Managing ADHD: Medication, Psychotherapy, and the Potential of Music Therapy

The ABCs of ADHD

ADHD is a prevalent neurodevelopmental disorder that primarily manifests in childhood and often continues into adulthood and is characterized by difficulties in maintaining attention, controlling impulsive behaviors (acting without considering the consequences), and excessive levels of activity.[1] It impacts approximately 11 percent of children attending school; in over 75 percent of cases, symptoms persist into adulthood. Although individuals with ADHD have the potential for success, it is crucial to identify and treat the condition appropriately and in a timely manner. Without proper intervention, ADHD can lead to significant consequences, including academic difficulties, strained family relationships, emotional distress, challenges in forming and maintaining social connections, substance misuse, involvement in delinquent behaviors, accidental injuries and difficulties in employment. Early identification and timely treatment play a vital role in mitigating these potential effects.[2] There are a number of intervention methods for people who experience symptoms of ADHD.

Common Treatments

Two common treatments for ADHD include medication and psychotherapy. 

Medication

ADHD medication is used to address the symptoms such as hyperactivity and impulsiveness.[3] 

Types of ADHD Medication Include:[4]

• Stimulants

• Non-stimulants

• Antidepressants 

Stimulants, such as medications containing methylphenidate or amphetamine, are the usual primary prescriptions for ADHD. These stimulants seem to enhance and stabilize the levels of neurotransmitters, which are brain chemicals responsible for various functions.[5] However, stimulants are classified as controlled substances, implying that they possess the risk of being misused or leading to substance use disorders.

Additional medications utilized in ADHD treatment consist of non-stimulant options (e.g., atomoxetine) and certain antidepressants (e.g., bupropion).[6] While non-stimulants are prescription medications, unlike stimulants, they are not classified as controlled substances. As a result, the risk of improper use or dependency is lower with non-stimulant medications. These medications function by elevating the levels of norepinephrine in the brain. Healthcare providers may prescribe non-stimulant medications either on their own or in conjunction with a stimulant for managing ADHD. 

Antidepressants are also used to treat symptoms of ADHD. The antidepressants commonly prescribed for ADHD primarily target the levels of dopamine and norepinephrine in the brain.[7] While atomoxetine and antidepressants have a slower onset of action compared to stimulants, they can still be viable choices when stimulants are not suitable due to health issues or when the side effects of stimulants are too severe for someone.[8] 

Psychotherapy

Psychotherapy is frequently utilized alongside medication to address mental health conditions. Depending on the situation, medication might be the more appropriate choice in some cases, while psychotherapy may be the preferred option in others.[9] 

Psychotherapy can assist people with ADHD in various ways:[10]

• Enhancing time management and organizational abilities 

• Teaching techniques to minimize impulsive behavior 

• Fostering improved problem-solving skills 

• Dealing with past academic, work, or social challenges 

• Boosting self-esteem

• Learning methods to strengthen relationships with family, co-workers, and friends

• Developing strategies to manage anger effectively

The typical forms of psychotherapy for ADHD treatment include cognitive behavioral therapy (CBT), marital counseling and family therapy. CBT involves a structured approach to teach skills for behavior management and transforming negative thought patterns into positive ones. It aids in handling life challenges like school, work, or relationship issues and also addresses other mental health conditions such as depression or substance misuse.[11] Marital counseling and family therapy aim to assist family members in coping with the challenges of living with someone who has ADHD. They provide tools and techniques to improve communication and problem-solving skills within the family dynamic.[12] 

Music Therapy

There is another form of psychotherapy that can be utilized for treatment of the symptoms of ADHD known as music therapy. Music therapy is a form of psychotherapy that follows a systematic process of intervention. The therapist employs musical experiences and the relationships that evolve from them as dynamic catalysts for promoting health in the client.[13]

During a music therapy session, a patient may:[14]

• Create music

• Sing music

• Listen to music

• Move to music

• Discuss lyrics

• Play an instrument

Music plays an inherent role in the human experience, eliciting responses related to pulse, rhythm, breathing, movement and a wide array of emotions. These deep connections with music can persist even in the face of disabilities and illnesses. As a result, music therapists and counselors can effectively use music to assist individuals, both children and adults, who have diverse needs arising from various causes such as learning disabilities, mental and physical illnesses, physical and sexual abuse, stress and terminal illnesses. Through interactive musical experiences, emotional, cognitive and developmental needs can be addressed.[15] The ADHD brain exhibits reduced levels of dopamine, a neurotransmitter that plays a crucial role in motivation, attention, working memory, and focus. Music has the unique ability to activate both hemispheres of the brain, facilitating comprehensive brain engagement, allowing the activated components to collaborate more effectively and potentially strengthen over time. Consequently, this process enhances motivation and improves the capacity to concentrate.[16]

A number of studies have highlighted the positive effects of music therapy on people with ADHD. One study conducted by Zhang et al. (2017) aimed to assess the effectiveness of music therapy in improving attention, behavior, and social skills in children and adolescents with ADHD. Music therapy was associated with a significant reduction in hyperactivity and impulsivity, and improvements in attention, social skills, and academic performance.[17] Another study by Park et al. (2023) investigated the effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability. The results showed that both music therapy and pharmacotherapy were effective in reducing depression symptoms.[18]

If you are interested in finding out if Music Therapy can benefit you, you can access the American Music Therapy Association’s provider link here. 

