?_ga=2.82610261.2142947331.1637096170-1362583773.1634590861 

11 Kashdan, T. B., Mishra, A., Breen, W. E., & Froh, J. J. (2009). Gender Differences in Gratitude: Examining Appraisals, Narratives, the Willingness to Express Emotions, and Changes in Psychological Needs. Journal of Personality, 77(3), 691–730. https://doi.org/10.1111/j.1467-6494.2009.00562.x 

12 Krause, N. (2009). Religious Involvement, Gratitude, and Change in Depressive Symptoms Over Time. International Journal for the Psychology of Religion, 19(3), 155–172. https://doi.org/10.1080/10508610902880204 

13 Ferenczi, A., Tanyi, Z., Mirnics, Z., Kovács, D., Mészáros, V., Hübner, A., & Kövi, Z. (2021). Gratitude, Religiousness and Well-Being. Psychiatria Danubina, 33(Suppl 4), 827–832.https://pubmed.ncbi.nlm.nih.gov/35026809/ 

14 Srirangarajan, T., Oshio, A., Yamaguchi, A., & Akutsu, S. (2020). Cross-Cultural Nomological Network of Gratitude: Findings From Midlife in the United States (MIDUS) and Japan (MIDJA). Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00571 

15 Freitas, L. B. L., Palhares, F., Cao, H., Liang, Y., Zhou, N., Mokrova, I. L., Lee, S., Payir, A., Kiang, L., Mendonça, S. E., Merçon-Vargas, E. A., O’Brien, L., & Tudge, J. R. H. (2022). How weird is the development of children’s gratitude in the United States? Cross-cultural comparisons. Developmental Psychology. https://doi.org/10.1037/dev0001383 

16 Obeldobel, C. A., & Kerns, K. A. (2021). A literature review of gratitude, parent–child relationships, and well-being in children. Developmental Review, 61, 100948. https://doi.org/10.1016/j.dr.2021.100948 

17 Health benefits of Gratitude. UCLA Health System. (n.d.). https://www.uclahealth.org/news/health-benefits-gratitude   

18 Jans-Beken, L., Jacobs, N., Janssens, M., Peeters, S., Reijnders, J., Lechner, L., & Lataster, J. (2019). Gratitude and health: An updated review. The Journal of Positive Psychology, 15(6), 1–40. https://doi.org/10.1080/17439760.2019.1651888 

19 Allen, S. (2018). The Science of Gratitude. https://ggsc.berkeley.edu/images/uploads/GGSC-JTF_White_Paper-Gratitude-FINAL.pdf?_ga=2.82610261.2142947331.1637096170-1362583773.1634590861 

20 Ibid. 

21 Tsang, J.-A., Carpenter, T. P., Roberts, J. A., Frisch, M. B., & Carlisle, R. D. (2014). Why are materialists less happy? The role of gratitude and need satisfaction in the relationship between materialism and life satisfaction. Personality and Individual Differences, 64, 62–66. https://doi.org/10.1016/j.paid.2014.02.009 

22 Tomczyk, J., Nezlek, J. B., & Krejtz, I. (2022). Gratitude Can Help Women At-Risk for Depression Accept Their Depressive Symptoms, Which Leads to Improved Mental Health. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.878819 

23 Chen, G. (2016). Does gratitude promote recovery from substance misuse? Addiction Research & Theory, 25(2), 121–128. https://doi.org/10.1080/16066359.2016.1212337 

24 Vieselmeyer, J., Holguin, J., & Mezulis, A. (2017). The role of resilience and gratitude in posttraumatic stress and growth following a campus shooting. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 62–69. https://doi.org/10.1037/tra0000149 

25 Li, D., Zhang, W., Li, X., Li, N., & Ye, B. (2012). Gratitude and suicidal ideation and suicide attempts among Chinese Adolescents: Direct, mediated, and moderated effects. Journal of Adolescence, 35(1), 55–66. https://doi.org/10.1016/j.adolescence.2011.06.005 

26 Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854–871. https://doi.org/10.1016/j.jrp.2007.11.003 

27 Diebel, T., Woodcock, C., Cooper, C., & Brignell, C. (2016). Establishing the effectiveness of a gratitude diary intervention on children’s sense of school belonging. Educational and Child Psychology, 33(2), 117–129. https://doi.org/10.53841/bpsecp.2016.33.2.117 

28 Hussong, A. M., Langley, H. A., Thomas, T. E., Coffman, J. L., Halberstadt, A. G., Costanzo, P. R., & Rothenberg, W. A. (2018). Measuring gratitude in children. The Journal of Positive Psychology, 14(5), 563–575. https://doi.org/10.1080/17439760.2018.1497692 

29 Kersten, A., van Woerkom, M., Kooij, D. T. A. M., & Bauwens, R. (2021). Paying Gratitude Forward at Work. Journal of Personnel Psychology. https://doi.org/10.1027/1866-5888/a000296

30 Wright, J. D. (2015). International Encyclopedia of the Social & Behavioral Sciences |ScienceDirect. Sciencedirect.com. https://www.sciencedirect.com/referencework/9780080970875/international-encyclopedia-of-the-social-and-behavioral-sciences 

31 Zhang, D. (2022). The relationship between gratitude and adolescents’ prosocial behavior: A moderated mediation model. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1024312 

32 Allen (2018) 

33 How Mindfulness and Gratitude Can Improve Your Well-Being | Ochsner Health. Ochsner Health System. https://blog.ochsner.org/articles/giving-thanks-how-mindfulness-and-gratitude-can-improve-your-well-being 

34 Gregoire, C. (2014, March 19). Mind and Body: Jack Kornfield on Gratitude and Mindfulness [Review of Mind and Body: Jack Kornfield on Gratitude and Mindfulness]. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/jack_kornfield_on_gratitude_and_mindfulness 

35 Fradkin, C. (2017). Janina Scarlet: Superhero Therapy: A Hero’s Journey Through Acceptance and Commitment Therapy. Journal of Youth and Adolescence, 46(7), 1629–1632. https://doi.org/10.1007/s10964-017-0658-8 

36 The Neuroscience of Gratitude and How It Affects Anxiety & Grief. (2019, April 9). PositivePsychology.com. https://positivepsychology.com/neuroscience-of-gratitude/#brain-changes 

Imposter Syndrome: Mirror, Mirror On the Wall… Am I Worthy of This All?

Drowning in Self-Doubt

 I don’t belong here. I don’t deserve this. I only got this far because I got lucky.  I’m going to fail one day, and then people are going to finally realize what a fraud I am. 

Imposter phenomenon, commonly termed as “Imposter Syndrome,” can drown a person’s mind with self-doubt, fear of failure, and feeling unworthy of their successes. This is a condition that typically affects high-achieving individuals who are unable to internalize their accomplishments, and constantly think of themselves as an “imposter,” or fraud. Instead of attributing their accomplishments to their own efforts and intelligence, they attribute their accomplishments to external factors, such as luck or social support. Despite their objective successes, they focus more heavily on their setbacks, and use those to internally justify the belief that they are a fraud. Currently, there is no formal accepted medical definition for the phenomenon in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or clinical diagnosis for this phenomenon.[1,2]

Competitive environments naturally bring a sense of self-doubt for many, and this often manifests as a healthy amount of stress that allows an individual to adapt and accomplish their goals appropriately. However, what distinguishes those with imposter phenomenon is excessive self-doubt and worry that significantly interferes with mental health and overall well-being. Some levels of stress can drive success and achievement, but it is important to recognize when the cost of one’s mental health becomes too great. 

Prevalence and Notable Characteristics 

Those who suffer from the imposter phenomenon can range across all ages and genders.[3] However, there it has been found to disproportionately affect students, those in the healthcare field, and minority racial/ethnic groups. High pressure and high stake environments tend to reveal and accentuate imposter phenomena in individuals. Minority groups may be predisposed to the imposter phenomenon due to higher psychological stress in educational and workplace experiences compared to their majority counterparts. In particular, minority individuals may face greater financial stress, racial discrimination, and the pressure to pursue higher education as a first-generation student - all of which contribute to the development of the imposter phenomenon.[4] For instance, minority individuals who work or study in predominantly Caucasian environments may already feel as if they do not belong or deserve a place there, leading them to compensate by working much harder than peers to achieve the same goals.

