Doomsday Prepping: Reactionary Behavior or Inherited Instinct?

The Prepper Next Door

In 2011, the television show Doomsday Preppers began airing on National Geographic, bringing mainstream attention to what appeared to be an obscure phenomenon.[1] The series featured “preppers” stockpiling bunkers with enormous amounts of food and ammunition while conducting drills to prepare for apocalyptic events such as an electromagnetic pulse (EMP) destroying modern technology or the collapse of society due to civil war.[2] As this trend became more popular, sales of preserved food surged 700% between 2009 and 2014.[3] Since then, interest in the practice has continued to increase with “prepper” groups uniting on social media and companies churning out the supplies needed to survive a doomsday scenario.

What is Prepping?

Prepping has been defined as, “The management of stockpiled household items in anticipation of market disruption.”[4] Individuals considering themselves preppers may perceive the current structure of society to be a landscape of risk in which the institutions that control access to energy, food, healthcare, shelter, water and waste disposal are associated with risks related to nuclear fallout, toxic pollution, climate change, resource depletion, and potential ecological collapse.[5] Activities of “prepping” tend to revolve around the six core needs of medicine, security, shelter, nutrition, hydration, and hygiene.[6]

Lessons from COVID-19

Smith & Thomas (2021) note that before the COVID-19 pandemic, doomsday prepping was sometimes associated with terms such as paranoia, conspiracy mentality, social dominance orientation, cynicism, and conservatism - but attitudes of the general public changed when COVID-19 lockdowns began in early 2020.[7] Shortages of toilet paper rippled throughout the country as the public frantically panic-shopped while preparing to stay home for an undetermined amount of time.[8] Two years later, supply chain issues related to the pandemic still continue, with 2022 seeing shortages in Sriracha, lumber, baby formula, and cream cheese.[9] To many, the previously-mocked lifestyle of prepping no longer seemed like a wild idea, but rather an intelligent way to prepare for uncertainty that may lie ahead.[10]

The pandemic spurred the immediate reaction of flight from densely-populated urban environments, with Manhattan experiencing a 15-20% reduction in population during the first few months.[11] By the end of 2020, the average new home purchase had shifted an additional 3 miles away from urban centers, though some analysts believe that urban flight may be temporary.[12,13] Some who migrated to rural areas started discovering the joys of hobbies like gardening, cooking from scratch, and creating homemade goods.[14] This shift in priorities and interests, combined with years of rotating shortages often attributed to disastrous events such as Hurricane Ian or Russia’s invasion of Ukraine, worked together to result in a public change in perception towards prepping.[15] Fetterman, (2021) believes this shift is not necessarily unfounded since recent research conducted in Denmark and the US indicates that those who had an interest in prepping were better-equipped psychologically, during the pandemic.[16]

The Surprising Effect of Media on Resilience

The beginning of the millennia produced a fascination with post-apocalyptic worlds, as can be seen by the popularity of shows like The Walking Dead and video games like Fallout 4.[17] While media has at times been credited, or possibly accused, with sewing the idea of individual self-reliance during the apocalypse, Dr. Troy Rondinone, historian of American culture, states these stories also provided narratives of hope by showing that the best chances of survival are through democratic, interracial neighbors selflessly helping each other.[18]

This concept was recently reinforced by research conducted by Scrivner et al., (2021) which found that during the COVID-19 pandemic, those who had engaged with thematically-relevant media (such as pandemic-related media and horror films) demonstrated greater psychological resilience and preparedness.[19] Additionally, horror fans showed greater resilience than fans of the prepper genre (including zombie, apocalyptic, and alien-invasion media) indicating that “trait morbid curiosity” and exposure to frightening fiction may give audiences the opportunity to practice effective coping strategies and results in positive resilience.[20]

Ancient Preppers

While prepping may sound like an extreme response to our current structure of society, historically, there may be precedence across cultures to indicate otherwise. The art of processing and storing food is what allowed humans to survive times of winter or long voyages overseas.[21] When agriculture was being developed, food storage served as a form of risk management that protected against crop failure.[22] To preserve food for winter, humans learned the art of shucking, shelling, boiling, blanching, and canning which gave humanity the benefits of reducing food waste, improving nutrition, and increasing leisure time.[23] Historically, food storage systems were needed to secure an excess amount of food that was greater than what was required for immediate annual household needs, provided sustenance through seasonal or yearly shortages, and allowed an excess amount for trading.[24]

Evidence of the importance of food storage to early humans is supported by research conducted by Blasco et al., (2019) on the Qesem Cave in Israel which found that during the Middle Pleistocene period, butchery techniques indicated that preservation was used for delayed consumption of bone marrow and bone fat.[25] Similarly, in Jordan, evidence gathered from a 19,000-year-old archaeological site showed evidence of gazelle meat being smoked and dried for preservation.[26] Recent evidence has also emerged indicating that prehistoric West Africa used clay pots to assist in the processing and storing of plants 10,000 years ago.[27]

During the Roman Empire, food storage was so advanced that Aelius Aristides, a second century grammarian, described it as the warehouse of the world since Roman consumers not only had access to food from different regions, but they were available year-round.[28] In ancient Peru, stone structures (qolcas) were constructed on the northern face of a mountain where icy wind produced natural refrigeration; they were used as a system of community food storage to help withstand times of bad harvest.[29] In Ireland, hundreds of butter cakes have been found (one dating back as early as 5,000 years ago) in peat bogs which prevented the growth of bacteria and decomposition.[30] Around the same time, China began using salt as one of the most important food preservatives.[31] Considering the long global history of humans storing food to avert shortages, it may not be that unusual that modern humans today have the instincts to engage in a similar behavior.

Prepping Across the Modern World

One unique aspect of prepping in modern America is the emphasis on self-sufficiency, the American ideal of individualism.[32] Some preppers in the US strive for independence and desire to break free from the institutions that regulate access in modern society.[33] Yet the prepping phenomenon is not unique to the United States.

In 2019, it was estimated that one-in-five consumers in Britain were storing medicine, food, and water in preparation for supply chain interruptions related to Brexit (the highly-debated decision for the United Kingdom to leave the European Union).[34] Yeoh (2020) reported that in Singapore, some preppers aim to use a methodical mindset towards preparation which provides a contingency plan for any crises.[35] This point is illustrated by descriptions of a family that is fully prepared with harnesses to quickly escape their 5th floor apartment in the event of a fire, and supplies of oxygen tanks in case a family member tested positive for COVID-19 but needed to wait for medical treatment.[36] It should also be recognized that not all cultures view prepping as an unusual activity. Nakkiah Lui, a First Nations actress and comedian from Australia who created the sitcom Preppers, describes her journey watching shows about entering the world of prepping and thinking, “Being a First Nations person… that idea of survival and prepping for the worst, and survival being part of your history…that’s definitely something I’ve inherited.”[37]

Inherited Instincts or Learned Behavior

With the historical context of food storage and preparedness across cultures, the question can be raised, “Is the act of prepping the result of human instincts or reactions to perceived threats in the environment?” In response to this question, different theories have emerged. Research conducted by Lindstrom et al., (2016) found that in dangerous environments, genetic preparedness and social learning co-evolve simultaneously.[38] In both humans and animals, preparedness behaviors have the tendency to reduce foraging efficiency, but can result in higher rates of survival which indicate the trade-off that needs to take place between safety and flexibility.[39]

Life History Theory (LHT) is an explanatory framework for behavior that integrates the perspectives of evolutionary, social developmental, and ecological theories while considering the amount of effort needed to invest in achieving a goal and the trade-offs that are required.[40] Living in an unpredictable environment tends to lead to activities that are focused on the present and may involve riskier behavior, while living in a more predictable environment leads to behavior that is more focused on long-term strategies such as lower levels of risk-taking and greater regard for social rules.[41] Since emergency preparedness requires a focus on long-term strategies, it tends to be adapted by those with a slower life history; those with a faster life history may experience greater fear of future disasters.[42]

The Instinct Theory of Motivation suggests the environment plays the role of triggering the cognitive abilities that are produced through natural selection.[43] Theorists from the Santa Barbara School of Evolutionary Psychology take a nativist outlook to cognitive instinct, teaching that cognitive mechanisms are hardwired and inherited genetically from our ancestors through the natural selection of genes.[44] In contrast, the California School Cultural Evolutionists endorse the view that our psychology is primarily culturally inherited, through social learning that may be underpinned by cognitive instincts.[45] Turner & Walmsley, (2021) state the view that cultural learning and social cognition are the result of a substantial amount of genetic inheritance.[46]

The way a person views apocalyptic scenarios may also offer insight into people’s beliefs about humans and society.[47] For example, it may be easier for a person to express that they would be fearful of how people would behave in an apocalyptic world than to say that they distrust people.[48]

Prepping and Mental Health

The historic and genetic aspects of this topic all work to raise the question, “Is prepping a psychologically healthy behavior?” Mills (2019) presents an understanding that prepping is a response generated by general anxiety about a variety of potential disasters in the future, which are fueled by reports and government warnings in mainstream media.[49] However, fieldwork interviewing preppers found that the majority of concerns were non-apocalyptic and focused instead on temporary disasters.[50] In terms of existential psychology, prepping thoughts and behavior may be an outlet for processing feelings of uncertainty.[51] To address these concerns, self-sufficiency can serve as an emotional management strategy that channels the emotional energy generated over risk into the more pleasurable activities of building water systems, gardening, and canning.[52]

While analyzing the events of 2020, which included the recent pandemic, the storming of the Capitol, protests for racial justice, a record-breaking hurricane season, and unprecedented freezes in Texas that left many without power, Psychologist Adam Fetterman determined that the majority of time people were cooperative and helped each other during these events.[53] Dr. Fetterman, who states that he previously believed prepping behavior to be a little irrational, found that while the COVID-19 pandemic showed that cynical views on human nature were largely unwarranted, there was some legitimacy about concerns to the supply chain.[54] This raises the question of how real threats to temporary access to resources can be addressed in a way that is psychologically healthy.

Psychologist Marty Nemko recommends avoiding hoarding, but stocking enough supplies to last a month, then supplementing them with smaller purchases as needed.[55] He recommends prioritizing water, food, medication, first aid supplies, hand-cranked/solar radios and flashlights, motor oil, cash, and back-up internet through a cell phone provider.[56] Taking these basic precautions is considered a productive way to take charge and effectively address concerns about the supply chain.

While preparing for potential disasters is warranted, it is still best to make sure it does not become an all-encompassing preoccupation. A person should consider speaking with a licensed mental health professional if worrying about potential disasters becomes obsessive, anxiety is interrupting eating or sleeping, preparations have negative impacts on a person’s finances, personal relationships are being impacted, or a person feels too overwhelmed to take the steps necessary to prepare for a future event.