If you or someone you know has or suspects that they have ADHD, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.

Contributed by: Ananya Kumar

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

References

1 Centers for Disease Control and Prevention. (2022). What is ADHD?. CDC.

https://www.cdc.gov/ncbddd/adhd/facts.html#:~:text=ADHD%20is%20one%20of%20the,)%2C%20or%20be%20overly%20active

2 Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2023). About ADHD - Overview. CHADD. https://chadd.org/about-adhd/overview/ 

3 Mayo Clinic. (2023). Adult attention-deficit/hyperactivity disorder (ADHD). https://www.mayoclinic.org/diseases-conditions/adult-adhd/diagnosis-treatment/drc-20350883#:~:text=and%20certain%20medications-,Treatment,they%20don%27t%20cure%20it

4 Cleveland Clinic. (2022). ADHD Medication. https://my.clevelandclinic.org/health/treatments/11766-adhd-medication

5 Mayo Clinic

6 Ibid.

7 Cleveland Clinic

8 Mayo Clinic

9 Bhatia, Richa. (2023). What is Psychotherapy?. American Psychiatric Association. https://www.psychiatry.org/patients-families/psychotherapy

10 Mayo Clinic

11 Ibid.

12 Ibid.

13 Zhang F, Liu K, An P, You C, Teng L, Liu Q. Music therapy for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2017 May 2;2017(5):CD010032. doi: 10.1002/14651858.CD010032.pub2. PMCID: PMC6481398.

14 Music Therapy. (2020). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/8817-music-therapy

15 Zhang (2017)

16 Attention Deficit Disorder Association. (2022). Can Music Therapy Help with ADHD?. ADDA. https://add.org/can-music-therapy-help-with-adhd/

17 Zhang (2017)

18 Park, J. I., Lee, I. H., Lee, S. J., Kwon, R. W., Choo, E. A., Nam, H. W., & Lee, J. B. (2023). Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability. BMC complementary medicine and therapies, 23(1), 73.

Exploring The Psychological Impacts of Pornography

Porn: The Widespread Taboo

Pornography is the most available it has ever been due to online accessibility. Consequently, the more views that pornography accumulates, the increasing amount of societal and psychological consequences people face. This includes, but is not limited to: stereotyping of gender and racial fetishes, sexual violence and misconduct, sex misinformation, content addiction, and sex worker stigmas. Solano et al. (2020) found that among a sample of 1,392 adults in the U.S. (ages 18 to 73), 91.5% of men and 60.2% of women reported that they had engaged in some type of pornography within the past month.[1] Exposure to sexual content seems to be a frequent and inevitable component of being connected to the internet. However, a wave of sexual health research indicates its usage is not inherently negative. Discussions surrounding the psychological impacts of pornography provide insights into how porn can be distributed in healthy ways while also reducing negative consequences. Understanding this research is pivotal in approaching mental health and its relationship with pornography in an exponentially growing online world.

Understanding Pornography

Pornography exists in a variety of forms ranging from written, still imagery, video and auditory content. The Merriam-Webster Dictionary defines pornography as the depiction of erotica for sexual enhancement or excitement.[2] Free online platforms invite higher usage of video content than other forms of porn.[3] Additionally, Solano et al. (2020) found that women are more likely to consume written porn than men.[4] Reasons for pornography usage were researched by Burtăverde et al. (2021), who found that many people seek content for short-term sexual enjoyment and masturbation.[5] Likely due to its increased availability, pornography viewership is also beginning at younger ages; among responses from university students, Biota et al. (2022) found that porn usage began at an average age of 10.4 years, with those partaking primarily out of curiosity.[6] Further, as many students from this study reported feeling that their sex education has been inadequate, this perceived lack of education has likely led to their increased search for sexual information online, through porn.[7] 

Opinions about users of porn, as well as actors, vary by culture and social norms. Societal attitudes about the motivations behind pornographers were studied by Evans-DeCicco & Cowan (2001) in which male performers were perceived as having more positive motivations for partaking in porn production (such as enjoying their work and being at the top of their profession) as opposed to female performers.[8] Female performers were more often than men perceived/stereotyped to come from dysfunctional families, have a lack of employment opportunities and be coerced into the work.[9] Additionally, Perry & Whitehead (2022) point out that in the U.S., the desire for anti-pornography legislation is predicted by Christain nationalism and strict values of sexual order.[10] 

The Neuroscience of Pornography & Addiction

Pornography addiction is not considered a DSM-5 categorized disorder, however, concern exists about the adverse effects of over-watching porn. For instance, Egan & Parmar (2013) note that online porn usage can be reflective of compulsive tendencies in men.[11] Market et al. (2021) also found that for men with higher sexual motivation, attention to pornographic pictures was enhanced but that there were also no connections made with symptoms of cybersex addiction.[12] A study done by Wang et al. (2022) likewise found that people with problematic internet pornography use display higher attention and brain responses to new sexual stimuli, maintaining a cycle of problematic porn consumption when they are presented with more porn.[13] Further, Biota et al. (2022) found that the self-perceived negative effects of pornography use were mainly decreased sexual satisfaction and the need for more stimuli and longer stimulation, suggesting possible reasons for cyclical tendencies.[14]