The idea of self-fulfilling prophecy also comes into play in this situation, as a minority individual who is stereotyped as less intelligent or less capable, and is expected to achieve less, is led to act in a certain way that confirms these expectations despite being perfectly capable to surpass expectations.[5] Children from minority families are also often taught they need to work much harder than their White counterparts to reach the same level of success due to systemic discrimination and racism. This familial and societal pressure to achieve contributes heavily to an individual’s development of imposter phenomena, as self-worth becomes internally contingent on external successes.[6] 

The inability to internalize one's successes is also associated with multiple comorbidities, including depression, anxiety, and other psychological health issues. The phenomenon has been commonly researched in population-based evaluations, but there is an unknown true prevalence due to differences in recruitment strategies for these studies. Bravata et al. (2020) note that the prevalence across studies has ranged from 9%-82%.[7] Common characteristics that may be present in those who suffer from imposter phenomenon include:[8]

• Perfectionism

• Super-heroism (e.g., the need to be the best)

• Atychiphobia (e.g., fear of failure)  

• Denial of competence

• Achievemephobia (e.g., fear of success)

• Burnout

• Low self-esteem 

• Excessive comparison to peers 

• Maladaptive personality

To evaluate for imposter phenomenon, the Clance Imposter Phenomenon Scale is highly utilized as a diagnostic tool. The tool contains 20 Likert-scale agree/disagree questions, which have not been externally validated.[9] Examples of some of these questions include:[10]

• “I can give the impression that I’m more competent than I really am.”

• “It’s hard for me to accept compliments or praise about my intelligence or accomplishments.”

• “I’m often afraid that I may fail at a new assignment or undertaking even though I generally do well at what I attempt.”

The Imposter Cycle 

The classic cycle that an individual with imposter phenomenon faces starts with an assignment, duty, obstacle, or another task which requires reaching a certain level of achievement. The individual will then choose one of two paths: over-preparation or procrastination. Those who over-prepare will feel as if they have to work excessively hard, especially harder than those around them, to achieve that goal. Those who procrastinate will feel as if they are an imposter because they are rushed in preparation, and worry that their rushed efforts portray them as a fraud. After the task is completed, and the goal is achieved, they will experience a short sense of success, which is quickly diminished by overwhelming feelings of fear, anxiety, and fraudulence that leads them to repeat the cycle when presented with a new task.[11] This cycle may end up sabotaging their own success, creating an obsession over any small mistake, and working intensely hard to prove they are not a fraud to themselves.[12]

Conquering The Voice in Your Head

Building resilience and overcoming imposter feelings requires active efforts on both the individual’s part, and the environment in which they work or study. For an individual, the medical and behavioral health treatments involve careful evaluation to determine how to target these feelings. Such treatments can include:[13]

• Self-reflection

• Counseling

• Cognitive Behavioral Therapy (CBT)

• Psychotherapy

Individuals must also actively practice gratitude strategies to appreciate their own achievements and work ethic. One way to start is by learning about imposter feelings, and where these negative feelings can derive from. Then, the practice of self-reflection can be used to identify the imposter-related negative feelings. Sharing these feelings with a counselor or therapist, or even trusted friends and family, can help a person gain a better appreciation for their achievements and abilities. Additionally, finding others that share these feelings can bring more solace and safety in one's workplace or academic environment, as building a support network can reduce isolation and loneliness while facing these negative feelings. It is also important to ask for help when needed, especially since many people suffering from imposter feelings believe they are completely alone in their pursuits, and in order to avoid fraudulent feelings, they steer clear from external support.[14] 

Genuinely celebrating each success, instead of simply brushing them off and moving ahead, can help one practice gratitude and internalize their successes, breaking down barriers of self-doubt in the future. Instead of focusing on perfectionism, and aiming for the achievement, take the time to appreciate any progress and efforts to get there. Track your success and remind yourself of your abilities when self-doubt becomes overwhelming. This serves as a way to increase your internal validation.[15] Practice mindfulness, and build a sense of self-worth outside of academic or professional accomplishments. Positive qualities about character and personality are also triumphs to be celebrated and appreciated. Doing so can help build self-compassion, and lean away from basing one's self-worth on how high a test score was achieved or how big of a promotion was obtained. Take time to learn from failures and mistakes, but also remember that behind every large success there is a series of setbacks.[16] Making an organized plan for success is another way to avoid overwhelming yourself and more strategically reaching your goals, one step at a time. Managing anxious imposter feelings can be done by breaking down a larger goal into smaller attainable goals/tasks that allow you to practice consistency in your work and confidence in yourself.[17]

Institutions can also actively reduce imposter feelings for their employees or students by generating a more inclusive and diverse community. This will help encourage minorities to feel more encouraged and comfortable in their environment, leading them to feel more confident with their successes and attempts for success.[18]

The imposter phenomenon can overwhelm a person’s mind and body. Developing healthy coping mechanisms is crucial to maintain a positive psychological state of well-being. After acknowledging one's feelings and practicing self-reflection, a person may make efforts to change their lifestyle to accommodate for such high levels of stress and anxiety due to impostor feelings. This may involve setting new reasonable goals or expectations, rather than aiming for the highest achievement at all times. Unreasonably high goals can hurt chances of success, leaving one feeling more discouraged. Instead, build a momentum for success by making reasonable and attainable goals, and build off of these goals more and more as they continue to be reached. In other words, take it one step at a time. One may choose to find a mentor that can guide them towards their goals, eliminating the feeling of isolation that frequently pairs with imposter feelings. Teaching others what you have learned through your accomplishments can also help internalize your own successes, building confidence in yourself while simultaneously encouraging others.[19]

If one has been feeling increasing symptoms of the imposter phenomenon, and it is impacting daily life and overall mental or physical health, it is recommended to contact a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance on reducing anxiety and impostor feelings.

Contributed by: Ananya Udyaver

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Bravata, D. M., Madhusudhan, D. K., Boroff, M., & Cokley, K. O. (2020, August 24). Commentary: Prevalence, Predictors, and Treatment of Imposter Syndrome: A Systematic Review. Journal of Mental Health and Clinical Psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174434/ 

2 Huecker, M. R., Shreffler, J., McKeny, P. T., & Davis, D. (2023, April 9). Imposter Phenomenon - statpearls - NCBI Bookshelf. Imposter Phenomenon. https://www.ncbi.nlm.nih.gov/books/NBK585058/  

3 Ibid.

4 Ibid.

5 Palmer, C. (2021, June 1). How to overcome impostor phenomenon. Monitor on Psychology, 52(4). https://www.apa.org/monitor/2021/06/cover-impostor-phenomenon 

6 Weir, K. (n.d.). Feel like a fraud?. American Psychological Association. https://www.apa.org/gradpsych/2013/11/fraud  

7 Bravata, et al. (2020) 

8 Huecker, et al. (2023)

9 Ibid.

10 Clance, P. R., & O'Toole, M. A. (1987). The Imposter Phenomenon: An internal barrier to empowerment and achievement. Women & Therapy, 6(3), 51–64. https://doi.org/10.1300/J015V06N03_05 

11 Ibid. 

12 Munley, K. (2020, December 2). Expert or poser? debunking the psychology behind Imposter Syndrome. ScIU. https://blogs.iu.edu/sciu/2020/11/21/expert-or-poser/  

13 Huecker, et al. (2023)

14 Weir, K. (n.d.). Feel like a fraud?. American Psychological Association. https://www.apa.org/gradpsych/2013/11/fraud  

15 Jaqua, E. E., Nguyen, V., Park, S., & Hanna, M. (2021). Coping With Impostor Syndrome. Family practice management, 28(3), 40. https://pubmed.ncbi.nlm.nih.gov/33973753/ 

16 Palmer (2021) 

17 Munley (2020)

18 Eruteya, K. (2022, January 5). You’re not an imposter. you’re actually pretty amazing. Harvard Business Review. https://hbr.org/2022/01/youre-not-an-imposter-youre-actually-pretty-amazing   

19 Jaqua, et al. (2021) 

Achieving Work-Life Balance: A Q&A with SAS Therapists

Beatdown, Balance or Blend?