Contributed by: Theresa Nair

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

REFERENCES

1 Doomsday preppers. IMDb Web site. https://www.imdb.com/title/tt2069270/. Accessed January 6, 2023.

2 Doomsday preppers. National Geographic Web site. https://www.nationalgeographic.com/tv/shows/doomsday-preppers. Updated 2023. Accessed January 6, 2023.

3 Mills MF. Obamageddon: Fear, the Far Right, and the Rise of “Doomsday” Prepping in Obama’s America. Journal of American studies. 2021;55(2):336-365. doi:10.1017/S0021875819000501

4 Kerrane B, Kerrane K, Bettany S, Rowe D. (Invisible) Displays of Survivalist Intensive Motherhood among UK Brexit Preppers. Sociology (Oxford). 2021;55(6):1151-1168. doi:10.1177/0038038521997763

5 Ford A. Emotional Landscapes of Risk: Emotion and Culture in American Self-sufficiency Movements. Qualitative sociology. 2021;44(1):125-150. doi:10.1007/s11133-020-09456-x

6 Mills (2021)

7 Smith N, Thomas SJ. Doomsday Prepping During the COVID-19 Pandemic. Frontiers in psychology. 2021;12:659925-659925. doi:10.3389/fpsyg.2021.659925

8 Fisher M. Flushing out the true cause of the global toilet paper shortage amid coronavirus pandemic. The Washington Post Web site. https://www.proquest.com/docview/2387125885?accountid=11243&parentSessionId=tet7dRjqBnZ4ODYs%2BJHwOpbh3ygcM8U2IzS3hGUGX6I%3D. Updated 2020. Accessed January 10, 2023.

9 Hernandez D, Wagh M. These 19 items are in short supply due to COVID-related supply chain issues. Popular Mechanics Web site. https://www.popularmechanics.com/culture/g38674719/covid-shortages/. Updated 2022. Accessed January 4, 2023.

10 Smith & Thomas (2021)

11 Haseltine W. Urban flight due to covid-19 is temporary, not permanent. Forbes Web site. https://www.forbes.com/sites/williamhaseltine/2020/12/21/urban-flight-due-to-covid-19-is-temporary-not-permanent/?sh=22faaa154cd5. Updated 2020. Accessed January 6, 2023.

12 Malone T. Is the pandemic-induced move to the suburbs over? CoreLogic Web site. https://www.corelogic.com/intelligence/is-the-pandemic-induced-move-to-the-suburbs-over/. Updated 2023. Accessed January 12, 2023.

13 Haseltine (2020)

14 Farrer L. 4 reasons rural destinations are winning in the great relocation. Forbes Web site. https://www.forbes.com/sites/laurelfarrer/2022/03/24/4-reasons-rural-destinations-are-winning-in-the-great-relocation/?sh=885ead733d84. Updated 2022. Accessed January 12, 2023.

15 Little A. The preppers were right all along. Bloomberg Web site. https://www.bloomberg.com/opinion/articles/2022-11-06/climate-change-is-launching-a-new-generation-of-preppers. Updated 2022. Accessed January 12, 2023.

16 Fetterman A. Were the doomsday preppers right? Psychology Today Web site. https://www.psychologytoday.com/us/blog/it-s-all-metaphor/202104/were-the-doomsday-preppers-right. Updated 2021. Accessed January 3, 2023.

17 Fetterman A., Rutjens B., Landkammer F, Wilkowski B. On Post-apocalyptic and Doomsday Prepping Beliefs: A New Measure, its Correlates, and the Motivation to Prep. European journal of personality. 2019;33(4):506-525. doi:10.1002/per.2216

18 Rondinone T. Has hollywood prepped us for the pandemic? Psychology Today Web site. https://www.psychologytoday.com/us/blog/the-asylum/202003/has-hollywood-prepped-us-the-pandemic. Updated 2020. Accessed January 4, 2023.

19 Scrivner C, Johnson JA, Kjeldgaard-Christiansen J, Clasen M. Pandemic practice: Horror fans and morbidly curious individuals are more psychologically resilient during the COVID-19 pandemic. Personality and Individual Differences. 2021;168:110397. https://www.sciencedirect.com/science/article/pii/S0191886920305882. doi: 10.1016/j.paid.2020.110397.

20 Ibid.

21 Temple N. How humanity has changed the food it eats. BBC Web site. https://www.bbc.com/future/article/20210514-how-humanity-has-changed-the-food-it-eats. Updated 2021. Accessed December 19, 2022.

22 Kuijt I. What Do We Really Know about Food Storage, Surplus, and Feasting in Preagricultural Communities? Current anthropology. 2009;50(5):641-644. doi:10.1086/605082

23 Temple (2021)

24 Kujit (2009)

25 Blasco R, Rosell J, Arilla M, et al. Bone marrow storage and delayed consumption at Middle Pleistocene Qesem Cave, Israel (420 to 200 ka). Science advances. 2019;5(10):eaav9822-eaav9822. doi:10.1126/sciadv.aav9822

26 Alex B. How did ancient people keep their food from rotting? Discover Web site. https://www.discovermagazine.com/planet-earth/how-did-ancient-people-keep-their-food-from-rotting. Updated 2020. Accessed January 4, 2023.

27 Dunne J. Chemical traces in ancient west african pots show a diet rich in plants. The Conversation Web site. https://theconversation.com/chemical-traces-in-ancient-west-african-pots-show-a-diet-rich-in-plants-177579. Updated 2022. Accessed January 6, 2023.

28 Cheung C. Managing food storage in the roman empire. Quaternary International. 2021;597:63-75. https://www.sciencedirect.com/science/article/pii/S1040618220304584. doi: 10.1016/j.quaint.2020.08.007.

29 Liendo Tagle I. In peru, ancient food technologies revived in pursuit of future security. Mongrabay Web site. https://news.mongabay.com/2021/09/in-peru-ancient-food-technologies-revived-in-pursuit-of-future-security/. Updated 2021. Accessed January 4, 2023.

30 Alex (2020)

31 Huebbe P, Rimbach G. Historical Reflection of Food Processing and the Role of Legumes as Part of a Healthy Balanced Diet. Foods. 2020;9(8):1056. Published 2020 Aug 4. doi:10.3390/foods9081056

32 Ford (2021)

33 Ibid.

34 Kerrane et al. (2021)

35 Yeoh G. Ever ready for an apocalypse: Inside the minds of doomsday preppers in singapore. Channel News Asia (CNA) Web site. https://www.channelnewsasia.com/cnainsider/always-ready-apocalypse-inside-minds-doomsday-preppers-singapore-629296. Updated 2020. Accessed January 6, 2023.

36 Ibid.

37 Connaughton M. Nakkiah lui on public shaming and her doomsday comedy: ‘Prepping for the worst is something i’ve inherited’. The Guardian Web site. https://www.theguardian.com/tv-and-radio/2021/nov/08/nakkiah-lui-on-public-shaming-and-her-doomsday-comedy-prepping-for-the-worst-is-something-ive-inherited. Updated 2021. Accessed January 10, 2023

38 Lindström, Selbing, I., & Olsson, A. (2016). Co-evolution of social learning and evolutionary preparedness in dangerous environments. PloS One, 11(8), e0160245–e0160245. https://doi.org/10.1371/journal.pone.0160245

39 Ibid.

40 Kruger DJ, Fernandes HBF, Cupal S, Homish GG. Life History Variation and the Preparedness Paradox. Evolutionary behavioral sciences. 2019;13(3):242-253. doi:10.1037/ebs0000129

41 Ibid.

42 Ibid.

43 Turner CR, Walmsley LD. Preparedness in cultural learning. Synthese (Dordrecht). 2021;199(1-2):81-100. doi:10.1007/s11229-020-02627-x

44 Ibid.

45 Ibid.

46 Ibid.

47 Fetterman et al. (2019)

48 Ibid.

49 Mills MF. Preparing for the unknown... unknowns: “doomsday” prepping and disaster risk anxiety in the United States. Journal of risk research. 2019;22(10):1267-1279. doi:10.1080/13669877.2018.1466825

50 Ibid.

51 Fetterman et al. (2019)

52 Ford (2021)

53 Fetterman (2021)

54 Ibid.

55 Nemko M. Should you prep for supply chain shortage? updated 4/15/20. Psychology Today Web site. https://www.psychologytoday.com/us/blog/how-do-life/202004/should-you-prep-supply-chain-shortage-updated-41520. Updated 2020. Accessed January 4, 2023.

56 Ibid.

Artificial Intelligence and the Question of Consciousness

An Artificial Lawyer

This February, an artificial intelligence (AI) legal assistant is scheduled to provide guidance to a human arguing against a speeding ticket in court.[1] These services will be provided through the application DoNotPay, a program created by Joshua Browder with the goal of providing legal representation for the average citizen.[2] The AI will listen to the court proceedings through the DoNotPay app and then prompt the defendant on what to say through an earpiece. This is expected to be the first case defended by a “robot lawyer”.[3]

The simulation of human intelligence is referred to as artificial intelligence, a term first coined by John McCarthy in 1956 at Dartmouth Conference.[4] Exact definitions have varied over time, but IBM defines artificial intelligence as, “a field, which combines computer science and robust datasets, to enable problem-solving. It also encompasses sub-fields of machine learning and deep learning…”[5]

Recent years have seen an explosion in AI with versions now prominent in social media, health care, finance, ecommerce, agriculture, education, and e-marketing.[6] In 2017, Sophia, a social humanoid robot, was found to be so realistic that she was granted Saudi-Arabian citizenship.[7] Last year 2022 was considered to be a pivotal period for Generative AI, a subcategory for artificial intelligence that creates original imaginative content including artwork and stories through machine learning algorithms.[8] These rapid transitions may leave many wondering: what is coming next?