Behavioral addictions in the brain impair reward systems through the frontal lobes via hyprofrontal syndromes (i.e., cerebral dysfunctions of addiction) leading to compulsivity and flawed judgment;[15] substance abuse, internet gaming disorder, compulsive eating and trauma may change the brain in the same way.[16] More research is warranted for problematic hypersexual tendencies and pornography use, as its general consumption may be completely healthy, while its over-usage may be indicative of compulsive tendencies.

Psychological Effects of Pornography

The sheer variety of porn produced has resulted in a range of negative and positive psychological effects on viewers, reflected in several conflicting pieces of evidence in the research. Since 2016, 17 states have introduced nonbinding resolutions declaring pornography a public health crisis, with concerns ranging from infidelity, addiction and sex trafficking.[17] Conversely, Nelson & Rothman (2020) report that porn, itself, does not meet the criteria for a public health crisis and that it has also been found to increase feelings of acceptance and health-promoting behaviors such as increased intimacy, communication and safer sexual practice.[18]

However, other researchers have found negative psychological and behavioral associations with pornography. In examining the link between porn and body image, Gewirtz-Meydan & Spivak-Lavi (2023) found that increased porn usage related to more body comparisons being made as well as an increase in eating disorder symptoms in men.[19] Additionally, Rostad et al. found that porn exposure is associated with teen dating violence and aggression (with a higher effect in boys than girls),[20] and Kohut, & Štulhofer (2018) note that porn use is associated with low adult quality of life.[21] 

These associations, however, do not imply a causal relationship with porn. Such consideration may be informative of the demographics of porn users, as porn may be used to improve or satisfy already-impaired psychological states.[22] Kohut, & Štulhofer add that controlling for external factors in an individual’s life (such as family environment and impulsiveness) may help us understand what porn actually does to our mental health.[23] While Mollaioli et al. (2021) found that more sexual activity is generally related to better mental health with lower participant depression and anxiety scores,[24] one must be aware that viewing certain portrayals in porn (e.g., flawless body image, condomless sex and violent fetishization), as well as a user’s dispositions may actually result in adverse effects. 

Relationship Function & Dysfunction

Kohut et al., (2021) investigated the notion that pornography use leads to poor relationship quality and satisfaction and found that differences in partner sex drive is what actually accounts for discrepancies in relationship quality.[25] Differences in sex drive can lead to differences in porn usage among partners, which leads to varied perceptions of the relationship and each person’s sexual satisfaction.[26] Further, when respondents were generally less accepting of porn, more porn usage led to lower perceived relationship satisfaction - but when men were more accepting of porn, they indicated higher relationship satisfaction.[27] These findings provide insight into the effects of the meaning that one places on using pornography, and how the stigmatization of its usage infiltrates itself into relationships.

Addressing The Issues

While the topic of sex and pornography is incredibly taboo in most cultures, increased dialogue surrounding the effects of pornography is important to promote mental health and safe porn use. Porn that portrays harmful aspects of society like nonconsent (i.e., assault) is damaging, such as instances where porn is leaked or promoted without the consent of the people involved.[28] Gius (2022) notes these leaks are societally perceived as extremely negative due to sexism and gender inequality, leading to social pressure on the assaulted/exposed individuals and even suicide.[29] 

Hilton & Watts (2011) add that some people argue for all porn usage to be viewed from a public health lens due to factors ranging from stigmatization of sex to addiction research.[30] Others believe that explicit sexual content is inevitable and that while compulsive use can be targeted with treatment, outlawing porn will not alter its use. Reducing life-impairing over-usage of pornography may be achieved through psychotherapeutic methods and Camilleri et al. (2021) found that morals, faith, and individual motivation were the most effective factors in reducing porn use.[31] Historically, since anti-sex views have not taken away sex from people, approaching porn in an open and informed way may help younger generations form healthy practices. 

For adolescents, sex education regarding healthy, consensual sex may help to reduce the harmful effects of mainstream porn content. Consuming online porn is among the many factors for intimate partner violence among young people.[32] Pathmedra et al. (2023) note that adolescent exposure to sexual content has a large role in establishing healthy sexual and romantic relationships - but acknowledge that it also has a role in establishing unhealthy relationships.[33] A conscientious approach to the way that porn is produced would be beneficial regarding the stereotypes and values it projects to its audiences.[34]

Overall, pornography usage is self-perceived as positive among both adolescents[35] and adults.[36] Additionally, an increased amount of people are participating in generating pornography through online platforms (such as OnlyFans), where they can personally capitalize off of content creation more lucratively than many professional productions and mainstream career paths. Further, Toder & Barak-Brandes (2022) examined homosexual WhatsApp exchanges for profit and discussed how it grants users sexual freedom, escaping from paths of porn careers that promote unethical sex.[37] 