Finding the right work-life balance is necessary for achieving fundamental mental health. Achieving the right balance may seem impossible at times; remote-work (while often beneficial with many upsides) also leads to workers being continually accessible. Harvard Business Review notes that one year into the pandemic, many companies were surprised that their standard metrics for productivity remained high, despite the work being conducted remotely.[1] According to an internal study of Microsoft employees in 2021, while they felt their productivity was up, the downside was that nearly half reported working longer hours, 54% felt overworked and 39% indicated they felt exhausted.[2] This lack of balance is damaging: Forbes notes the compounding stress from the never-ending workday can hurt one’s relationships, health and overall happiness.[3]

But it doesn’t have to be this way. The work-life dichotomy has always been misleading in the notion that work is “simply the thing we do for a paycheck” while life comprises the space between showing up at the office. When work engages people, it can be life-affirming.[4]

Generational Balance Shifts

The term work-life balance didn’t come into popular use until 1986; while still in use, the original meaning no longer fits current circumstances. Starting in the mid-70s, after witnessing the downsizing of many companies and subsequent loss of their parents’ jobs, Gen X workers discovered ways to leverage technology and reimagine how work and the workplace should look. In doing so, they were able to begin to shift the needle towards greater work-life balance.

Unfortunately, Gen Xers had difficulty truly balancing work and home-life and felt that in order to succeed professionally, “work had to come first.” At this point in time, the best they could hope to achieve was to build a workplace that had enough flexibility to allow for shifting priorities and personal needs.[5]

Fast-forward to the Millennial mindset, and things look quite different. Best described as work-life integration, Millennials have not achieved better work-life balance and have actually broken down the walls between the professional and personal spheres of life. Contrary to those employed in the 70s and prior, Millennials tend to not invest themselves in one company for the entirety of their career, especially as companies can no longer be counted on to take care of a person into their retirement. Many seek to craft careers in the gig economy and pursue part time or flexible work arrangements. While this may sometimes be out of necessity, others elect this lifestyle choice to experience multiple roles and explore different paths in pursuit of finding their purpose.

The Gen Z workplace identity is still in process of development as they navigate an ever-changing economy. Like Millennials, they have not experienced the expectation and normalcy of working for one company for the entirety of their adulthood. One of the biggest differences occurring within the Gen Z generation is the acknowledgment that not only can they not expect a pension, but that Medicare and Social Security may not be supportive or existent when they retire.[6]

Moving beyond work-life integration and to pursue work-life options, Gen Z appears to strongly value employment stability. Similar to Millennials, they are very interested in establishing a career with employers who offer professional growth and development. However, unlike Millennials, they aren’t pursuing multiple jobs in order to find their purpose: they are generally pursuing stable careers while cultivating side projects that could one day develop into revenue streams. As Fortune notes, the aspirations of this cohort veer toward the practical.[7]

Image Source: Canva

Flexibility is Key

More than two years after remote work became the new standard, flexibility remains highly sought-after among the workforce. CNBC reported a recent study conducted by Future Forum which surveyed more than 10,000 workers across the globe. They found that 94% of respondents desire a flexible work schedule; this ranked second only to compensation when determining workplace satisfaction.[8] Research conducted by Glassdoor (2020) found that the companies highest-rated for work-life balance have embraced flexible work via arrangements such as: flextime, remote-work and unlimited PTO.[9]

Developing Self-Care

The American Psychological Association (APA) notes several self-care strategies to promote physical and emotional self-care as well as overall quality of life.[10]

• Know Your Limitations - Realize when you need to say “No,” and when it’s time to step back and take a break. If you’re feeling overwhelmed, that’s often a good indicator that you are at your limit.

• Develop a Social Support Network - Support networks at work and at home tend to lead to less work-home conflict at home. Supportive peer groups can occur via consultation groups, informal sharing with friends and colleagues as well as via personal psychotherapy.

• Develop Interests Outside of Work - Hobbies, volunteering and/or engaging in activities such as exercise or travel can relieve stress and help achieve balance.

• Don't Let Work Take Over Your Life - Be careful not to let your workplace role define you; those who identify with multiple roles tend to be healthier than those identifying with one role (as long as the multiple roles are not overwhelming).

• Embrace Flexibility - Setting aside time for various responsibilities requires discipline as well as flexibility. This can come in the form of working different times of the day out of the typical 9-5 in order to prioritize what is important in one’s life as well as handle unexpected occurrences such as an illness, deadline, new opportunity, etc.

• Seek out a Supportive Work Environment - Both employees and employers can benefit from supportive work-life balance programs, such as flexible scheduling and childcare or eldercare. In addition, organizations that offer alternative work arrangements tend to lessen work-family conflicts while promoting organizational commitment and job satisfaction.

• Adopt a Long-Range Perspective - Work-life balance looks differently for each person, dependent on each individual's life and career stage. Keeping things in perspective and creating long-term balance is important. While we may not be able to balance every day as we desire, the goal is to keep the week or month balanced as much as possible.

Additionally, Forbes.com notes six strategies one can use to promote better work-life balance; these include:[11]

1. Letting Go of Perfectionism - While many overachievers develop perfectionist tendencies at a young age, it’s easier to maintain that perfectionist habit when demands are limited to school, hobbies and possibly an after-school job. As we grow up, life gets more complicated and responsibilities multiply. At this point, perfectionism often becomes out of reach; striving for perfectionism across all facets of life as an adult can lead to a decline in mental health. Instead of “perfectionism”, a more-attainable level of “excellence” should be sought-after.

2. Unplug - While technology has helped our lives in many ways, including the ability to work remotely in many cases, it has also led to expectations of constant accessibility. Work and phone notifications when someone is otherwise off the clock can cause disruptions in down-time and take away from the potential to recharge and destress. 

3. Exercise and Meditate - Exercise is effective at reducing stress and can, at times, help someone get to a meditative state. If limited in time, even a five-minute meditation session in the morning and night can make a difference. Additionally, one may try incorporating deep breathing exercises during a lunch break or before bed. The key is to find something relatively easy that can be incorporated into one’s life to activate the parasympathetic nervous system, such as deep breathing, grounding your senses in your present surroundings (i.e., mindfulness). By activating the parasympathetic nervous system, a sense of calm can be felt, reducing stress and anxious feelings.

 4. Limit Time-Wasting Activities and People - By identifying what’s most important in one’s life, firm boundaries can be drawn to protect and prioritize those people and activities. This list will differ for everyone and should be reflective of what is most important to you and not based on expectations of others. Once these priorities are defined, the excess can be trimmed from one’s schedule (e.g., limiting mindlessly scrolling through social media and lessen interactions with those who make you feel as though you are wasting your time.) It is not selfish to focus on the people and activities that reward you the most.

5. Change the Structure of Your Life - By stepping back and looking at your life, you may find there are ways that you can do things that make life easier. Just because you (and perhaps your family) have gotten into a certain habit or routine does not mean that habit/routine will be best long-term, especially as roles and other responsibilities shift over time. By redefining who does what, when things get done and how they get done may lead to less stress, greater organization and overall happiness for those involved.

6. Start Small. Build from There. - Change doesn’t have to be revolutionary to occur; evolutionary changes can lead to great things. Crash diets fizzle out, New Year’s resolutions are forgotten within a few weeks and a sudden all-or-nothing ideal can sometimes lead to a big crash. Marathons aren’t conquered without long-term, dedicated training. If you’re trying to rewrite a script in your life (such as by working less hours, eating healthier, exercising more) understand and accept that it’s ok to start slowly and just “do better” than you did the previous week. By building upon small steps, it will be easier to commit to lifestyle changes and stick to those changes long-term.