This image was created by NightCafe, an AI artist that generates images based on a description it is given. This piece was generated by the request for, “a picture of artificial intelligence.”[9]

Artificial Intelligence and Consciousness

Social robots (defined as “a physically embodied autonomous agent that communicates and interacts with humans on a social level”) have qualities that can make them appear human to those who interact with them including recognizing speech, communicating verbally, exhibiting behavior, learning, decision making, and facial expressions.[10] This raises the “hard problem of consciousness” referring to the difficulty of understanding whether these beings can ever be considered conscious and whether subjectivity can emerge from matter.[11]

Artificial consciousness (AC) is the aspect of the mind that is generally thought to be the most difficult to replicate or produce artificially.[12] To determine whether a machine is conscious, it is first necessary to answer the proverbial question: What is consciousness? This topic has been widely debated by philosophers for centuries and as of now no clear definition is agreed upon. In a recent New York Times’ article, Oliver Whang (2023) compares defining consciousness with other large vague concepts such as love, freedom, and existence.[13] While early philosophers Descartes and Leibniz believed that consciousness could not be explained by simple mechanics, some modern programmers disagree.[14,15]

Meissner, (2020) cites the Computational Theory of the Mind (CTM) which claims that the human mind is essentially a computer and defines consciousness as, “the awareness of one’s own existence.”[16] However, he distinguishes between “primitive consciousness,” which only has a basic understanding of one’s existence and “reflective consciousness,” which includes the ability to analyze the existence of both oneself and others.[17] This notion is reinforced by Banjeree (2020) who wrote a model for artificial consciousness based on the belief that consciousness is a system of information processing that requires a feedback loop in which a deep learning network feeds back into itself and the emergent property that is produced.[18] He argues that not only can a computer be taught to recognize itself, but it can also learn to identify its own unique characteristics that make it separate from other computers such as memories of its own past actions, color, size, identification markers, and amount of memory.[19] Xie, (2021) states that the generation of consciousness can be tracked by the development of memory, rationality, self-awareness, intelligence, sensation, and emotion.[20] This can be combined with a seventh ability of super-intelligence, which might be possessed by a potential super-human in the future.[21] However, Zhou, (2021) asserts that human consciousness requires emotions, that the motivation of rational thinking is derived from emotions, and that intelligence without emotion can neither exist or be meaningful.[22]

To further explore this question, a series of tests have been proposed to evaluate whether an artificial entity has developed consciousness. One problem encountered with this approach is that there is no corresponding definition of consciousness for other individual living entities, such as amphibians.[23] Despite the evasiveness of this type of categorization, attempts at this assessment have already begun. The wise-man puzzle (a.k.a. knowledge game or muddy children puzzle) was a test developed by Luciano Floridi in 2005 intended to challenge AI with philosophically rich and challenging questions to prove consciousness.[24] However, research conducted by Bringsjord, (2010) indicated there may be ways to program AI to pass this test.[25] Pipitone & Chella, (2021) similarly determined that a robot is capable of passing the classic mirror test (a test evaluating if a robot is self-aware enough to see itself in the mirror) by talking to itself.[26] Researchers are still working to decide if any test of consciousness exists that could not be conquered solely through programming.

Dr. Hod Lipson, who has been working on AI development since the early 2000s recently explained to the New York Times that developers take cues from nature and the process of evolution.[27] He states that whether AI can develop consciousness is not just another research question, but it is “the question” explaining that it could eclipse everything else that scientists have done.[28] A recent article published in Forbes magazine asserts that “true” AI has the ability to simulate human emotions, behavior, and intelligence, though no machine yet has reached that level.[29] In surveys conducted by Hildt (2019), the majority of researchers agreed that current electronic computers are not conscious.[30] However, Hildt clarifies that it may be difficult for humans to determine if a machine has consciousness because it can only be evaluated from a third-person perspective, whereas humans perceive the consciousness of other humans from a first-person perspective.[31]

Should humans be concerned?

While the benefits of unsupervised AI include the ability of these machines to rapidly detect skin cancer, or become personal assistants to humans, Meissner (2020) notes that some programmers fear there is the potential threat that a super-intelligent AI could try to dominate or eliminate the human race.[32] To overcome this potential threat, Meissner, proposes regulations that include keeping robots slow-moving, creating them physically weak, preventing physical proximity to large numbers of other AIs, using a firewall to prevent control of intruders, supervising engineers, creating an on/off switch that is inaccessible to the robot, and creating an overwriting code or “kill-switch”.[33] However, not all researchers in the field share this view of AI as a potential threat.

Dong et al., (2020) believe the future of AI will enhance, rather than replace, the intelligence of humans and predicts they will act as a service provider for human beings, such as when elaborate calculations are  needed. Their research team wants AI to be seen as a tool to assist us in achieving the next stage of civilization, similar to how machines were invented to assist in manufacturing during the industrial revolution, or how agricultural tools were invented to assist in farming. Since AI does not have independent needs, nature, social behavior, or attributes, Dong et al. expect it will be impossible for any AI to become a subject like a human.[34]

Moving Forward

Gardner’s Hype Cycle explains how new technology goes through a phase of overenthusiasm followed by disillusion before an eventual enlightenment of understanding the innovation’s relevance.[35] IBM’s website quotes Lex Fridman as stating, “we are at the peak of inflated expectations, approaching the trough of disillusionment.”[36] However Kelsey Piper, senior writer at Future Perfect, believes otherwise - quoting Greg Brockman (president of OpenAI) as tweeting, “Prediction: 2023 will make 2022 look like a sleepy year for AI advancement & adoption.”[37]

Though the future of consciousness in AIs remains debated, the benefits of developing AI are rapidly becoming apparent. Within the National Institute of Health’s National Human Genome Research Institute (NHGRI), scientists have been using AI to characterize genomic disorders, such as skin conditions, and analyze how communicating this information influences a person's behavior.[38] A new project led by Texas A&M University will use AI to monitor the heating and cooling of buildings through efficient heat pumps to decrease carbon emissions.[39] The field of psychiatry may also soon see its benefits with the recent news that automated analysis of speech patterns may be able to correctly identify depression, psychosis, and suicide risk.[40,41]

While the development of AI is perceived by many as a sign of progress, it has also been associated with negative consequences including rising unemployment, leakage of private information, algorithms that promote bias, and widening of the wealth gap.[42] Dr. Glenn Geher, professor of psychology at the State University of New York, recently stated his concern in Psychology Today where he warns that AI-assisted writing software may reduce thinking abilities and writing skills in future generations.[43] He even illustrates this by writing the majority of his article in the AI software ChatGPT in under 20 seconds.[44]

As scholars continue debating the pros and cons of this rapidly evolving technology, public judgment may come down to people’s individual perception of benefits versus risks. If the robot lawyer is successful in getting its human defendant out of a speeding ticket next month, the public may welcome its assistance with open arms.

Contributed by: Theresa Nair

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

References

1 Sparkes M. AI legal assistant will help defendant fight a speeding case in court. News Scientist Web site. https://www.newscientist.com/article/2351893-ai-legal-assistant-will-help-defendant-fight-a-speeding-case-in-court/. Updated 2023. Accessed January 7, 2023.

2 Browder J. DoNotPay | The world's first robot lawyer. DoNotPay Web site. https://donotpay.com/about/. Updated 2023. Accessed January 10, 2023.

3 Leffer L. DoNotPay's 'robot lawyer' is gearing up for its first U.S. court case. GIZMODO Web site. https://gizmodo.com/donotpay-speeding-ticket-chatgpt-1849960272. Updated 2023. Accessed January 7, 2023.

4 Dong Y, Hou J, Zhang N, Zhang M. Research on how human intelligence, consciousness, and cognitive computing affect the development of artificial intelligence. Complexity (New York, NY). 2020;2020:1-10. doi:10.1155/2020/1680845

5 What is artificial intelligence (AI)? IBM Web site. https://www.ibm.com/topics/artificial-intelligence. Accessed January 7, 2023.

6 Applications of artificial intelligence across various industries. Forbes Web site. https://www.forbes.com/sites/qai/2023/01/06/applications-of-artificial-intelligence/?sh=410b10923be4. Updated 2023. Accessed January 7, 2023.

7 Hildt E. Artificial intelligence: Does consciousness matter? Frontiers in psychology. 2019;10:1535-1535. doi:10.3389/fpsyg.2019.01535

8 Market Trends. Why 2023 is a breakout year for generative AI? Analytics Insight Web site. https://www.analyticsinsight.net/why-2023-is-a-breakout-year-for-generative-ai/. Updated 2023. Accessed January 7, 2023.

9 Creator N. A picture of artificial intelligence. NightCafe Web site. https://creator.nightcafe.studio/creation/OoeiQbAh08fiJbWuET9t. Updated 2023. Accessed January 10, 2023.

10 Hildt (2019)

11 Ibid.

12 Chrisley R. Philosophical foundations of artificial consciousness. Artificial intelligence in medicine. 2008;44(2):119-137. doi:10.1016/j.artmed.2008.07.011

13 Whang O. ‘Consciousness’ in robots was once taboo. now it’s the last word. The New York Times Web site. https://www.nytimes.com/2023/01/06/science/robots-artificial-intelligence-consciousness.html. Updated 2023. Accessed January 7, 2023.

14 Xie J. An explanation of the relationship between artificial intelligence and human beings from the perspective of consciousness. Cultures of Science (online). 2021;4(3):124-134. doi:10.1177/20966083211056376

15 Kramer B. Mind, symbolism, formalism: Is Leibniz a precursor of artificial Intelligence? . Knowl.Org. 1996;23(2):84-87. https://www.nomos-elibrary.de/10.5771/0943-7444-1996-2-83.pdf.

16 Meissner G. Artificial intelligence: consciousness and conscience. AI & society. 2020;35(1):225-235. doi:10.1007/s00146-019-00880-4

17 Ibid.

18 Banerjee S. A Framework for Designing Compassionate and Ethical Artificial Intelligence and Artificial Consciousness. Interdisciplinary Description of Complex Systems. 2020;18(2-A):85-95. doi:10.7906/indecs.18.2.2

19 Ibid.

20 Xie (2021)

21 Ibid.

22 Zhou Z. Emotional thinking as the foundation of consciousness in artificial intelligence. Cultures of Science (online). 2021;4(3):112-123. doi:10.1177/20966083211052651

23 Xie (2021)

24 Bringsjord S. Meeting Floridi’s challenge to artificial intelligence from the knowledge-game test for self-consciousness. Metaphilosophy. 2010;41(3):292-312. doi:10.1111/j.1467-9973.2010.01639.x

25 Ibid.

26 Pipitone A, Chella A. Robot passes the mirror test by inner speech. Robotics and Autonomous Systems. 2021;144:103838. https://www.sciencedirect.com/science/article/pii/S0921889021001238. doi: 10.1016/j.robot.2021.103838.

27 Whang (2023)

28 Ibid.

29 Forbes (2023)

30 Hildt (2019)

31 Ibid.

32 Meissner (2020)

33 Ibid.

34 Dong et al. (2020)

35 Blosch M, Fenn J. Understanding gartner’s hype cycles. Gartner Web site. https://www.gartner.com/en/documents/3887767. Updated 2018. Accessed January 7, 2023.