Sexual openness and literacy may help to reduce the negative effects of pornography. Biota et al. (2022) stress that since people tend to consume porn at early ages, sex education needs to be tailored so that people can have a normalized understanding of porn and what is healthy.[38] Further, this education may aid in helping people identify what is unethical and ethical in portrayals of sex so that rape culture and violence are not perpetuated by porn. Regarding problematic or compulsive porn usage, Testa et al. (2023) note that promoting media literacy is an effective strategy to use in order to develop greater critical thinking skills, reduce the shame associated with porn, recognize unrealistic productions of sex and interpret the meaning behind what is being viewed, thereby creating healthier choices. In addition, cognitive behavioral therapy (CBT) and mindfulness-based therapies are evidence-based modalities that can help with compulsive porn usage.[39] Many different factors combine to create the negative mental health and societal effects of porn, and these may be generally addressed through open and updated sex perspectives, in addition to conscientiousness surrounding porn production and distribution. 

If one is experiencing problematic pornography consumption that impairs well-being, relationships and/or daily life, 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 Solano, I., Eaton, N. R., & O'Leary, K. D. (2020). Pornography Consumption, Modality and Function in a Large Internet Sample. Journal of sex research, 57(1), 92–103. https://doi.org/10.1080/00224499.2018.1532488 

2 Merriam-Webster. (n.d.). Pornography. In Merriam-Webster.com dictionary. Retrieved July 3, 2023, from https://www.merriam-webster.com/dictionary/pornography 

3 Ibid.

4 Ibid.

5 Burtăverde, V., Jonason, P. K., Giosan, C., & Ene, C. (2021). Why Do People Watch Porn? An Evolutionary Perspective on the Reasons for Pornography Consumption. Evolutionary Psychology, 19(2). https://doi.org/10.1177/14747049211028798

6 Biota, I., Dosil-Santamaria, M., Mondragon, N.I., Ozamiz-Etxebarria, N. (2022). Analyzing University Students' Perceptions Regarding Mainstream Pornography and Its Link to SDG5. Int J Environ Res Public Health. Jun 30;19(13):8055. doi: 10.3390/ijerph19138055. PMID: 35805712; PMCID: PMC9265877.

7 Ibid. 

8 Evans-DeCicco, Jennee & Cowan, Gloria. (2001). Attitudes Toward Pornography and the Characteristics Attributed to Pornography Actors. Sex Roles. 44. 351-361. 10.1023/A:1010985817751.  

9 Ibid.

10 Perry, S. L., & Whitehead, A. L. (2022). Porn as a threat to the mythic social order: Christian nationalism, anti-pornography legislation, and fear of pornography as a public menace. Sociological Quarterly, 63(2), 316-336. doi:10.1080/00380253.2020.1822220 

11 Egan, V., & Parmar, R. (2013). Dirty habits? Online pornography use, personality, obsessionality, and compulsivity. Journal of sex & marital therapy, 39(5), 394–409. https://doi.org/10.1080/0092623X.2012.710182

12 Markert, C., Baranowski, A. M., Koch, S., Stark, R., & Strahler, J. (2021). The impact of negative mood on event-related potentials when viewing pornographic pictures. Frontiers in Psychology, 12 doi:10.3389/fpsyg.2021.673023

13 Wang, J., Chen, Y., & Zhang, H. (2022). Electrophysiological evidence of enhanced processing of novel pornographic images in individuals with tendencies toward problematic internet pornography use. Frontiers in Human Neuroscience, 16 doi:10.3389/fnhum.2022.897536 

14 Biota et al. (2022)

15 Hilton DL, Watts C. Pornography addiction: A neuroscience perspective. Surg Neurol Int. 2011 Feb 21;2:19. doi: 10.4103/2152-7806.76977. PMID: 21427788; PMCID: PMC3050060.

16 Ibid.

17 Nelson, K. M., & Rothman, E. F. (2020). Should Public Health Professionals Consider Pornography a Public Health Crisis?. American journal of public health, 110(2), 151–153. https://doi.org/10.2105/AJPH.2019.305498

18 Ibid.

19 Gewirtz-Meydan, A., & Spivak-Lavi, Z. (2023). The association between problematic pornography use and eating disorder symptoms among heterosexual and sexual minority men. Body Image, 45, 284-295. doi:10.1016/j.bodyim.2023.03.008

20 Rostad et al. (2019)

21 Kohut, T., & Štulhofer, A. (2018). Is pornography use a risk for adolescent well-being? An examination of temporal relationships in two independent panel samples. PloS one, 13(8), e0202048. https://doi.org/10.1371/journal.pone.0202048 

22 Ibid.

23 Ibid.

24 Mollaioli, D., Sansone, A., Ciocca, G., Limoncin, E., Colonnello, E., Di Lorenzo, G., & Jannini, E. A. (2021). Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. The journal of sexual medicine, 18(1), 35–49. https://doi.org/10.1016/j.jsxm.2020.10.008