Q&A

SAS THERAPISTS DISCUSS WAYS TO MAINTAIN GOOD MENTAL HEALTH AND WORK-LIFE BALANCE

1. How do you “turn off” work and stop thinking about it when you’re off the clock?

“It definitely is struggle in our current times to draw hard and fast boundaries between work and personal life. With remote work being a feature of our collective lives, work has begun to permeate our home lives/personal spaces in a very real way. In addition, the demands that seem to be made of working professionals is that because they are working remote or from home, they “should” be available at all hours that the work/company needs them to be. With this recognition, we can begin creating distance between these two aspects of our lives by recognizing how we are reacting to our work environment. Are we assuming an urgency that isn’t present? Are we responding to urgency created by others that we don’t need to? I think once we have a more realistic understanding of the consequences of drawing good boundaries between work and personal time, it becomes easier to defend those boundaries. Giving yourself some time to transition between work responsibilities and home responsibilities is also necessary. Learning to approach your thoughts from a place of observation rather than engagement can often be helpful in turning the volume down on work related thoughts in times/spaces you don’t want to be thinking about them.” (Priyanka Shokeen, Ph.D.)

“I have found a mindful perspective towards intrusive work thoughts to be helpful: I try to notice when I am still thinking about work, and reassure myself that ‘that thought doesn't need you right now’ or ‘work will be waiting for you tomorrow morning, you can let it wait until then.’ Sometimes it can be helpful to write myself a note if I am worried I will forget to do something later, as this allows me to trust that I can let it fade from my attention now without negative consequences.” (Case Lovell, LMHC)

“I don’t think there is a singular answer to this or any of the other questions here; each one is dependent on a person’s context. Sometimes it is appropriate (and enjoyable) to think about work during off hours. Sometimes it is unnecessary and unpleasant. Perhaps the questions are ‘How do you turn off work when you don’t want to be thinking about work, don’t need to be thinking about work, and aren’t enjoying thinking about work?’ Or maybe you are simply asking *me* how I turn off work mode and enjoy my life when I am away from my desk?

I know that if I don’t take time out to care for myself, then I will eventually burn out and be of no use to anyone (including myself). I know it is in my best interests, and therefore in the interests of those who depend on me and my work, to take care of myself. Engaging in hobbies, being active, spending time with friends and family, resting, laughing, sleeping, eating, and living refills my capacities and gives me the energy and perspective I need to be effective at work. Self care allows me to come back with fresh eyes and to more engage fully with my my work.” (Jim McDonnell, LMFT)

2. How can you stop feeling guilty about taking vacation time and actually take time off of work?

“I think this is a unique feature of the society we currently occupy where taking a break inspires guilt. I always encourage people to reflect on what is it that is triggering their guilt? Often times it’s the thought that you may be leaving colleagues with more work. In those times I think it is important to recognize that if your team/company is held up by either being unfair to you (in that you cannot legitimately take a break) or unfair to your colleagues (in that their lives will necessarily become worse if you take a vacation) then asking yourself if this is the place you want to be a part of. More often than not, it is also an overestimation to say that you taking a vacation will necessarily make life difficult for others. Having these conversations with yourself can provide the space to examine what it is that you are reacting to.” (Priyanka Shokeen, Ph.D.)

“My sale's pitch to myself is always that I do my best work when I am taking the best care of myself, and so I owe it to my work to be taking the time off I need to stay refreshed and engaged. Like any kind of routine maintenance, it requires stepping back from productivity in the short term, but it prevents catastrophic breakdown in the long term!” (Case Lovell, LMHC)

“Again, there is no singular answer to this question. As a therapist, I would want to know more about why taking time off creates feelings of guilt. The guilt could be coming from a person’s prior life experience, it could come from non-verbal cues in the workplace, it could come from comparisons to others in their life who don’t have vacation, etc.

Regardless of the reasons for the guilt, it is important to remember that taking time off is part of a good self care routine. Vacation time is there to be used. It is there to prevent an individual from burning out, and in the long run benefits both the organization and the individual.” (Jim McDonnell, LMFT)

3. Conversely, how can you best handle guilt/pressure when you cannot take time off and your family/friends want you to?

“I think this situation also requires a closer examination. Is it that you cannot take time off or that asking for it is difficult/anxiety-provoking/uncomfortable? Similarly, when your friends and family want you to take time off and you know that that is not an option, having conversations with them about how both parties can have their needs met. Communication about what it is that you expect from the other person, what you can provide to them to meet their expectations and what you would need from them in order to function well are all necessary topics to touch upon.” (Priyanka Shokeen, Ph.D.)

“For me personally, it has helped to communicate to my personal connections why my work is important, not just to the world but to me. It might be hard to hear that a loved one is not taking time to be with us if we believe that this time is spent in the pursuit of company profits or the arbitrary demands of a boss, but easier to feel good about them investing their time to feel productive and fulfilled, or to feel pride in the way they are supporting their family, or to feel accomplished in pursuing their long term career goals.” (Case Lovell, LMHC)

“I would start by reflecting and validating the family member or friend’s desire to spend time with me, reframing their request from one where I feel like I am letting them down to one where I feel valued and wanted. I would let them know how much they mean to me and how much I would love to spend time with them were I able. I could also request that they trust that I want to spend time with them and will do so when I am able.” (Jim McDonnell, LMFT)

4. What’s the best way (or ways) to maintain a healthy separation between work and one’s personal life to keep things professional, but without seeming cold/aloof in the work environment?

“I think this is a difficult one to tread because regardless of what you think you’re doing right and respectfully, other people also have their own perceptions, informed by their own biases of what’s happening in their environment. That is to say, your healthy boundary may rub someone the wrong way. Which is not to say you shouldn’t have your boundaries. I think instead it means that approaching a conversation about these boundaries from a non-defensive space. For example, if someone in the workplace has a problem with you not immediately responding to their emails, having a conversation with them informing them that it isn’t feasible or possible for you to respond or be present every moment and if there was a specific time during which they could direct all their urgent questions so you know how to differentiate between immediate vs non immediate matters.” (Priyanka Shokeen, Ph.D.) 

“Firm and consistent boundaries do not have to be harsh or aggressive! It can be difficult, especially when it goes against work culture, but finding ways to warmly but unapologetically communicate one's boundaries is worth doing.” (Case Lovell, LMHC)

“How we are perceived in the workplace is not completely in our control. We have influence but not total control over how we are perceived.

Developing an identity that includes work, family, friends, play, hobbies, and self care is vital. Doing so can help us feel more confident when establishing and maintaining boundaries between work and non-work and allows us to remain engaged and present with those at work without losing ourselves in our work identity.” (Jim McDonnell, LMFT)

5. If someone is working excessive hours and/or has a highly stressful job, what are the best ways for them to find “me time” and recharge to stay healthy?

“Again, the question of why someone is working excessive hours is important. Is that the expectation from your job? Is it the amount of work you’re being asked to handle alone? I think recognizing the need for “me time” is step one to creating a set-up where you can actually pursue it. Being mindful of what you’re putting your body through every day is also crucial. Getting in a 20 minute walk during the day is as important as a free weekend and one cannot replace the other. It is also important to not expect “productivity” during these “me times”. If you are working 80 hours a week, your weekend isn’t enough for you to rest and cook and finish that book you’ve been thinking about and clean the house and so on. Recognize the limits of your time and your energy and prioritize activities during your rest times.” (Priyanka Shokeen, Ph.D.) 