36 IBM (2023)

37 Piper K. Think AI was impressive last year? wait until you see what’s coming. Vox Web site. https://www.vox.com/future-perfect/2023/1/4/23538647/artificial-intelligence-chatgpt-openai-google-meta-facial-recognition. Updated 2023. Accessed January 7, 2023.

38 Artificial intelligence and machine learning becoming pervasive at NHGRI and in genomics. NIH | National Human Genome Research Institute Web site. https://www.genome.gov/about-nhgri/Director/genomics-landscape/jan-5-2023-artificial-intelligence-and-machine-learning-becoming-pervasive-at-nhgri-and-in-genomics#ai-ml. Updated 2023. Accessed January 7, 2023.

39 Kulhmann S. Applying artificial intelligence to decarbonize buildings. Texas A&M Today Web site. https://today.tamu.edu/2023/01/06/applying-artificial-intelligence-to-decarbonize-buildings/. Updated 2023. Accessed January 7, 2023.

40 Dikaios K, Rempel S, Dumpala SH, Oore S, Kiefte M, Uher R. Applications of speech analysis in psychiatry. Harvard Review of Psychiatry. 2023;31(1):1-13. https://journals.lww.com/hrpjournal/Abstract/2023/01000/Applications_of_Speech_Analysis_in_Psychiatry.1.aspx. doi: 10.1097/HRP.0000000000000356.

41 DeStafano J. Speech analysis can help measure diagnosis, severity, and onset of mental illness. Neuroscience News Web site. https://neurosciencenews.com/speech-analysis-mental-health-22194/. Updated 2023. Accessed January 10, 2023.

42 Dong et al. (2020)

43 Geher G. ChatGPT, artificial intelligence, and the future of writing. Psychology Today Web site. https://www.psychologytoday.com/us/blog/darwins-subterranean-world/202301/chatgpt-artificial-intelligence-and-the-future-of-writing. Updated 2023. Accessed January 7, 2023.

44 Ibid.

Expression Over Suppression: Why We Need Emotions

It’s More Than Just Feels 

Ancient schools of thought propagated by various philosophers, such as Plato, the Stoics, and the Puritans, have suggested for thousands of years that emotions are irrational, primal, and potentially even destructive.[1] However, newer research suggests that this is not the case— in fact, it suggests the opposite. Emotions have been found to play many vital roles in the human experience, from increasing chances of survival in ancient times to helping us connect with each other in the modern day.[2,3] Emotions guide our decisions, actions, relationships, and friendships. They provide roadmaps to help navigate the complexities of human challenges, the ones that exist within the self as well as those impacting society as a whole. In these ways, emotions act as key components of not only our social lives, but also our internal lives, through building our identities and moral judgments.[4]

Unfortunately, despite the important role emotions play in various aspects of our lives, many societies seem to favor the suppression rather than expression of emotions— Western, individualistic cultures tend to suppress negative emotions in an attempt to maximize positive emotions while collectivist cultures, such as that of many Asian countries, tend to suppress both positive and negative emotions.[5,6] This suppression stems from beliefs that emotions are unnecessary byproducts of life, the result of individual choices, or spawns of irrationality.[7-9] However, emotional suppression is neither effective nor helpful to us— and a greater emphasis needs to be placed on the idea that emotions are vital, unavoidable, and important to guiding the human experience.[10,11]

Functions of Emotions

Evolutionary Functions: 

Basic emotions, such as anger and sadness, have historically helped our ancestors increase their chances of survival by resulting in adaptive behavior that help subvert specific evolutionary issues (e.g., fear motivates escaping behaviors in the face of danger).[12,13] Although times have changed significantly since then, the overarching themes of emotion-eliciting stimuli have remained the same (e.g., sadness is caused by suffering a loss, while anger is caused by perceived injustice).[14,15] Additionally, these basic emotions remain consistent in their expression across cultures.[16] This universality that transcends both space and time highlights the importance of emotions in solving dilemmas that arise in every person's life.[17] 

Social Functions:

Emotions help with both the creation and maintenance of various interpersonal relationships— such as intimate, platonic, and filial relationships. Towards the beginning of interpersonal relationships, emotions help determine the nature of the relationship being established: for instance, feelings of sympathy and love may drive parents to adopt the role of caregivers. Additionally, interacting with specific people results in specific emotional responses based on the nature of the relationship: for instance, seeing a friend may evoke joy while seeing an authoritative figure may evoke fear. This specific emotional response that occurs upon meeting a certain person acts as a maintenance mechanism for the established relationship.[18] 

Emotions also help us communicate with others through expression, whether it be vocal, tactile, or facial displays. Emotions provide others with information not only about one’s current affect, but also their intentions and perspectives. Emotional expressions also help trigger certain responses from others (e.g., tears trigger concern and caregiving, which can help bond people together).[19]

Lastly, emotions determine and impact group dynamics, for both intra-and inter-group relations. Within groups, positive emotions promote a sense of belonging and create stronger, tight-knit bonds between members.[20,21] Between different groups, negative emotions such as anger and disgust can act as catalysts of inter-group conflict.[22]

Intrapersonal Functions:

Emotions guide vital and interconnected aspects of ourselves, such as our actions, memories, personalities, and moralities. In human life, wherein most situations lack the scope for objective, calculated rationality, emotions allow us to still respond appropriately by promoting quick, intuitive action. Additionally, emotions guide what we pay attention to and what we remember, thus impacting the way in which we perceive the world. In this way, emotions guide the creation of our intuitions and beliefs about right and wrong, as well as our temperaments and traits— consequently guiding the development of our moral judgements and personalities.[23]

Expression vs. Suppression

Emotional suppression involves the deliberate inhibition of expressive behaviors during emotional arousal. It specifically involves preventing external, physical displays in an attempt to both conceal and subvert a feeling.[24] Suppression is often seen as an effective way to regulate emotions— however, pure suppression is neither efficacious nor beneficial, and is actually destructive towards physical and emotional well-being.

Although emotional suppression reduces outward expressions of emotions, it does not impact the actual experience or the intensity of the emotion.[25-27] In fact, it has been found that suppression can actually increase stress more than natural emotional expression.[28] This is because suppression increases rumination and fixation around the repressed emotion, amplifying distress.[29] Consequently, suppression results in an increased risk of a plethora of negative psychological outcomes, such as depression, anxiety, stress-related conditions, impaired memory, suicidal tendencies, and substance abuse.[30,31]

Emotional suppression has been linked not only to negative mental health impacts but also to worsened physiological outcomes.[32,33] In a study by Derogatis et al., higher mortality rates were found in cancer patients who tended to repress their emotions as compared to their more emotionally expressive counterparts.[34] Furthermore, among patients suffering from chronic illnesses, those who express rather than suppress emotions tend to report less pain.[35] These effects arise because emotional suppression impacts various systems in the human body. As a result, it can lead to various conditions, such as: heart conditions, thyroid dysfunction, muscular pain, and sexual dysfunction.[36,37]

Additionally, emotional suppression can impact one’s social life, by impacting both the suppressor as well as surrounding people. When someone is suppressing their emotions during a social interaction, both people experience more anxiety and negative affect, and also wind up feeling less connected to each other.[38,39] This is likely due to the communicative role emotions play in social interactions as they provide insight into the other person— about their thoughts, intentions, and personality traits— to both people involved.[40]

In general, emotional expression promotes better health and well-being while suppression tends to do the opposite. Although emotional suppression is often seen as the easier and more effective coping mechanism in the short-term, choosing emotional expression instead can lead to not just better physical and mental health, but also more emotional stability as well as a deeper understanding of the self and others.[41]

Image Source: Canva

Yes, We Need Emotions— But Also, Their Regulation

Then should we forego all societal norms and constantly express all our emotions as we feel them? Not necessarily. Despite the clear benefits of emotional expression, there are times when it may be helpful to regulate or even eliminate aspects of an emotion— situations wherein emotional responses are extreme, unwarranted, or undesirable. For instance, emotional regulation is adaptive in disorders that provoke abnormally high levels of certain emotions— such as anxiety in phobias and generalized anxiety disorder, or anger in borderline personality disorder.[42, 43] In general, strong bursts of emotion in daily life result in negative feedback from surrounding people.[44] In such contexts, emotional regulation could be the most effective or desirable response. 

However, emotional regulation is not the same as suppression. Emotional regulation involves attempting to alter the intensity or duration of an emotion. This can be achieved through strategies that aim to change either the cognitive aspects of emotion or its physiological manifestations.[45] 

Emotional regulation, when done properly, avoids the negative consequences of suppression, while also being far more effective in alleviating negative emotions and promoting positive affect.[46,47] This is because effective emotional regulation involves targeting all aspects of the emotional response from start to finish— it involves re-assessing and re-framing the triggering context and occurs early on in the process of feeling an emotion. On the other hand, suppression only targets expression, a mechanism that occurs later on in the emotional response. Furthermore, healthy emotional regulation specifically targets negative emotion whereas suppression impacts positive emotions as well. Since it is likely that the resultant loss of positive affect is what causes suppression to inhibit interpersonal connections, emotional regulation does not lead to any negative social consequences.[48,49] As a result, emotional regulation results in improved affect without negative outcomes such as impaired memory, loss of positive affect, and risk of negative psychological outcomes.[50]

Regulating emotions using strategies such as re-appraisal or mindful acceptance can actually be beneficial, both in the short-term as well as the long-term: it not only helps alleviate suffering in the moment, but it can also lead to a broader perspective that can help guide future personal growth. In fact, healthy emotional regulation is key to emotional well-being, while imbalances in regulation make up the primary symptoms of many disorders (e.g., major depressive disorder, phobias, generalized anxiety disorder, and borderline personality disorder).[51] Overall, emotional regulation enables us to learn and grow from stressful situations, mitigate disordered emotions, and to exist harmoniously with others, even in the face of hardship.

Why This Matters

Emotional suppression has a host of consequences for individuals that go beyond the short-term. Resulting in issues across the board, from increased risk of psychopathology to physiological symptoms, emotional suppression is an unhealthy habit that is unfortunately promoted by many societies. While some level of emotional regulation is a requisite of living harmoniously in society, suppression is not the best way to go about achieving this.[52]

Promoting focus on emotions and healthier coping strategies could enhance not only individual well-being, but also the well-being of society as a whole. Healthy emotional regulation can help improve mental and physical health outcomes, resulting in social benefits such as more positive affect, more social connection, and reduced suffering, while also reducing strain on the economy. For instance, depression— a condition primarily involving impaired emotional regulation and heightened emotional suppression— is currently the world’s largest cause of disability, incurring billions of dollars in costs to U.S. employers every year.[53,54] Additionally, putting emotions at the forefront of solving societal issues can provide multiple benefits to society. The Emotion Revolution 2020, an international psychotherapy conference, promotes the idea that emotions are integral, rational processes that are central to human psychology and that emotions should be centered when designing systems.[55] This approach can result in a wide variety of societal benefits such as a more restorative justice system, new healthcare solutions, new approaches in law, and less violence.[56]

Centering emotions as relevant and vital aspects of human life will not only help us cope with them in a healthier manner but can also allow us to recognize their wisdom and use them to grow as individuals and a society. Emotions exist and persist for a reason— and perhaps it is time that we stop encouraging their suppression.