25 Kohut, T., Dobson, K. A., Balzarini, R. N., Rogge, R. D., Shaw, A. M., McNulty, J. K., Russell, V. M., Fisher, W. A., & Campbell, L. (2021). But What's Your Partner Up to? Associations Between Relationship Quality and Pornography Use Depend on Contextual Patterns of Use Within the Couple. Frontiers in psychology, 12, 661347. https://doi.org/10.3389/fpsyg.2021.661347 

26 Ibid.

27 Maas, M. K., Vasilenko, S. A., & Willoughby, B. J. (2018). A Dyadic Approach to Pornography Use and Relationship Satisfaction Among Heterosexual Couples: The Role of Pornography Acceptance and Anxious Attachment. Journal of sex research, 55(6), 772–782. https://doi.org/10.1080/00224499.2018.1440281

28 Gius, C. (2022). Addressing the blurred question of ‘responsibility’: Insights from online news comments on a case of nonconsensual pornography. Journal of Gender Studies, 31(2), 193-203. doi:10.1080/09589236.2021.1892610 

29 Ibid.

30 Hilton & Watts (2011)

31 Camilleri, C., Perry, J. T., & Sammut, S. (2021). Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United States. Frontiers in Psychology, 11, Article 613244. https://doi.org/10.3389/fpsyg.2020.613244

32 Barter, C., Lanau, A., Stanley, N., Aghtaie, N., & Överlien, C. (2022). Factors associated with the perpetration of interpersonal violence and abuse in young people’s intimate relationships. Journal of Youth Studies, 25(5), 547-563. doi:10.1080/13676261.2021.1910223

33 Pathmendra, P., Raggatt, M., Lim, M. S. C., Marino, J. L., & Skinner, S. R. (2023). Exposure to pornography and adolescent sexual behavior: Systematic review. Journal of Medical Internet Research, 25 doi:10.2196/43116

34 Ibid. 

35 Dwulit, A. D., & Rzymski, P. (2019). Prevalence, Patterns and Self-Perceived Effects of Pornography Consumption in Polish University Students: A Cross-Sectional Study. International journal of environmental research and public health, 16(10), 1861. https://doi.org/10.3390/ijerph16101861

36 Hald, G.M., Malamuth, N.M. Self-Perceived Effects of Pornography Consumption. Arch Sex Behav 37, 614–625 (2008). https://doi.org/10.1007/s10508-007-9212-1

37 Toder, N., & Barak-Brandes, S. (2022). A booty of booties: Men accumulating capital by homosocial porn exchange on WhatsApp. Porn Studies, 9(2), 145-158. doi:10.1080/23268743.2021.1947880  

38 Biota et al. (2022)

39 Testa, G., Mestre-Bach, G., Chiclana Actis, C., & Potenza, M. N. (2023). Problematic pornography use in adolescents: From prevention to intervention. Current Addiction Reports, 10(2), 210-218. doi:10.1007/s40429-023-00469-4  

Anxious Attachment: Self-Sabotaging Romance

Growing the Roots of Attachment 

A child hides behind his mother’s leg, crying and tugging on her jeans, begging her to stay with him. She gently pulls him off of her, and guides him into the classroom with all of the other students who are now in the caring hands of the teacher. The child is clearly in distress, now wailing and screaming loudly as his mother walks away. The teacher tries to calm him down by rubbing his back and offering him toys, but it seems as if nothing will soothe this anxious child. This is a common experience for many young children when they are first separated from their parents and sent off to school - and most children grow out of this issue. However, if this display of extreme anxiety persists as the child grows older, it can be a telltale sign of having anxious attachment.[1]

Anxious attachment is one of the four attachment styles: secure, avoidant, ambivalent, and disorganized. Developing at a young age, anxious attachment style can carry on into adulthood, at various degrees. A few important signs/symptoms in a child include:[2] 

• Severe distress when separated from caregivers

• Fear of strangers

• Extreme clinginess to caregivers

• Little desire for exploration for the environment around them

• Behaviors of aggression

Although the anxious attachment style is more easily visible in infants and children (due to their higher likelihood of displaying adverse reactions) it exists in adults, as well. Adult attachment is important to investigate in romantic relationships, as one’s attachment style  impacts how they think, act and feel.[3]

Forming Attachment: Nature vs. Nurture? 

Attachment forms regardless of one’s gender.[4] To understand the basis of anxious attachment, the evolutionary perspective can be applied; the instinctive reason why children feel an intense desire to stay close to their parents is because children are vulnerable and seek protection, especially when distressed. Protection by their caregiver increases chances of survival (which is the fundamental basis of natural selection) causing the genes coding for this anxious attachment style to be passed onto future generations.[5]

However, anxious attachment is not solely a product of genetics and evolutionary patterns - it is also affected by environment and interpersonal relationships in an individual’s life. For example, a caregiver who is consistently neglectful towards a child will likely induce feelings of stress in the child. This neglect may be displayed by the caregiver as turning away and ignoring the child when he/she cries for comfort or attention. If the child’s emotional needs are persistently failing to be met, it may cause them to develop an anxious attachment style; this can continue later into life and project on their romantic relationships, as well.[6]

How an individual is treated by others, especially in a time of stress, has a serious impact on the attitudes and expectations they carry into the rest of their lives. If a child has been conditioned to learn that when they are upset, they cannot count on their caregiver for support, they may develop an anxious attachment style. This type of insecure attachment style could have been avoided if the caregiver had more quickly and reliably attended to the crying child. Being able to count on their caregiver for assurance and comfort allows for the formation of a secure attachment style. 