“This is of course not the only answer to this question, but one approach to try might be to start with consistency: Don't focus on what time you can take when you get to your vacation or even when you get to the weekend, rather what can you do every day to recharge? Even if this is just for 5 minutes, having a way to recharge every day can often feel more sustainable.” (Case Lovell, LMHC)

“Setting and maintaining firm boundaries between work and non-work hours is crucial in situations like this. Most of us simply can’t expect to work every waking hour for our entire lives. Sometimes we have to work long hours, sometimes we are on a stressful project. And sometimes the ‘sometimes’ is all the time. In these cases, setting and maintaining boundaries between work and non work hours is crucial. You need time to sleep, eat, and engage in some forms of self care. That might mean logging off at a particular time every day regardless of the status of a project. It might mean scheduling a massage for yourself on a regular basis. It might mean making sure you are getting in some time to exercise a few times a week.

Most of us won’t stay with one company for our entire lives. This means that at some point in the not too distant future, you will change jobs. Don’t sacrifice your mental, physical, and emotional health for something that is transient.” (Jim McDonnell, LMFT)

6. Do you have any other words of advice for those concerned about their work-life balance?

“People often expect themselves to be able to achieve a work-life balance all on their own and that might be a bit of a fallacy. Recognize the kind of support you need in order to achieve and maintain this balance and draw on your support systems.” (Priyanka Shokeen, Ph.D.) 

“The right balance between work and life is not anything that can be defined for you, it has to be the balance that is right for you as an individual, and it may shift over time. If you are struggling to figure out how to balance your work and your life priorities, I have found focusing on my core values to be a helpful way to clarify what is important to me, and thus what priorities I should be focusing on holding time for.” (Case Lovell, LMHC)

“Most of us will be working for many years, so it is important to look at the long game when it comes to work life balance. Remember - no one is going to make you take care of yourself at work. Often times the company we work for will take as much of us as we will give, and then some. It is therefore imperative that we learn how to set and maintain boundaries, process and understand negative emotions with regards to work, tolerate some distress, engage in restorative self care, and communicate with our fellows.” (Jim McDonnell, LMFT)

Contributed by: Jennifer (Ghahari) Smith, Ph.D.

Priyanka Shokeen, Ph.D., Case Lovell, LMHC & Jim McDonnell, LMFT

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Teevan, J. Harvard Business Review. Let’s Redefine “Productivity” for the Hybrid Era. Updated 2021. (accessed 11-15-2022) Let’s Redefine “Productivity” for the Hybrid Era (hbr.org)

2 Ibid.

3 Lee, D.J. Forbes. 6 Tips for Better Work-Life Balance. Updated 2014. (accessed 11-16-2022) 6 Tips For Better Work-Life Balance (forbes.com)

4 DeSantis, C. Fortune. The myth of ‘work-life balance’ is a generational illusion. (accessed 11-16-2022) The myth of 'work-life balance' is a generational illusion | Fortune

5 Ibid.

6 Ibid.

7 Ibid.

8 Smith, M. CNBC. The 10 best U.S. companies for work-life balance, according to Glassdoor. (accessed 11-15-2022) Glassdoor: top U.S. companies for work-life balance in 2022 (cnbc.com)

9 Stansell, A. Glassdoor. Burning out? These are the Highest Rated Companies for Work-Life Balance During COVID-19. Updated 20202. (accessed 11-16-2022) https://www.glassdoor.com/research/companies-work-life-balance/

10 American Psychological Association (APA). (n.d.) Tips from Practitioners on Finding Work-Life Balance. (accessed 11-20-2022) https://www.apaservices.org/practice/ce/self-care/balance

11 Lee (2014)

The Radical Acceptance of an Ocean of Grief

Understanding Waves of Grief

Grief has been described as “the conflicting feeling caused by the end of or change in a familiar pattern of behavior.”[1] Emotions brought on by the experience of a significant loss can be turbulent; and in some cases, can feel like a wave from the ocean as they build and release into one’s reality. Briana MacWilliam (2017) notes, “Some things you never get over, you just learn to carry them.” It is difficult to say whether grief is an experience that one can be rid of, or if it is better understood as something that can be learned to cope with overtime. It is possible for one to feel they have gotten over a loss, and for grief to then show up again causing more unexpected emotional turbulence. Grief can sometimes create the illusion that one cannot move forward, or that one’s life is irreparably damaged. While it is true that one may never be the same, there are ways to grow after experiencing a traumatic loss.[2] 

A loss can take on various forms: the death of a loved one, a romantic heartbreak, loss of a job, loss of a friend, death of a pet, and so on. One cannot control the rain that ruined the picnic, the missed flight that cost a promotion, the fall-out of a romantic relationship, or the cancer that took a loved one’s life. However, one is able to control how to move forward from such experiences. A decision must be made on how to shape one’s future experiences in a positive manner instead of succumbing to horrible events and allowing them to control future events. “Easier said than done,” one might say - and they would be right. However, the initial choice of moving forward is one of the most imperative moments in shaping one’s reality. Dwelling on feelings of heartache is not always a healthy way of honoring the dead or the lost; it can also be a form of self-punishment. MacWilliam notes, “The work of grief is the work of growth.”[3] Tolle (2004) adds that, “It is a choice between falling into a victimized identity or ‘discovering grace’ on the opposite side of helplessness and surrender.”[4] 

After experiencing a loss, there are many ways that one can be reminded of their grief (e.g., hearing a song, the anniversary of a loss, and even seeing something small that reminds you of the person or the loss). Such triggers can make it difficult to maneuver through the five common phases of grief: denial, anger, bargaining, depression, and acceptance.[5] Being reminded about one’s grief can create a feeling of one’s heart being enclosed in a vacuum seal, provoking anxiety about the onset of difficult memories. Various approaches can be used to cope with such emotions and triggers. However, one must first understand common myths of the nature of grief and how societal factors play into one’s experience with grief.  

Common Myths of Grief

In an attempt to cope with grief, society has developed myths about the appropriate approaches to facing our difficult emotions. Popular phrases in the Western world can have a negative impact on the process of growth after experiencing loss. MacWilliam notes a few common phrases associated with myths surrounding how one should experience grief:[6]

• Don’t Feel Bad

• Replace the Loss

• Grieve Alone

• Just Give it Time

• Be Strong for Others

• Keep Busy

The issue with these common myths is that they involve repressing and disregarding feelings of pain, which in turn, can become “stuck” in one’s body, leading to significant diagnoses such as anxiety and depression.[7] Grief is a normal and natural reaction to any kind of loss. Therefore, one should embrace the waves of emotion that are associated with traumatic loss.[8] To embrace grief, one may try:

• Feeling as Bad as You Do

• Not Replacing the Loss

• Finding Others That Share Your Pain

• Taking One’s Time to Acknowledge the Loss

• Letting Others Take Care of Themselves

• Not Burning Out on Distractions

Grieving is Not Selfish

It is common for feelings of grief to become internalized, creating a sense of shame and selfishness in an individual. However, the experience of grief is not selfish, nor is it selfish to move on and experience feelings of joy again. The way in which one reacts to grief is generally in-line with one’s personality traits. For example, if one is quiet by nature, grief might be expressed more quietly and internally. Introverts, as such, are likely to hear encouragement from others to express their grief more outwardly when it happens. Conversely, individuals that are more naturally outgoing might express grief more openly; prompting responses from some people to keep emotions inside.[9] Social acceptance, or the lack thereof, can help or hinder one’s experience of grief. It is important for each individual to figure out what level of expression works best for them on their journey of self-growth. To find what works best for you, there are resources available such as self-help groups. These groups can help one to acknowledge the myths surrounding grief while providing a safe place to express oneself.[10]

Radical Acceptance 

Radical acceptance is a technique derived from Dialectical Behavior Therapy (DBT), that encourages one to look at the reality of a situation without judgment or distortion.[11] Instead of idealizing a scenario to be what you want it to be, radical acceptance means understanding that we are all doing the best we can. The practice of radical acceptance validates one’s emotions, thoughts, and actions.[12] Validating emotions such as loneliness and fear can help to change one’s perspective on a situation and in turn the experience of a challenging situation such as grief. Brian Therialut, a writer who lost his wife to cancer, notes that “Grief loses its power when it is radically accepted in the moment.”[13] By normalizing experiences such as grief, one can find coping mechanisms to deal with the stress and heavy emotions. Simple radical acceptance inquiry has been known to significantly improve coping and reduce suffering.[14] Even one’s inquiry into simple radical acceptance has been found to significantly improve coping and reduce suffering.