Contributed by: Sanjana Bakre

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

REFERENCES

Keltner, D., Oatley, K., Jenkins, J.M. (2018). Understanding Emotions. (4th ed.). Wiley. 

1 Gu, S., Wang, F., Patel, N. P., Bourgeois, J. A., & Huang, J. H. (2018). A Model for Basic Emotions Using Observations of Behavior in Drosophila. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2019.0078

2 Dacher Keltner & Jonathan Haidt (1999) Social Functions of Emotions at Four Levels of Analysis, Cognition and Emotion, 13:5, 505-521, DOI: 10.1080/026999399379168

3 Keltner et al. (2018)

4 Tsai, W. (2019). Culture and Emotion. In J.A. Cummings, L. Sanders (1st ed.), Introduction to Psychology. University of Saskatchewan. https://openpress.usask.ca/introductiontopsychology/chapter/culture-and-emotion/ 

5 Tsai, W., Sun, M., Wang, S.-w., & Lau, A. S. (2016). Implications of emotion expressivity for daily and trait interpersonal and intrapersonal functioning across ethnic groups. Asian American Journal of Psychology, 7(1), 52–63. https://doi.org/10.1037/aap0000043

6 Emotion Revolution. (2022). About Emotion Revolution. Emotion Revolution. https://www.emotionrevolution.no/about-emotion-revolution

7 Keltner et al. (2018)

8 Tsai (2019)

9 Cullen, M. (2020, January 30). How to Regulate Your Emotions Without Suppressing Them. Greater Good Science Center. https://greatergood.berkeley.edu/article/item/how_to_regulate_your_emotions_without_suppressing_them

10 Keltner et al. (2018)

11 Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6(3-4), 169–200. https://doi.org/10.1080/02699939208411068

12 Lench, H.C. (2018). The Function of Emotions: When and Why Emotions Help Us. (1st ed.). Springer. https://doi.org/10.1007/978-3-319-77619-4

13 Ibid.

14 Keltner et al. (2018)

15 Ekman (1992)

16 Ibid.

17 Keltner et al. (2018)

18 Ibid.

19 Stellar, J. E., Gordon, A., Piff, P. K., Anderson, C.L., Cordaro, D., Bai, Y. & Maruskin, L. & Keltner, D. (2017).Self-transcendent emotions and their social functions: Compassion, gratitude, and awe bind us to others through prosociality. Emotion Review, 9(3), 200–207.

20 Keltner et al. (2018)

21 Ibid.

22 Ibid.

23 Gross JJ, Levenson RW. (1993). Emotional suppression: physiology, self-report, and expressive behavior. J Pers Soc Psychol.64(6):970-86. doi: 10.1037//0022-3514.64.6.970. PMID: 8326473.

24 Cullen (2020)

25 Ehring, T., Tuschen-Caffler, B., Schnulle, J., Fischer, S., & Gross, J. J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10, 563–572.

26 Keltner et al. (2018)

27 Butler EA, Egloff B, Wilhelm FH, Smith NC, Erickson EA, Gross JJ.(2003). The social consequences of expressive suppression. Emotion. 3(1):48-67. doi: 10.1037/1528-3542.3.1.48. PMID: 12899316.

28 Cullen (2020)

29 Ibid.

30 Gross, Levenson (1993)

31 Cullen (2020)

32 Jainish Patel, Prittesh Patel (2019) Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being. International Journal of Psychotherapy Practice and Research - 1(3):16-21.

33 Derogatis LR, Abeloff MD, Melisaratos N. Psychological Coping Mechanisms and Survival Time in Metastatic Breast Cancer. JAMA. 1979;242(14):1504–1508. doi:10.1001/jama.1979.03300140020016

34 Patel, Patel (2019)

35 Ibid.

36 Abbass A. (2005) The case for specialty-specific core curriculum on emotions and health. , Royal Coll Outlook 4, 5-7.

37 Butler et al. (2003)

38 Gross, J. J. (2001). Emotion Regulation in Adulthood: Timing Is Everything. Current Directions in Psychological Science, 10(6), 214–219. https://doi.org/10.1111/1467-8721.00152

39 Keltner et al. (2018)

40 Patel, Patel (2019)

41 Ibid.

42 Keltner et al. (2018)

43 Cullen (2020)

44 Keltner et al. (2018)

45 Ibid.

46 Gross (2001)

47 Ibid.

48 Butler et al. (2003)

49 Gross (2001)

50 Keltner et al. (2018)

51 Cullen (2020)

52 Keltner et al. (2018)

53 Meadows Mental Health Policy Institute. (2022). The Cost of Depression. Meadows Mental Health Policy Institute. https://mmhpi.org/topics/educational-resources/the-cost-of-depression/

54 Emotion Revolution (2022)

55 Keltner, D. (2022, August 24). Introduction to Human Emotion [PowerPoint Slides]. Psychology Department, University of California, Berkeley.

Post-Modernism & Spirituality: A Remedy for Depression

The Epidemic of Depression in the Post-Modern Age

Depression is one of the most common mental illnesses in the US. Among the 21 million adults that are affected by at least one major depressive episode, it is majorly prevalent in individuals aged 18-25, and higher among adult females.[1] Depression is still rising at an alarming rate despite the existence of multi-billion-dollar pharmaceutical companies and growing healthcare industry, as not everyone has access to care nor can afford it. Some of the signs and symptoms of depression include, but are not limited to:[2]

• Persistent sad, anxious, or “empty” mood

• Feelings of hopelessness, or pessimism

• Feelings of irritability, frustration, or restlessness 

• Feelings of guilt, worthlessness, or helplessness

• Loss of interest or pleasure in hobbies and activities

• Decreased energy, fatigue, or feeling "slowed down"

• Difficulty concentrating, remembering, or making decisions

• Difficulty sleeping, early morning awakening, or oversleeping

• Changes in appetite or unplanned weight changes

Hidaka (2012) notes that, using a retrospective methodology, modernity is a cause of the current predicament [2]. That is to say, the equivalent progress of physical well-being in mental health is lacking. For example, significant lifestyle changes have occurred over the past century due to technological advancements and urbanization, resulting in a decrease in individuals' physical activity.[3] Similarly, technological facilities like social media can become problematic wherein they contribute to psychological distress – manifesting as depression and anxiety – of adolescents and young adults by impairing their personal and social development.[4]

Daniel Goleman, who has written extensively on mindfulness, emotional intelligence, and depression, identified the consequences of modernity in 1992 as a cause for rising depression. He reported that the rise in divorce rates, loss of nuclear families, and increasing industrialization (which often results in parents spending less time with their children) prepared a breeding ground for a lack of self-identification, hopelessness, and social support for young adolescents as well as elderly people.[5]

Spiritually Integrated Psychotherapy

Treating depression with modern therapeutic measures (such as Cognitive Behavioral Therapy (CBT) and SSRIs) has been largely successful; one way to improve outcome efficacy may be to include Spiritually Integrated Psychotherapy (SIP). One difficulty with this implementation, however, is noted by Harris & Goldberg: modernity is, unfortunately, characterized by a conflict between religion and the secular world.[6,7]

Despite this characterization, a study by Pew Research in 2010 found that nearly 84% of the world’s 6.9 billion people still identified as religious.[8] As Rosmarin et al. noted, individuals facing mental health distress are showing a growing interest in practices that involve spirituality/religion.[9] As the religious needs of the population increase, the 21st century is seeing a rise in the integration of the mind, body, and spirit in the psychological field. Luchetti et al. (2021) identified a new interest rising among clinical mental health practices: integrating spirituality/religion into therapeutic measures;[10] as a result, SIP has become one of the major fields in psychology.[11]

To shed light on SIP, an understanding of ‘spirituality’ is in order. Defined by author Kenneth Pargament, as “the search for the sacred,”[12] it is not a concrete set of beliefs that are rooted in one religion - rather it is fluid and constantly changing. The word ‘sacred’ might prompt a notion of the individual’s relationship with God or a higher power; however, secular, psychological, physical, and social aspects can also be imbued with the sacred. As defined by Pargament, the ‘sacred’ is a significant object that is responsible for order and coherence in an individual’s life. Additionally, stages in an individual’s life that include discovery, struggle, and transformational coping can all be part of one’s spirituality.[13]

Psychotherapy (i.e., talk therapy) emphasizes building a relationship with the patient to relieve them of their mental strain. Even though this does not guarantee the complete eradication of a mental illness, it is especially helpful for patients to develop better strategies of their own, alleviate stress, and establish a better understanding of their obstacles. SIP builds upon traditional psychotherapy, enhancing it with the added component of spirituality.

Through SIP people can draw from psychological, religious, and spiritual perspectives to create and sustain a meaningful purpose in life. A client may choose to use music, art, poetry, church, ritual, prayer, meditation, and mindfulness to express their spiritual emotions. These methods can be used to examine if a client feels they have a spiritual emptiness and help them discover meaning in difficult life events, catering to any emotional/spiritual struggles.

SIP & Depression

Spirituality can be a coping mechanism when facing physical or psychological adversity, which has made spiritual intervention an important aspect of health care. In the event of physical adversity and in regards to mental health, spirituality-based interventions have shown promising results in the recovery from, and the prevention of, depression.[14] For example, In 2011, Delaney et al. examined patients suffering from cardiovascular diseases who took part in a 1-month intervention program focusing on spirituality. Participants demonstrated an increase in the overall quality of life as well as lower depression scores.[15] Similarly, Saisunantararom et al. (2015) found that patients with chronic kidney disease were better able to manage their depression with an understanding of spirituality.[16] A study by Bamonti et al. (2016) showed depressive older adults with high levels of spirituality reported levels of meaning in life equal to those who did not have depressive symptoms. This suggests that incorporating spirituality fosters a meaning of life, showing a link between the preservation of the meaning of life and spirituality.[17] 

In light of these studies, patients who indicate higher spirituality also indicate higher meaning in life and peace. As a result, most (if not all) types of spiritualities show common themes of a quest for deeper meaning and a kind of transcendence from the material aspect of life, resulting in a deeper sense of meaning. Considering the broad nature of spirituality, it encompasses many elements which can be used independently in psychotherapy based on the needs of the client. These elements help tackle the significant symptoms of depression such as hopelessness, loss of interest, or feelings of worthlessness. Such elements include:[18]

• Self-acceptance - Uncovering and accepting the real you; breaking through barriers

• Forgiveness - Dealing with past trauma and moving forward

• Self-Transcendence - Connecting with nature, others, and the divine

• Gratefulness - Counting your blessings; includes forgiveness of others

• Prayer - Counseling sessions, active listening, or asking for divine help

Spiritually integrated psychotherapy that is well-developed and fluid caters to the varying worldviews of individuals and often helps them gain a comprehensive methodology to overcome the challenges life throws at them. If you are interested in exploring SIP, reach out to a licensed mental health care provider who is versed in this methodology to discuss your options.