In these examples, the caregiver serves as a working model for the child. A “working model” is a significant person (e.g., a parent, friend or romantic partner) who shows various levels of responsiveness to an individual’s extreme desire for comfort and support in interactions. The working model also includes one’s self, and how they themselves respond themselves to others when they desire closeness. Working models guide an individual's future attitudes and expectations towards relationships (especially during stressful times) based on how they have been responded to in the past. Thus, working models shape an individual’s type of attachment style.[7]

Attachment in Romantic Relationships

As we grow into adults, insecure attachment styles can divide into one of two main categories in a romantic relationship: avoidant and anxious. Avoidant adults tend to hold more negative views of their romantic partners, and value the maintenance of independence and autonomy in their relationships. They generally act this way because they have internally decided that seeking further proximity/closeness to their romantic partner is not possible or not desirable.[8] They are overall less interested in their relationships, and maintain psychological and emotional independence from their partners. They do not feel as comfortable with having closeness and emotional intimacy.[9]

Conversely, anxious adults tend to be very invested in their romantic relationships, and want to be emotionally and physically close to their partner to avoid worry and feel more secure. Anxious individuals tend to worry that their partner will reject or abandon them. Due to the deep-rooted distress from childhood, causing them to question the availability of their caregivers, highly anxious individuals strongly question whether they can count on their partner’s presence. For this reason, they often heavily crave a lot of support, emotional intimacy, and reassurance.[10] 

Anxious adults will hold more negative views of themselves, and more positive views of their partner. They tend to feel underappreciated or highly distressed and worry that they cannot depend on their partner or that their partner will leave them. Their partner leaving would lead them to question their own worth. Anxious individuals will also use unfavorable coping strategies to react to chronic distress they feel regarding the security in their romantic relationships; this ironically can lead to a less stable and less satisfying relationship. Gender differences do not necessarily impact whether an individual will display more avoidant or anxious attachment styles, and their potential relationship outcomes.[11] 

Signs of anxious attachment style in adults that reflect in their romantic relationships include:[12]

• Constant worry that their partner will leave them

• Extreme distress when separated from their partner

• Needing constant reassurance 

• Hypersensitive to rejection 

• High sensitivity and emotional reactivity to partner’s actions 

• Negative self-view compared to a much more positive view of partner

• Very afraid of being alone 

• Overanalyzing minor events/words/actions

• Intensifying degree of relationship-threatening cues

Ending the Cycle of Self-Sabotage

If you are experiencing anxious attachment, and it is negatively affecting your relationships by causing high levels of distress and worry, there are many ways you can learn to self-soothe and heal, to develop a more secure attachment style. It is important to recognize that distance/separation from your partner, or the uncertainty of the future, is not actually a reason to be emotionally distressed. It is important to start perceiving yourself, your partner and your relationship more positively, rather than negatively, and actmore constructively. To help learn these steps, a licensed mental health provider (e.g., psychotherapist) can guide someone through cognitive behavioral therapy (CBT) which teaches these evidence-based methods.

This control of emotions and thoughts is known as self-regulation. Calming oneself during moments of internal distress can be achieved by activities such as exercise, walks, taking deep breaths, journaling and meditation. In the long run, however, anxious individuals must work on creating a better self-image and creating healthy boundaries for themselves. Finding hobbies and things you enjoy doing, pursuing them, and building a positive self-image though that can be extremely beneficial to healing your anxious attachment and overbearing need for external support from a partner. It is vital to learn to be content with yourself, and only pursue healthy relationships to avoid the internal stressors associated with an anxious attachment style.[13] 

To reduce the distress one may experience when they desire greater intense proximity to a romantic partner, one must actively use coping strategies to avoid needing constant reassurance and support. This is because if this constant intense desire for proximity and support is met by a romantic partner, the anxious attachment system stays activated, continuing the cycle of distress and fear of rejection in a relationship. Actively breaking away from the cycle and deactivating the anxious attachment system requires one to tire of needing constant physical and emotional proximity. It is also crucial for one to actively begin viewing their partner’s actions and words in a more positive light during stressful times. This will help avoid the anxious anticipation of the worst-case outcome in every situation.[14]

Negative views and attributions towards a romantic partner due to the anxious attachment style decreases relationship satisfaction. These negative perceptions also feed into the cycle of anxious attachment. The only way to overcome this is to self regulate and manage internal stressors to cope with stressful events within one’s relationship. These pessimistic attributions may also be linked to higher cortisol levels in the anxious partner, especially after discussing a conflict. This physiological stress is not only detrimental to one’s health, but can also reflect in the overall relationship satisfaction of both individuals. This is because the attachment behaviors of one partner will affect the other as well, in terms of their behavior and level of relationship satisfaction.[15]

The actor-partner interdependence model (APIM) was implemented by Kimmes et al. (2015) to understand the relationship between one partner’s attributions and the other partner’s relationship satisfaction over time. The results of this study showed a significant negative association between pessimistic attributions of one partner and the relationship satisfaction level of the other. This data indicates that the attributions which stem from anxious attachment from one partner negatively affects relationship satisfaction in the other, emphasizing the importance of overcoming anxious attachment to achieve a more stable and satisfactory romantic relationship.[16]

If you feel you are suffering from an anxious attachment style and it is negatively impacting your relationships, a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) can offer guidance and support.