A study by Görg et al. (2017) measured the success of radical acceptance when treating trauma-related memories and associated emotions. Shame, guilt, disgust, distress, and fear were all found to significantly decrease from the start to the end of radical acceptance therapy. Radical acceptance has been found to be successful in treating emotions associated with trauma because it focuses on how to reduce the avoidance of memories.[15] Specifically, DBT encourages individuals to accept past traumatic events, painful memories of those events, and emotions about having experienced the events. In the study by Görg et al. (2017) the DBT treatment approaches utilized training for self-esteem, mindfulness, psychoeducation, and music or art therapy. In the end, radical acceptance functioned as a way to cope with traumatic or painful memories.

Practice & Implementation

There are various approaches to implementing radical acceptance into one’s reality. For instance, when acceptance of a situation feels almost impossible, Cuncic (2022) offers some coping statements to help one practice radical acceptance:[16]

Image Source: Tori Steffen

Searching for beauty in a difficult situation can replace suffering with feelings of gratitude. Focusing on the sound of rain hitting the roof, the smell of burning firewood, or the taste of your favorite beverage can foster love and compassion. The more beauty one seeks out, the more likely one is to disengage in self-criticism.[17] Another approach is to outsmart your inner critic by discrediting self-doubt. Self-criticism can help one to grow, but it can also be self-destructive in that your perspective is clouded by a negative filter. One way to bring positivity into the picture when you are feeling self-critical is to think of a loved one and write a letter to yourself from their perspective. People often judge themselves too harshly, and rarely look at themselves from others’ perspectives. Taking the viewpoint of a loved one towards oneself can remind one of what they should admire about themselves.[18]

Additional approaches to implementing radical acceptance include embracing vulnerability and giving yourself the love you are searching for.[19] After expressing oneself in a vulnerable manner, it is likely that one can feel they have shared too much of themself. The reality of the situation is that the expresser is the one who reflects and cringes the most after being “too vulnerable”. Those that witnessed someone else being vulnerable are likely to feel closer to said person, and this connection is what fosters a sense of love for others.[20] To give yourself the love that you are searching for in others is to empower your independence and self-esteem. 

Radical acceptance is often not an easy practice to implement in reality due to the nature of heavy emotions associated with grief. Radically accepting a situation does not mean that you agree with what is happening or what has occurred. Rather, it creates a chance to feel hopeful for the future because one can stop fighting the reality of a situation.[21] Lack of acceptance in a tough situation is normal and many have experienced the trials and tribulations of grief. 

Another way to practice radical acceptance includes paying attention to triggers and noticing when acceptance is difficult. Imagining what reality would look like if you accepted the situation can be a great first step in practicing radical acceptance.[22] Ultimately, accepting the fact that life can still be worthwhile even when experiencing pain will help one to navigate the ocean of grief. Moreover, committing to the practice of radical acceptance when feeling resistance will help it to become more second-natured to an individual dealing with grief.

When feelings of depression and anxiety related to grief are chronic and impacting everyday life, steps should be taken to reduce such negative experiences by contacting a licensed mental health professional for further guidance.

Contributed by: Tori Steffen

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 James, J. and Friedman, R. (2009) The Grief Recovery Handbook: The Action Program for Moving beyond Death, Divorce, and Other Losses including Health, Career, and Faith. New York: Harper Collins Publishers.

2 Briana MacWilliam. (2017). Complicated Grief, Attachment, and Art Therapy : Theory, Treatment, and 14 Ready-to-Use Protocols. Jessica Kingsley Publishers.

3 Ibid.

4 Tolle, E. (2004) The Power of Now: A Guide to Spiritual Enlightenment. Novato, Canada: Namaste Publishing.

5 Kessler, D., and Kubler Ross, E. (2022). Five stages of grief by Elisabeth Kubler Ross and David Kessler. Grief.com. https://grief.com/the-five-stages-of-grief/#:~:text=The%20five%20stages%2C%20denial%2C%20anger,some%20linear%20timeline%20in%20grief.

6 MacWilliam (2017)

7 Ibid.

8 Ibid.

9 Ibid.

10 Ibid.

11 Tapper, M. L. (2016). Radical acceptance. MedSurg Nursing, 25(1), S1.

12 Ibid.

13 Theriault, B. (2012). Radical Acceptance A Nondual Psychology Approach to Grief and Loss. International Journal of Mental Health & Addiction, 10(3), 354–367.

14 Tapper (2016)

15 Goerg, N., Priebe, K., Bohnke, J. R., Steil, R., Dyer, A. S., & Kleindienst, N. (2017). Trauma-related emotions and radical acceptance in dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse. BORDERLINE PERSONALITY DISORDER AND EMOTION DYSREGULATION, 4, UNSP 15.

16 Cuncic, A. (2022). What is radical acceptance? Verywell Mind. https://www.verywellmind.com/what-is-radical-acceptance-5120614 

17 Try these practices daily for radical self-acceptance. (2019). Yoga Journal, 311, 20.

18 Ibid.

19 Ibid.

20 Ibid.

21 Cuncic (2022)

22 Ibid.

Mindfulness: Armor Against Anxiety

Anxiety Snapshot

Approximately 25% of adults in the United States will experience an anxiety disorder in their lifetime.[1] Feelings of anxiety and worry can stem from regular daily events such as taking an important exam, giving a speech, or going on a first date. Normal occurrences as such will not always point to the presence of an anxiety disorder. However, when feelings of worry and negative thought patterns are chronic and uncontrollable, they can indicate that an anxiety disorder is present.[2] Experiences of anxiety can vary from person to person, and different types of anxiety disorders can provoke various uncomfortable feelings or thought patterns. BetterHelp (2022) lists the ten most common “hallmarks” of an anxiety disorder whether it be generalized anxiety disorder (GAD), panic disorder or social anxiety disorder (i.e., social phobia):[3]

1. Excessive Worry - Experiencing a sense of dread that lasts six months or longer about regular topics such as school, work, social life, relationships, heath, and finances.

2. Difficulty Sleeping - Lying awake at night and not being able to fall asleep due to anxious or fearful thoughts about a possible upcoming event.

3. Fatigue - Feeling exhaustion throughout the day or becoming easily tired even if one gets an adequate amount of sleep.

4. Trouble Concentrating - Procrastinating either knowingly or unknowingly and struggling to complete daily tasks at school or work due to blanking out.

5. Irritability and Tension - Feeling on edge regularly or becoming easily angered when stressed out. Tension can also present itself physically in tense muscles or aches and pains.

6. Increased Heart Rate - Experiencing rapid heart rate or irregular palpitations can occur during panic attacks and episodes of social anxiety. 

7. Sweating and Hot Flashes - Feeling one’s body temperature rise can stem from increased heart rate and higher blood pressure.

8. Trembling and Shaking - Feelings of fear and anxiety can induce limb shaking, especially in the hands. A state of heightened adrenaline and a fight-or-flight response can cause shaking as well.

9. Chest Pains and Shortness of Breath - Limiting the amount of oxygen in the lungs can cause chest pains, particularly during panic attacks. One may feel a sensation of tightness in the chest.

10. Feelings of Terror or Impending Doom - Feeling like something negative is going to occur can happen suddenly and come from an unknown source. Such feelings are likely to be disproportional to the actual events causing anxiety and panic.