Contributed by: Musa Zafar

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

references

1 U.S. Department of Health and Human Services. (2022, January). Major depression. National Institute of Mental Health. Retrieved December 6, 2022, from https://www.nimh.nih.gov/health/statistics/major-depression 

2 Hidaka, B. H. (2012). Depression as a disease of modernity: explanations for increasing prevalence. Journal of affective disorders, 140(3), 205-214.

3 Lambert, K. G. (2006). Rising rates of depression in today's society: consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning. Neuroscience & Biobehavioral Reviews, 30(4), 497-510.

4 Greenfield, S. (2015). Mind change: How digital technologies are leaving their mark on our brains. Random House.

5 Goleman, D. (1992, December 8). A rising cost of modernity: Depression. The New York Times. Retrieved December 6, 2022, from https://www.nytimes.com/1992/12/08/science/a-rising-cost-of-modernity-depression.html

6 Harris, S. (2005). The end of faith: Religion, terror, and the future of reason. WW Norton & Company.

7 Goldberg, M. (2006). Kingdom coming: The rise of Christian nationalism. WW Norton.

8 Author. (2022, April 14). The global religious landscape. Pew Research Center's Religion & Public Life Project. Retrieved December 6, 2022, from https://www.pewresearch.org/religion/2012/12/18/global-religious-landscape-exec/ 

9 Rosmarin, D. H., Forester, B. P., Shassian, D. M., Webb, C. A., & Björgvinsson, T. (2015). Interest in spiritually integrated psychotherapy among acute psychiatric patients. Journal of consulting and clinical psychology, 83(6), 1149–1153. https://doi.org/10.1037/ccp0000046

10 Lucchetti, G., Koenig, H. G., & Lucchetti, A. (2021). Spirituality, religiousness, and mental health: A review of the current scientific evidence. World journal of clinical cases, 9(26), 7620–7631. https://doi.org/10.12998/wjcc.v9.i26.7620

11 Smith, L. C. (2007). Conceptualizing Spirituality And Religion: Where We'Ve Come From, Where We Are, And Where We Are Going. Journal of Pastoral Counseling, 42.

12 Derezotes, D. S. (2009). Kenneth I. Pargament: Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred.

13 Ibid.

14 Baetz, M., & Toews, J. (2009). Clinical implications of research on religion, spirituality, and mental health. The Canadian Journal of Psychiatry, 54(5), 292-301.

15 Delaney, C., Barrere, C., & Helming, M. (2011). The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: a pilot study. Journal of Holistic Nursing, 29(1), 21-32.

16 Saisunantararom, W., Cheawchanwattana, A., Kanjanabuch, T., Buranapatana, M., & Chanthapasa, K. (2015). Associations among spirituality, health-related quality of life, and depression in pre-dialysis chronic kidney disease patients: An exploratory analysis in thai buddhist patients. Religions, 6(4), 1249-1262.

17 Bamonti, P., Lombardi, S., Duberstein, P. R., King, D. A., & Van Orden, K. A. (2016). Spirituality attenuates the association between depression symptom severity and meaning in life. Aging & mental health, 20(5), 494-499.

18 Pečečnik, T. M., & Gostečnik, C. (2022). Use of Spirituality in the Treatment of Depression: Systematic Literature Review. Psychiatric Quarterly, 1-15.

The Big Five Personality Traits: Exploring the Connection Between Personality & Mental Health

Origins: The Formation of the Big Five

Some people are more outgoing than others; some prefer to keep to themselves. Some people love to argue and others prefer to keep the peace. Some people are highly organized, making their beds every morning; others can hardly find a pair of socks under the mountain of a pile of clothes. In our own experience of life, we can probably think of a vast variety of individuals with their own personalities, each coping uniquely with the challenges life throws at them.

Personality psychologists have come up with a concept of ‘traits’ – the stable tendencies of individuals – to explain everyday behaviors like journaling, throwing socks on the floor, cleaning after themselves, etc. But how do we figure out which traits are the most important? Are there any traits that serve as the most common among every individual? Can we describe someone’s personality in just a few words? To answer these questions, personality psychologists have tried for more than a century to develop a comprehensive measure of personality traits, resulting in questionnaires such as the Minnesota Multiphasic Personality Inventory (MMPI).

The modern study of personality psychology is attributed to Francis Galton who developed the idea of the lexical approach.[1] This idea explains how language captures the traits most important to people in their everyday lives. It argues that if a trait is important, then it would be encoded in language with individual words such as “nervous” or “outgoing”. Following this reasoning, all of the adjectives in the English dictionary were recorded; screening out words that referred to momentary states (e.g., annoying), the remaining words alluded to psychological attributes (e.g., outgoing, nervous, and neat).[2]

After the researchers had people rate themselves on the recorded adjectives, they did a factor analysis [3,4] which formed groups of adjectives based on their correlation with each other. This resulted in five major factors that had the most adjectives, which we now know as the Big Five Personality Traits: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. 

Understanding the Big five Personality Traits

These five factors are best understood as a continuum of traits, each having its own sub-categories (i.e., facets).[5] The following facet examples helps explain the diversity of characteristics within each grouping:[6]

1. Extraversion: friendliness, gregariousness, assertiveness, activity level, excitement seeking, cheerfulness

2. Agreeableness: trust, morality, altruism, cooperation, modesty, sympathy

3. Conscientiousness: self-efficacy, orderliness, dutifulness, achievement-striving, self-discipline, cautiousness

4. Neuroticism: anxiety, anger, depression, self-consciousness, immoderation, vulnerability

5. Openness to Experience: imagination, artistic interests, emotionality, adventurousness, intellect, liberalism

Internalizing these facets also helps us avoid common misunderstandings about the traits. Apart from being a continuum, there is no “right” or “wrong” personality – each trait has its advantages and disadvantages. For example, the extrovert might delve too much into excitement-seeking which can turn out to be reckless at times. The neurotic person, on the other hand, might be anxious, but that will prevent them from reckless behavior.

The Five traits and Mental Health

1. Extraversion

Extraversion is the dimension that ranges from how outgoing and stimulant-seeking a person is to how much they conserve their energy and do not actively engage to earn social rewards. Extraversion includes preferring the company of others as opposed to being alone, aspiring for leadership roles, being physically active, and experiencing more happiness and joy. It captures the most positive emotions – joy, energy, happiness – out of all the traits because of which extraverts are more likely to experience positive moods.[7] Due to its link with positive emotions, individuals who score higher on extraversion tend to have better mental health; they are less likely to suffer from mood and anxiety disorders.[8] These benefits occur not from extraversion itself but because extroverts are often better at maintaining relationships, which are linked to physical and mental health.[9]

The opposite dimension of extraversion is introversion. Introverts are not hermits who isolate themselves; instead, they prefer the company of close friends and family as opposed to large gatherings. Hans Eysenck (1967) posited that introverts are sensitive to stimuli which causes them to prefer solitude.[10] On the other hand, extroverts seek stimulation and excitement which might be linked to higher levels of dopamine – the brain-chemical responsible for pleasure.[11]

2. Agreeableness

The dimension of agreeableness describes an individual’s tendency to put others’ needs ahead of their own, making those low in agreeableness more antagonistic. Agreeable individuals are sympathetic to the needs and feelings of others and trust them more. They prefer cooperation as opposed to competition and tend to be honest, humble, and compliant. In short, individuals high in agreeableness tend to hold other people’s needs above their own; they tend to gain pleasure from serving others and taking care of them.[12] While agreeableness is the least studied factor in the Big Five, most research on it is done by investigating both ends of its spectrum.[13] The opposite end of the agreeableness spectrum – antagonism – encompasses characteristics such as: angry, argumentative, hostile, egotistical, condescending and skeptical.[14]

Unfortunately, these characteristics result in a correlation with antisocial behavior. Research has found that disagreeable individuals are more likely to be involved in crime, aggressive behavior, drug abuse, and gambling.[15-18] Those high in agreeableness, however, show behavior that includes helpfulness, forgiveness, and acceptance.[19] As a result of prosocial behavior, agreeableness comes with many benefits which include, but are not limited to: positive emotions, decreased depression, healthy social connections and relationships as well as greater life satisfaction.[20]

3. Conscientiousness

This dimensional trait measures an individual’s self-discipline and control in order to achieve their goals, making those on the other end of the spectrum more impulsive. Conscientiousness involves willpower; individuals high in this trait can delay gratification, consider the consequences before acting, and work hard toward their goals. As a result, conscientious people are diligent and organized, achieving their goals despite boredom, frustration, or distractions. Similar to individuals low in agreeableness, research has found those low in conscientiousness are more likely to abuse drugs, involve themselves in criminal behavior, and gamble more often.[21]

Due to greater self-control, highly conscientious people tend to enjoy better mental and physical health, including living longer.[22,23] Willpower motivates this cohort to be more-likely to exercise, follow a well-balanced diet, avoid drug abuse, and achieve educational and career goals to try and avoid stressful financial problems. For example, they have been found more likely to eat salads and are less likely to be overweight.[24] They also benefit from better mental health by managing their negative emotions; as a result, perhaps, conscientious people are more likely to have stable marriages.[25]

4. Neuroticism

This spectrum describes how much someone experiences negative emotions as a reaction to a situation. Neuroticism is the tendency to experience negative emotions such as anger, depression, anxiety, shame, and self-consciousness. Highly neurotic individuals may experience negative emotions more frequently and intensely. As a result, they are more prone to mental health issues such as depression, generalized anxiety disorder, PTSD, OCD, substance abuse disorder, and eating disorders.[26-28]

An individual high in neuroticism is less likely to engage in processing their emotions than an individual who does not worry often. To aid a neurotic person in psychotherapy, it is beneficial to help them overcome their inclination to avoid emotions. This is better achieved by helping them realize their emotions as negative, instead of figuring out the origin of their emotions. It is this suppression that harms their mental health, so labeling their emotions as negative serves to alleviate the stress they experience.[29]

5. Openness to Experience

The openness dimension ranges from thinking in abstract, complex ways to thinking more traditionally. Openness is the least intuitive of the Big Five. It has been labeled differently – such as ‘intellect’, ‘culture’, and ‘imagination’ – in many personality questionnaires; McCrae (1996) defined it according to the lines of ‘vivid fantasy’, ‘intellectual curiosity’, ‘behavioral flexibility’, and ‘unconventional attitudes’.[30] Individuals high in openness to experience love to try new things, play with complex ideas, and consider alternative perspectives. Most importantly, they are more likely to name travel as an important personal goal.[31] For example, they are more likely to engage in meditation (associated with new experiences), go to art exhibits, or speak a foreign language.[32] In contrast, low-openness people value the status quo, favor traditional activities, and prefer routine.