Contributed by: Ananya Udyaver

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

References

1 Evans, O. G. (2023, June 8). Anxious attachment style: Signs in adults, how it develops & How to Cope. Simply Psychology. https://www.simplypsychology.org/anxious-attachment-style.html#Signs-in-Children 

2 Ibid. 

3 Simpson, J. A., & Steven Rholes, W. (2017, February). Adult attachment, stress, and romantic relationships. Current opinion in psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845754/ 

4 Ibid.

5 Ibid.

6 Ibid.

7 Ibid.

8 Evans, O. G. (2023, June 8)

9 Campbell, L., & Marshall, T. (2011, February 7). Anxious attachment and relationship processes: An Interactionist Perspective. Journal of Personality. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-6494.2011.00723.x  

10 Ibid

11 Ibid.

12 Simpson, J. A., & Steven Rholes, W. (2017, February).

13 Campbell, L., & Marshall, T. (2011, February 7)

14 Kimmes, J. G., Durtschi, J. A., Clifford, C. E., Knapp, D. J., & Fincham, F. D. (2015). The role of pessimistic attributions in the association between anxious attachment and relationship satisfaction. Family Relations, 64(4), 547–562. https://doi.org/10.1111/fare.12130  

15 Ibid.

16 Ibid.

Revamping the Conversation on Love Languages

“What’s your love language?” is a Pigeonhole

As a quick and simple way to try and glean compatibility or greater understanding of another, it has become trendy to ask people the question, “What’s your love language?” In order to talk about love languages in a way that builds deeper connection and understanding, the question we should really be asking is “Which love languages do you speak and what is your favorite to communicate in?” Investigating the interactive patterns we fall into as a society allows us to identify areas in which we can strengthen the quality of our relationships and our overall health and well-being.[1-3]

The love languages so ubiquitously recognized today were introduced in 1992 by a Southern Baptist Pastor, Gary Chapman, who wrote mostly for an audience of married Christian couples. What has been lost from Chapman’s original texts as his book rose to widespread fame, is his urging toward learning to communicate in other people’s love languages.[4]

There are several issues with the way in which people broach the contemporary conversation about love languages, starting with the oversimplicity of the well-known question: “What’s your love language?” People often feel compelled to answer with one-- maybe two-- of the five options:[5] 

• Quality time 

• Acts of service 

• Physical touch 

• Words of affirmation 

• Gift giving  

As a result of having to identify one singular language, their significant others may begin expressing affection in one singular way; a pigeonhole effect emerges and context is no longer considered. This is a loss because the way in which we communicate and behave is always impacted by our context; so, the way in which we each want to receive love probably shifts depending on circumstances, too.

A Tangent on Gift Giving

Of the five popularized love languages, it’s often most unpopular to say that one’s love language is gift giving-- it can sound shallow, frivolous, and meaningless. In actuality, gift giving is as legitimate and communicative a love language as any other. Gift giving does not have to mean your loved ones are running out to buy you a new watch or the latest iPhone, slapping a bow on it, and declaring your need for love fulfilled. Gift giving can look like your mom going grocery shopping, stumbling upon a new item that has candied almonds-- your favorite-- and buying them because she’s excited to make your day better. It can look like your roommate remembering that you mentioned you needed new sheets and then ordering them for you in your favorite color because they know you’re too stressed to deal with that yourself right now. And, it could be your partner picking up the latest iphone, putting a bow on it, and giving it to you because your current phone battery doesn’t last more than two hours. 

Gift giving can be incredibly thoughtful, nurturing, connecting, and kind. It shows that you’re alive in people’s minds and hearts even when you’re not physically together; it shows that they were thinking of you and wanted you to feel their care, so they bought something to symbolize their desire for your happiness and wellbeing. Shankar Vedantam, the host of the Hidden Brain podcast, interviewed Jeff Galak (a Professor of Marketing at Carnegie Mellon University) about the secret of gift giving. Galak shared that he and his wife have kept an ongoing google doc for 12 years with items they’d like to one day receive or acquire. With this list, they eliminate the guessing inherent in much of our gift giving norms and are empowered to reliably purchase gifts for each other with complete certainty it will make the other happy. Galak reports success with this method, as neither joy nor surprise are extinguished as a consequence to explicitly recording what they want.[6]

The Multiplicity of Expression

Some people do not find it comforting to have a hand on their back when feeling sad. They may also find it irritating or unpleasant to hug others. That’s okay. Physical touch is generally not how they like to receive or show care. Some people have an extremely difficult time accepting compliments or do not feel supported by verbal validation. Words of affirmation probably tend to fall flat for them. Some people find that the bedrock of a good relationship is to have time together where both parties are fully present and undistracted by screens (i.e., quality time)… and also need physical touch and acts of service to feel seen and cared for. For many, there isn’t as clear a distinction between the categories as their different labels might imply. As an example, some people might define quality time as time spent cuddling or touching. Some of the languages might overlap or be part and parcel of each other. 