Mindfulness Meditation as a Modern Practice

The field of positive psychological research has a common goal of focusing on what can go right in life, also known as positive affect. Positive affect can include enjoyment, personal connection, and states of pleasant feelings.[4] Deliberate trainings of positive emotions are referred to as Positive Psychology Interventions (PPIs); mindfulness meditation (MM) is one of the most effective known PPIs (Morgan, 2021). MM recently made its way into Western culture during the last century and can be defined as, “The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment”.[5] As a result of practicing MM, emotions can be regulated, and physiological and mental changes can occur, enhancing one’s reality.[6] 

Mindfulness meditation manifests in two forms: state mindfulness and trait mindfulness. State mindfulness is the feeling of being present in the moment after practicing MM, whereas trait mindfulness is a practice one carries throughout their life, regardless of knowing about mindfulness or not.[7] There are five approaches one can take when practicing MM:[8]

• Body Scan: Focusing on one’s bodily sensations; typically starting at the top of the head down to the toes.

• Focused Attention: Holding concentration on one object or a specific feeling.

• Open Monitoring: Allowing your mind to wander and focusing on the sensations it naturally is pulled towards while remaining present.

• Mindful Movement: Utilizing practices such as yoga and tai chi to focus on one’s bodily sensations.

• Loving Kindness: Visualizing oneself and others while cultivating feelings of gratitude, forgiveness, and love. First turning inward to oneself and progressing outward toward a cherished friend, a neutral person, a difficult person, and eventually everyone elsewhere.

Loving-Kindness Meditation and Loving-Kindness Coloring

A study conducted in the United Kingdom by Mantzios et al. (2022) found that loving-kindness meditation (LKM) and loving-kindness coloring (LKC) were both successful in decreasing feelings of anxiety.[9] Previously mentioned in the last section, LKM is one of the primary and effective practices that show up in mindfulness meditation. LKC is an alternative practice where one redirects attention to a colorful design such as a mandala and actively observes one’s thought patterns to understand which thoughts are provoking certain feelings.[10] Ultimately, both LKM and LKC showed to partially increase state mindfulness, self-compassion, and decrease anxiety.[11] Having the choice between different meditation practices allows individuals to find what works best for them. Some limitations to the study include: the results were only minimally statistically significant and only included under-graduate students as participants. In the case of such limitations, future research should replicate the same study with more of a general population to improve the external validity of the information.[12]

Coping with Anxious Thought Patterns

Additional mindfulness approaches for coping with anxious and fearful thoughts include: thinking realistically, facing one’s fears, and getting regular exercise.[13]

Think Realistically

A real-life example of coping with anxiety using realistic thinking is when one is experiencing health anxiety. For instance, if an individual feels tired most of the time and wonders, “What if I have cancer and don’t know it?” Catastrophic patterns of thought can cause one to go down roads of fearful thinking that are counterproductive to becoming healthier. 

First, one must identify the distorted thoughts that may be occurring on a regular basis. One way to identify a distorted thought is to change a “what-if?” question to an affirmative statement. For example, change “What if my low energy and fatigue are signs of cancer?” to “Because I have low energy and fatigue, I have cancer.” Then, question the validity of the affirmative statement. For instance, what are the actual odds that low energy and fatigue could be indicative of cancer and not something more simple and likely such as a lack of sleep, being overworked, overstressed or possibly dehydrated? Additionally, considering the results of an unrealistic outcome can bring about feelings of peace: “If the worst did happen, is it really true that I’d not find any way to cope?” Once you have assessed the validity of the statements, replace them with more realistic ones. Since there are several possible explanations for fatigue, the “worst-case” odds of having cancer in this scenario are very low.[14]

Face Your Fears

One of the most effective approaches to overcoming one’s fears is to face them head-on.[15] For individuals that experience phobia-related anxiety, facing fears can seem extremely off-putting. However, exposure should be a gradual, step-by-step process instead of immediate and sudden immersion into a fearful situation. This process, known as exposure therapy, usually involves a comprehensive plan to face one’s phobias when feasible.[16] Phobias are likely to induce avoidance behaviors, which can interfere with normal routines such as work or relationships and cause significant distress. Common phobias include: public speaking, riding in elevators, fear of flying, and fear of heights.[17] Sensitization (i.e., the process in which one becomes overly sensitive to particular stimulus) is a prime factor in the development of phobias. For example, a phobia of giving speeches in public can stem from past negative experiences with public speaking. These prior negative experiences are likely to lead to feelings of physical anxiety (e.g., sweating and shaking) as well as psychological symptoms (e.g., worry and low self-esteem). Real-life exposure allows one to unlearn the connection formed between a situation and an anxious response by re-associating feelings of calmness and confidence with that certain situation.[18] A licensed mental health professional can help direct one how to safely be exposed to stimuli they are afraid of. 

Exercise Your Fears Away 

Bourne and Garano (2016) note that getting regular exercise is one of the most powerful and effective methods to combat feelings of anxiety. The body’s natural fight-or-flight response is activated when faced with a perceived threat bringing along an influx of adrenaline. Exercise acts as a natural outlet for an overwhelming amount of adrenaline, diminishing the tendency to react with an anxious response to one’s fears.[19] Regular exercise has a direct effect on the following various physiological factors associated with anxiety:[20]

• Reduction of Muscle Tension

• Rapid Metabolism

• Discharge of Frustration

• Enhanced Oxygen of the Blood and Brain

• Increased Levels of Serotonin

In addition to physiological factors, there are also several psychological benefits that accompany increased amounts of regular exercise:[21]

• Increased Self-Esteem

• Reduced Insomnia

• Reduced Dependence on Alcohol and Drugs

• Improved Concentration and Memory

• Greater Sense of Control Over Anxiety

If feelings of anxiety are chronic and impact one’s everyday life, steps should be taken to reduce such negative experiences by contacting a licensed mental health professional for further guidance.[22]

Contributed by: Tori Steffen

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Bourne, E. J, & Garano, L. (2016). Coping with Anxiety: Ten Simple Ways to Relieve Anxiety, Fear, and Worry. New Harbinger Publications. https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1197205&site=eds-live&scope=site

2 BetterHelp. (n.d.) How to tell if you have anxiety: 10 signs and symptoms. (accessed 10-20-2022) https://www.betterhelp.com/advice/anxiety/how-to-tell-if-you-have-anxiety-10-signs-and-symptoms/

3 BetterHelp

4 Morgan, W. J., & Katz, J. (2021). Mindfulness meditation and foreign language classroom anxiety: Findings from a randomized control trial. Foreign Language Annals, 54(2), 389–409. https://doi-org.ezproxy.snhu.edu/10.1111/flan.12525

5 Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. 

https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswah&AN=000182986300002&site=eds-live&scope=site

6 Morgan (2021)

7 Ibid.

8 Roeser, R. W. (2016). Mindfulness in students' motivation and learning in school. In K. Wentzel & D. Miele (Eds.), Handbook of motivation in school (pp. 385–487). Taylor and Francis. https://www.researchgate.net/publication/301813078_Mindfulness_in_students'_motivation_and_learning_in_school

9 Mantzios, M., Tariq, A., Altaf, M., & Giannou, K. (2022). Loving-kindness colouring and loving-kindness meditation: Exploring the effectiveness of non-meditative and meditative practices on state mindfulness and anxiety. Journal of Creativity in Mental Health, 17(3), 305–312. https://doi-org.ezproxy.snhu.edu/10.1080/15401383.2021.1884159

10 Mantzios et al. (2022)

11 Ibid.

12 Ibid.

13 Bourne & Garano (2016)

14 Ibid.

15 Ibid.

16 Ibid.

17 Ibid.

18 Ibid.

19 Ibid.

20 Ibid.

21 Ibid.

22 Mantzios et al. (2022)

The Impact of Nervous System Attunement on Social Anxiety

Understanding Social Anxiety

There is a growing body of research elucidating the scientific complexity of communication and information between people in a social context.[1] Neurons transmit information throughout one’s body, but our whole selves interact with the whole selves of other people, as well. Mirror neurons are one key way in which we empathize and connect with others in social situations, and are fundamental to interpersonal connection. In The Whole Therapist podcast, psychotherapists Abby Esquivel and Kellee Clark discuss the importance of mirror neurons and explain that, “When we stick our tongue out to a baby and the baby’s at a developmental age where they stick their tongue out back at us, they’re mirroring what we just did. Those are the mirror neurons firing. And when they fire, they wire together.”[2] In addition to empathy, mirror neurons have also been shown to be involved in understanding the intentions of others.[3,4] The role of mirror neurons is relevant to the discussion of social anxiety, as they can serve as a way of spreading safety to others, while the regulation of our own physiology can signal safety to ourselves. 