Openness does not have many links with psychiatric disorders; however, researchers argue having too much vivid imagination overlaps with psychotic symptoms like hallucinations or unusual beliefs.[33] Overall, those high in openness are less likely to suffer from anxiety disorder or depression.[34] It is also the only factor linked with intelligence; although the correlation is small, those high in openness tend to score higher in IQ tests.[35] The facets of being highly open to experience allow an individual’s brain to retain its plasticity as they age, minimizing the decline in cognitive abilities.

Again, it is important to note how the five personality traits are a continuum more so than a concrete representation of who we are. Since life is not black and white but nuanced in essence, how we react to situations is equally gray and can differ from situation to situation. Just as our personality traits can determine how we react to circumstances; our circumstances can also impact our personality traits. Nevertheless, it is beneficial and empowering to know our personality features as it can equip us with a better understanding of ourselves and the people around us. It can help us cater to the specific characteristics of our friends and colleagues and at the same time allow us to make better choices considering our personalities.

Contributed by: Musa Zafar

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

REFERENCES

1 De Vries, R. E., Tybur, J. M., Pollet, T. V., & Van Vugt, M. (2016). Evolution, situational affordances, and the HEXACO model of personality. Evolution and human behavior, 37(5), 407-421.

2 Cattell, R. B. (1943). The description of personality: Basic traits resolved into clusters. The journal of abnormal and social psychology, 38(4), 476.

3 Norman, W. T. (1963). Toward an adequate taxonomy of personality attributes: Replicated factor structure in peer nomination personality ratings. The journal of abnormal and social psychology, 66(6), 574.

4 Goldberg, L. R. (1993). The structure of phenotypic personality traits. American psychologist, 48(1), 26.

5 Bratko, D., & Marušić, I. (1997). Family study of the big five personality dimensions. Personality and Individual Differences, 23(3), 365-369.

6 Ibid.

7 Lucas, R. E., Le, K., & Dyrenforth, P. S. (2008). Explaining the extraversion/positive affect relation: Sociability cannot account for extraverts' greater happiness. Journal of personality, 76(3), 385-414.

8 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological bulletin, 136(5), 768.

9 Pollet, T. V., Roberts, S. G., & Dunbar, R. I. (2011). Extraverts have larger social network layers: But do not feel emotionally closer to individuals at any layer. Journal of Individual Differences, 32(3), 161.

10 Eysenck, S. B., & Eysenck, H. J. (1967). Salivary response to lemon juice as a measure of introversion. Perceptual and motor skills, 24(3_suppl), 1047-1053.

11 Wacker, J., Chavanon, M. L., & Stemmler, G. (2006). Investigating the dopaminergic basis of extraversion in humans: A multilevel approach. Journal of personality and social psychology, 91(1), 171.

12 Psychology Today. (n.d.). Agreeableness. Retrieved from https://www.psychologytoday.com/us/basics/agreeableness

13 Miller, J. W., & Lynam, D. (Eds.). (2019). The handbook of antagonism: Conceptualizations, assessment, consequences, and treatment of the low end of agreeableness. Academic Press.

14 Graziano, W. G., & Tobin, R. M. (2017). Agreeableness and the five factor model. The Oxford handbook of the five factor model, 1, 105-131.

15 Miller, J. D., & Lynam, D. (2001). Structural models of personality and their relation to antisocial behavior: A meta‐analytic review. Criminology, 39(4), 765-798.

16 Jones, S. E., Miller, J. D., & Lynam, D. R. (2011). Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice, 39(4), 329-337.

17 Lackner, N., Unterrainer, H. F., & Neubauer, A. C. (2013). Differences in Big Five personality traits between alcohol and polydrug abusers: Implications for treatment in the therapeutic community. International Journal of Mental Health and Addiction, 11(6), 682-692.

18 MacLaren, V. V., Fugelsang, J. A., Harrigan, K. A., & Dixon, M. J. (2011). The personality of pathological gamblers: A meta-analysis. Clinical psychology review, 31(6), 1057-1067.

19 Psychology Today

20 Aknin, L. B., & Whillans, A. V. (2021). Helping and happiness: A review and guide for public policy. Social Issues and Policy

21 Miller, J. D., & Lynam, D. (2001). Structural models of personality and their relation to antisocial behavior: A meta‐analytic review. Criminology, 39(4), 765-798.

22 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010)

23 Kern, M. L., & Friedman, H. S. (2008). Do conscientious individuals live longer? A quantitative review. Health psychology, 27(5), 505.

24 Keller, C., & Siegrist, M. (2015). Does personality influence eating styles and food choices? Direct and indirect effects. Appetite, 84, 128-138.

25 Claxton, A., O’Rourke, N., Smith, J. Z., & DeLongis, A. (2012). Personality traits and marital satisfaction within enduring relationships: An intra-couple discrepancy approach. Journal of Social and Personal Relationships, 29(3), 375-396.

26 Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64(4), 241.

27 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010) 

28 Samuel, D. B., & Widiger, T. A. (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis. Clinical psychology review, 28(8), 1326-1342.

29 Whitbourne, S. K. (2020, January 18). Neuroticism, emotions, and your health. Psychology Today. Retrieved December 6, 2022, from https://www.psychologytoday.com/us/blog/fulfillment-any-age/202001/neuroticism-emotions-and-your-health 

30 McCrae, R. R. (1996). Social consequences of experiential openness. Psychological bulletin, 120(3), 323.

31 Reisz, Z., Boudreaux, M. J., & Ozer, D. J. (2013). Personality traits and the prediction of personal goals. Personality and Individual Differences, 55(6), 699-704.

32 Chapman, B. P., & Goldberg, L. R. (2017). Act-frequency signatures of the Big Five. Personality and Individual Differences, 116, 201-205.

33 Widiger, T. A. (2011). The DSM-5 dimensional model of personality disorder: Rationale and empirical support. Journal of Personality Disorders, 25(2), 222.

34 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010) 

35 DeYoung, C. G., Quilty, L. C., Peterson, J. B., & Gray, J. R. (2014). Openness to experience, intellect, and cognitive ability. Journal of personality assessment, 96(1), 46-52.

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.

Thyroid and Mental Health: An Intertwined Relationship

A Case Study of Psychosis

In 2003, a 73-year-old-woman was admitted to the hospital while experiencing unprecedented visual and auditory hallucinations.[1] Since blood work indicated she was in a state of hypothyroidism, she was treated with both risperidone (for the hallucinations) and low-dose thyroid replacement medicine for the hypothyroid state.[2] After two-weeks, the patient discontinued risperidone, continuing only with the thyroid medication, and the hallucinations never returned.[3]

This clinical example is one case study in a mounting body of research correlating the relationship between thyroid and mental health. While it is estimated that 12% of Americans will develop a thyroid condition at some point in their lives,[4] 60% of those affected in the United States are not aware they may have a problem with their thyroid.[5]

Connections to Psychiatric Diagnoses

Hirtz et al., (2020) state that psychological impairments affect up to 30% of adults diagnosed with thyroid dysfunction.[6] Similarly, a study conducted by Herda et al., (2021) of 243 patients determined there was a close relationship between thyroid disease and mental health, including the diagnosis of behavior disorders.[7] However, though a relationship between thyroid disease and mental health disorders has been well-established in recent decades, it is often unclear which is developed first,[8] and patients can be diagnosed with a psychiatric designation before a thyroid condition is detected.[9]

The wide variety of presentations of thyroid dysfunction can sometimes lead to a delayed or missed diagnosis.[10] Yet thyroid function tests (TFTs) in psychiatric patients still remain debatable, in part because thyroid function markers can be affected by acute stress, illicit substances, psychiatric medications, and inflammatory responses.[11]

Image Source: Cleveland Clinic (2022) [12]

How the Thyroid Works

The thyroid gland is located in the neck and is butterfly-shaped.[13] Because the hormones produced by this gland regulate the way energy is used in the body, thyroid changes can affect nearly every organ, including the heart and brain.[14] This production is normally stimulated by the hypothalamus, which sends thyroid-stimulating hormones (TSH) into the bloodstream causing the thyroid to produce thyroxine (T4) and triiodothyronine (T3). T3 and T4 regulate how a body uses energy, which can impact a person’s temperature, weight, nervous system, and muscle strength.[15] In cases of hypothyroidism (i.e., underactive thyroid) the thyroid does not respond accurately to TSH, which causes T3 and T4 to remain low, while TSH accumulates.[16] In hyperthyroidism (i.e., overactive thyroid) there is an overproduction of the thyroid hormone, causingT3 and T4 to be elevated, while TSH remains low.[17]

Further, iodine is required for a body to properly produce thyroid hormones. Since iodine is an essential mineral (i.e., the body cannot produce it), table salt has been supplemented with iodine in the United States since the late 1920s.[18]

Hypothyroidism

Approximately 80% of thyroid disorders in the U.S. are caused by an underactive thyroid gland (hypothyroidism),[19] which is a result of the thyroid gland failing to sufficiently produce thyroid hormones.[20] Hypothyroidism is associated with a wide range of psychiatric and neuropsychological disorders including depression, anxiety, delusions of persecution, attention deficit, psychomotor retardation, and memory impairments.[21]

The knowledge that hypothyroidism affects mental health goes back over a century. It was first linked with psychosis by the Committee on Myxedema of the Clinical Society of London in 1888 when the committee found that half of the 109 patients they studied with myxedema (a physical phenomenon observed in some hypothyroid patients) had hallucinations and delusions, primarily when the disease was advanced.[22] This later led to the coining of the term “myxedema madness” in 1949 to describe the relationship between psychosis and hypothyroidism.[23]