There also exist people who feel comfortable and capable of communicating love in any and all of the five Chapman ways. The manner in which they choose to express themselves on a given day or in a given moment can depend on their mood, energy levels, financial situation, and who they are with. To ask a person, “What is your love language?” is to force that person to place the five options into a hierarchical ranking that fails to capture the complexity of the ways that person likes to receive and spread love. The question compels someone to have to select a single method of expressing love (out of an actual multitude of nuanced ways) above the rest. By having to whittle away the rich and important aspects of communicating love in order to give the questioner an extremely digestible response, with which they are likely using to simply sprinkle more of into the relationship, all of the depth and potential for greater understanding of one another is lost. 

A Richer Conversation

Therefore, it is extremely limiting to ask someone to identify their one love language. Due to the fact that there are people who are versed in multiple languages and find joy in some, most, or all of the five (however that looks for them), more illuminating and exploratory avenues of conversation would be:

• The languages expressed around them growing up; what languages did they learn from their parents/ caregivers?

• Which situations do they prefer an emphasis on one language over another? 

• Which languages, if any, they struggle to feel safe or seen in; do any just never resonate?

• Which languages, if any, do they want to learn or are trying to become more fluent in?

• Which ones they like to receive more than give, or give more than receive (potential follow up question: how did that unidirectionality come to be?)

The Question About Love Languages Is Merely a Starting Point

While it makes sense that people would assume utility in the love language question as a concrete determinant of compatibility, research findings have been mixed. Ashley Fetters, a former staff writer at The Atlantic, explains that “If you sit down and read Chapman’s book, it’s clear that the love language you’re meant to think about isn’t your own, but your partner’s.”[7] The rushed way in which people discuss love languages today reflects an intention to find a partner with the same language, or at least to find someone willing to communicate in their preferred ones. We have lost sight of Chapman’s mission in having this conversation-- which was to learn how to express love in the language of the other-- in order to expedite the process of assessing compatibility. One study that tested the hypothesis that couples with the same love language would report higher relationship satisfaction found that self-regulatory behaviors had a greater impact on relationship satisfaction than having aligned languages.[8]

The ambiguity of the five terms also typically goes un-probed and assumed; what does “quality time” or “words of affirmation” even mean, if not explicated on an individual and personal level? By accepting an interlocutor’s answer at face value, one is projecting their own definition of those phrases onto the other, without learning what it means to them. A simple remedy for that is to ask the follow up question: What does that mean to you?/ What does that look like for you? Asking another about love language(s) is useful as a starting point, rather than as a conclusion. 

The various styles in which we crave tenderness also begs a bigger conversation about the importance of relying on community for love and support, rather than just one’s primary partner. It can be burdensome, unrealistic, and unsustainable to expect one’s romantic partner to fulfill all of one’s needs. Love languages are relevant not just to the romantic realm, but the platonic and familial realms as well. Communication and expression are requisite for building and maintaining strong relationships while nurturing good mental health. The ways in which we give and receive love impact all relationships, and therefore are worthy of consideration in a much more expanded and thoughtful sense than society currently does.

Contributed by: Maya Hsu

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

REFERENCES

1 Canavello, A. & Crocker, J. (2010). Creating good relationships: Responsiveness, Relationship Quality, and Interpersonal Goals. Journal of personality and social psychology, 99(1), 78-106. https://doi.org/10.1037/a0018186

2 Downs, V. C. & Javidi, M. (2009). Linking communication motives to loneliness in the lives of older adults: An empirical test of interpersonal needs and gratifications. Journal of Applied Communication Research 18(1), 32-48. https://doi.org/10.1080/00909889009360313

3 Yanguas, J., Pinazo-Henandis, S., & Tarazona-Santabalbina, F. J. (2018). The complexity of loneliness. Acta bio-medica: Atenei Parmensis, 89(2), 302-314. https://doi.org/10.23750/abm.v89i2.7404

4 Fetter, A. (2017). It isn’t about your love language; it’s about your partner’s. The Atlantic, https://www.theatlantic.com/family/archive/2019/10/how-the-five-love-languages-gets-misinterpreted/600283/

5 Chapman, G. D. (1995). The five love languages: How to express heartfelt commitment to your mate. Northfield Publishing. 

6 Vedantam, S. (Host). (2022). The secret to gift giving [Audio podcast episode]. In Hidden Brain. NPR. https://hiddenbrain.org/podcast/the-secret-to-gift-giving/

7 Fetter, A. (2017)

8 Bunt, S. & Hazelwood, Z. J. (2017). Walking the walk, talking the talk: Love languages, self-regulation, and relationship satisfaction. Personal Relationships 24(2), 280-290. https://doi.org/10.1111/pere.12182