Social anxiety is most-common among 18-29 year-olds and about 12.1% of U.S. adults experience social anxiety disorder at some point in their lives. While 31.3% of sufferers experience only mild severity of symptoms, 38.8% report moderate severity, and 29.9% fit into the serious severity category.[5] This disorder can cause significant impairment in daily functioning, especially for those who live in societies that demand regular interaction with others. Not only can it interfere with daily chores like talking to cashiers at the grocery store, but it can hinder participation in class or collaboration in the workplace, prevent people from initiating conversations, and inhibit cultivation of deeper friendships or romantic relationships. 

Social anxiety is experienced as a persistent fear about how one is being perceived.[6] This type of anxiety can be distressing during a social interaction, as well as before and after. People who suffer from social anxiety might try and control others’ perceptions of them by altering their behavior toward what they think is a more desirable way of being. According to Goldin, et al. (2009), people with social anxiety have less neural activation associated with cognitive regulation related to social threat stimuli.[7] In other words, people with social anxiety may struggle to regulate when they feel threatened. Due to neuroplasticity research, we know that brains change and re-shape constantly, which provides hope for those who feel chronically socially anxious.[8,9] If people with social anxiety can introduce a feeling of safety when they ordinarily feel threatened, over time their brains may adapt to react less fearfully in similar contexts. Due to the fact that we simply cannot control or ever know what goes on inside other people’s heads, there is scant evidence in the moment if we have achieved the perspective we seek. Even if others view us favorably in the moment, stress can persist about maintaining that positive regard. Therefore, we must shift our energy away from trying to control others’ perceptions and focus more on the internal responses that occur within our bodies when a threat is registered. 

Symptoms

Figure 1

Note: This figure was based on a chart produced by Trudeau, K. (2020). [10] 

Rehearsal and role-play, exposure treatments, and cognitive behavioral therapy all serve as common psychotherapeutic treatments for social anxiety. SSRIs, MAOIs, and Benzodiazepines are medications that may provide relief as well.[11] However, one type of intervention that can be implemented immediately and without professional supervision is the attunement to one’s own nervous system. Our nervous systems guide our behavior.[12] Whether we are in fight, flight, freeze, or a state of safety, the way in which we interact and function will look different depending on which state we’re in. For instance, if someone has anxiety about driving, when they merge on the freeway they may experience tunnel vision, increased blood pressure, increased muscle tension, a release of stress hormones, and be distracted and irritable to others in the car.[13] Alternatively, if one is in a state of safety when checking out at the grocery store, they may take their time bagging their food and chat with the cashier. Or, they might decide not to engage in conversation with the employee, but remain calm in the absence of discussion. Someone with social anxiety may experience rapid thoughts in the silence or a subtle tightness in their shoulders as they wonder whether they should say something. By tuning into one’s nervous system, it is possible to determine whether one is in fight-or-flight mode and then carry out an exercise to shift into a state of safety. Gaining this awareness can help with emotional regulation by following up with breathing and muscle relaxation strategies.

Neuroscientist Stephen Porges developed Polyvagal Theory (1994) to explain the relationship between the nervous system and human behavior. This theory postulates that our bodies constantly scan and survey our environments, registering different stimuli as safe or threatening.[14] When safety is detected, the parasympathetic nervous system engages; when threatening stimuli are detected, the sympathetic nervous system engages. When the latter system activates, our bodies automatically release stress hormones, heart rates increase, and digestion slows to prepare us to fight or flee for survival.[15] Through mirror neurons, when we self-regulate through intentional physiological relaxation, it is likely that we will communicate more calmness and safety subconsciously through tone of voice, posture, and gestures.[16] Not only will this decrease the felt experience of social anxiety within oneself, but there is an added benefit of spreading calmness and openness to those we are interacting with. We therefore can spread safety to others through attuning to ourselves.

By manually regulating our nervous system through mindful awareness and muscle relaxation techniques, we can train our bodies to realize that socializing is not threatening.[17,18] The repetition of this practice can eventually lead to quicker parasympathetic (rest) responses and decrease the intensity of socially-activated anxiety. Further, since social anxiety is widely experienced as the fear of rejection, it may be comforting to consider that there is a smaller likelihood of being rejected if one comes across as emotionally stable, confident, and open-minded.[19] Even if one can’t achieve a certain image of perfection in another’s mind, people remember most vividly how they felt during an experience--  including social interactions. Making others feel comfortable and safe through one’s own authenticity and comfortability can lead to trust building as well as positive regard, which is potentially helpful for the rational part of the socially anxious mind. However, the point of this article is not to encourage or reinforce the tendency or desire to control others’ perceptions about oneself. Ultimately, the only control we have is over how much we practice mindful awareness of physical sensations during an anxious moment and then intervening with the following techniques:

Paced Breathing for Nervous System Relaxation

Breathing is one simple, yet powerful, way to move our systems out of a state of fight-or-flight. Inhaling activates the sympathetic nervous system (fight-or-flight), while exhaling activates the parasympathetic nervous system (rest and digest).[20] Therefore, there is an important caveat to be aware of when taking a deep breath: to effectively calm down, the exhale should be longer than the inhale. One exercise to try is breathing in for 4 counts, holding the breath for 7 counts, and exhaling for 8 counts. Any variation on these numbers should still elicit a calming response if the exhale is noticeably longer than the inhale.[21] 

Figure 2

Note: This figure was produced by Reddy, S. (2021).[22] 

Muscle Relaxation for the Nervous System

Mindfulness of the physical body is the other critical piece of tuning into one’s nervous system.[23] Catching oneself feeling socially anxious is ideal, because one can then question: what areas of my body are tense right now? First, just notice if the shoulders, jaw, stomach, or any other area are carrying tension. Exhaling, while releasing tension in those body parts, signals safety and relaxation to the brain. This exercise can be used during a social interaction, as well as when one is alone and feeling anxiety. Both of these methods serve as ways of “hijacking” the autonomic nervous system and reducing the automatic fight-or-flight response that happens when threat and danger are subconsciously detected.

Figure 3

Note: This figure was produced by Innovasium Cam’s Kids [24]

The goal is not to be calm all the time, because stress and anxiety are important and adaptive feelings that provide necessary information about our environments. Rather, the goal is to have a flexible nervous system that can smoothly flow into a state of fight-or-flight when there is a real threat and then back to a state of safety when one is not in danger. In moments where a threat is registered by the nervous system but one knows that they are actually safe, moving the body out of a physiological panic response can 1) be rapidly calming, 2) help rewire neural associations between safety and socializing, and 3) communicate safety and openness to others. Due to mirror neurons, when we can regulate and calm our systems, other people can also pick up on that safety and regulation and feel more receptive, open, and secure. This can serve as an incentive to practice mindfulness of one’s nervous system, because effective communication usually occurs when people feel safe. 

Dr. Fallon Goodman, researcher of social anxiety at University of San Francisco, says that we must foster social courage “knowing that rejection lurks right around the corner.” Furthermore, Goodman says to “Pursue experiences knowing that the chances of rejection are not zero. In fact, the chances that you get rejected at some point in your life-- at some point this year-- are high.” We must pursue the things that are meaningful to us and remember that the successes of those pursuits do not determine our worth as human beings.[25] 

For more information, click here to access an interview with Psychologist Kevin Chapman on panic & social anxiety.

Additionally, you may click here to access an interview with Venerable Thubten Chodron on meditation & anxiety.

Contributed by: Maya Hsu

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

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