Hyperthyroidism

An overactive thyroid can produce an excess of thyroid hormones (T3 and T4), which increases the body’s metabolism and is described as hyperthyroidism.[24] Symptoms of hyperthyroidism can include mood swings, tension, anxiety, interrupted sleep, lack of patience, and panic attacks.[25] Additionally, out of those diagnosed with hyperthyroidism, up to 69% have been found to experience depression.[26] Some symptoms of hyperthyroidism (e.g., weight loss, increased energy, and agitation) are similar to those observed in episodes of mania.[27] Grave’s disease, an autoimmune disorder that causes the body to produce too much thyroid hormone, is the most common cause of hyperthyroidism.[28]

Hashimoto’s Thyroiditis

Hashimoto’s Thyroiditis (HT) is an auto-immune disease in which the body’s immune system attacks the thyroid’s hormone producing cells.[29] The development of autoimmunity may be caused by stressful life events, puberty, giving birth or menopause.[30] In regions with sufficient iodine intake, such as in the United States, HT is the most common cause of hypothyroidism.[31] In some cases, HT may also cause a temporary enlargement of the thyroid gland leading to hyperthyroidism.[32]

Patients with HT tend to report symptoms of depression and anxiety, which may impact quality of life.[33] Research conducted by Leyhe & Mussig (2014) found that HT patients may experience cognitive and affective disturbances even when in a state of euthyroid (when thyroid levels are considered to be normal).[34] It is hypothesized that the high levels of thyroid antibodies, which are present in patients with Hashimoto’s encephalopathy (a rare disorder that may be associated with HT), may cause brain alterations and could result in lower psychological well-being.[35] Patients with Hashimoto’s encephalopathy suffer from mental health impairments and are sometimes misdiagnosed with psychiatric conditions since individuals affected may experience changes in their personality, depression, anxiety, emotional instability, or failure to understand basic concepts.[36]

Bipolar Disorder

Current research indicates there is a complex relationship between thyroid function and bipolar disorder (BD). In 2007, Vonk et al., found that autoimmune thyroiditis was related to both BD and to the genetic vulnerability that makes a person susceptible to developing BD.[37] Another study conducted by Cole et al., (2002) of patients in the depressed phase of bipolar 1 disorder found they were sensitive to thyroid fluctuations, even when results were considered to be in the normal range.[38] Similarly, a study conducted by Zhao et al., (2021) on 291 subjects with bipolar disorder found that there were significant differences in thyroid functions between participants experiencing manic episodes and those experiencing depressive ones.[39]

This relationship is further complicated by the effect of commonly prescribed psychiatric medications on thyroid function. Lithium, a prevalent treatment for BD, has been associated with hypothyroidism, the development of goiters, hyperthyroidism due to thyroiditis, and in rare cases Grave’s disease.[40] Similarly, quetiapine and valproic acid (two other medications used to treat BD) have both been shown to affect thyroid function.[41,42] Since thyroid abnormalities are common amongst patients with BD, and some of the medications used to treat BD, it is recommended that patients undergoing treatment regularly have their thyroid levels tested to prevent changes in mood due to hormone imbalances.[43]

Anxiety

Approximately 60% of people diagnosed with hyperthyroidism and 30% of those diagnosed with hypothyroidism are affected by anxiety.[44] The correlation between symptoms of thyroid malfunction and anxiety are so similar that Grave’s disease, an immune-system disorder that results in hyperthyroidism, can at times be misdiagnosed as a panic disorder.[45] An investigation conducted by Dr. Juliya Onofriichuk from Kyiv City Clinical Hospital, and summarized by the European Society of Endocrinology in 2020, found that patients experiencing panic attacks showed signs of inflammation of the thyroid gland even though thyroid function and levels fell within normal categories.[46] Dr. Onofriichuk noted this study illustrates the complex relationship between anxiety and the endocrine system and urges doctors to consider this relationship when treating patients with anxiety.[47]

Depression

An analysis conducted by Siegmann et al., (2018) found that the chances of developing symptoms of clinical depression were 3.3 times higher in patients diagnosed with hypothyroidism compared to healthy individuals in control groups.[48] This correlation between depression and hypothyroidism has been hypothesized for years, but results of studies are often conflicting, leaving the relationship difficult to determine.[49] Dayan & Panicker (2013) note that in subjects without thyroid disease, studies have indicated that there is no relationship between thyroid function and depression; yet those being treated for thyroid disease present a relationship between thyroid function and mental health.[50] Additionally, Asamoah (2020) adds that symptoms of depression are estimated to be reported by 60% of patients with hypothyroidism, and the symptoms of hypothyroidism are also similar to those with depression that it is sometimes difficult to distinguish between the two.[51]

When to Speak to a Doctor

Though the relationship between thyroid and mental health is well-documented, it is complex. If a person has a family history of thyroid disorders or is experiencing symptoms that may be the result of a thyroid-related condition, it is recommended they speak with a psychiatrist or primary care physician to determine if thyroid testing is needed.

Contributed by: Theresa Nair

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

References

1 Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Prim Care Companion J Clin Psychiatry. 2003;5(6):260-266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419396/. Accessed Nov 10, 2022. doi: 10.4088/pcc.v05n0603.

2 Ibid.

3 Ibid.

4 Watson K. Are thyroid conditions and depression linked? Healthline Web site. https://www.healthline.com/health/thyroid-and-depression. Updated 2019. Accessed Nov 12, 2022.

5 Is thyroid disease causing your moodiness? St. Luke's Health Web site. https://www.stlukeshealth.org/resources/thyroid-disease-behind-your-mood-swings. Updated 2019. Accessed Nov 12, 2022.

6 Hirtz R, Keesen A, Hölling H, Hauffa BP, Hinney A, Grasemann C. No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study. Frontiers in endocrinology (Lausanne). 2020;11:454-454. doi:10.3389/fendo.2020.00454

7 Herda J, Okoński P, Parfin A, Wdowiak K, Kos M. Thyroid diseases and mental illness together with behavioural disorders versus mental illness together with behavioural disorders and thyroid diseases. Zdrowie publiczne. 2021;131(1):35-40. doi:10.2478/pjph-2021-0007

8 Ibid.

9 Heinrich & Grahm (2003)

10 Estabrook K.  Hypothyroidism: An important diagnostic consideration for the psychiatrist. Psychiatric Times. 2013;30(7).  https://www.psychiatrictimes.com/view/hypothyroidism-important-diagnostic-consideration-psychiatrist.

11 Garnier KA, Ismail KA, Moylan S, Harvey R. Thyroid function testing in an inpatient mental health unit. Australasian psychiatry : bulletin of the Royal Australian and New Zealand College of Psychiatrists. 2016;24(3):256-260. doi:10.1177/1039856215618522

12 Thyroid hormone. Cleveland Clinic Web site.  https://my.clevelandclinic.org/health/articles/22391-thyroid-hormone. Updated 2022.

13 St. Luke’s Health (2019)

14 Hyperthyroidism (overactive thyroid). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) | National Institute of Health Web site.  https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism. Updated 2021. Accessed Nov 16, 2022.

15 Triiodothyronine (T3) tests. Medline Plus | National Library of Medicine | NIH Web site. https://medlineplus.gov/lab-tests/triiodothyronine-t3-tests/#:~:text=T3%20is%20one%20of%20two,how%20your%20body%20uses%20energy. Updated 2021. Accessed Nov 28, 2022.

16 Thyroid Deficiency and Mental Health. Vol 23. Harvard Health Publications Group; 2007:4-5.

17 Hyperthyroidism (overactive). American Thyroid Association Web site. https://www.thyroid.org/hyperthyroidism/. Updated 2022. Accessed Nov 28, 2022.

18 Iodine deficiency. American Thyroid Association Web site. https://www.thyroid.org/iodine-deficiency/#:~:text=Iodine%20is%20an%20element%20that,cannot%20make%20enough%20thyroid%20hormone. Updated 2022. Accessed Nov 28, 2022.

19 Harvard Publications Group (2007)

20 Martino G, Caputo A, Vicario CM, et al. Interrelations between mental health, generic and thyroid-related quality of life in patients with Hashimoto’s thyroiditis receiving levothyroxine replacement. Mediterranean Journal of Clinical Psychology. 2021;9(2):1-22. doi:10.13129/2282-1619/mjcp-3072

21 Leyhe T, Müssig K. Cognitive and affective dysfunctions in autoimmune thyroiditis. Brain, behavior, and immunity. 2014;41(1):261-266. doi:10.1016/j.bbi.2014.03.008

22 Heinrich & Grahm (2003)

23 Ibid.

24 Staff MC. Hyperthyroidism (overactive thyroid). Mayo Clinic Web site. https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659#:~:text=Hyperthyroidism%20(overactive%20thyroid)%20occurs%20when,treatments%20are%20available%20for%20hyperthyroidism. Updated 2020. Accessed Nov 28, 2022.

25 St. Luke’s Health (2019)

26 Watson (2019)

27 Garnier et al. (2016)

28 NIDDK (2021)

29 Staff MC. Hashimoto's disease - symptoms and causes. Mayo Clinic Web site. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855. Updated 2022. Accessed Nov 16, 2022.

30 Leyhe & Mussig (2014)

31 Ibid.

32 Hashimoto's disease. University of Michigan Health Web site. https://www.uofmhealth.org/conditions-treatments/endocrinology-diabetes-and-metabolism/hashimotos-disease. Accessed Nov 16, 2022.

33 Martino et al. (2021)

34 Leyhe & Mussig (2014)

35 Yalcin MM, Altinova AE, Cavnar B, et al. Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto’s thyroiditis? Endocrine journal. 2017;64(4):425-429. doi:10.1507/endocrj.EJ16-0418

36 Hashimoto encephalopathy. NORD (National Organization for Rare Disorders) Web site. https://rarediseases.org/rare-diseases/hashimoto-encephalopathy/. Updated 2018. Accessed Nov 28, 2022.

37 Vonk R, Schot ACvd, Kahn RS, Nolen WA, Drexhage HA. Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder? Biological Psychiatry. 2007;62(2):135-140. https://www.biologicalpsychiatryjournal.com/article/S0006-3223(06)01112-7/abstract. Accessed Nov 12, 2022. doi: 10.1016/j.biopsych.2006.08.041.

38 Cole DP, Thase ME, Mallinger AG, et al. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry. 2002;159(1):116-121. Accessed Nov 14, 2022. doi: 10.1176/appi.ajp.159.1.116.

39 Zhao S, Zhang X, Zhou Y, et al. Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder. BMC endocrine disorders. 2021;21(1):210-210. doi:10.1186/s12902-021-00869-5

40 Lazarus JH. Lithium and thyroid. BEST PRACTICE & RESEARCH CLINICAL ENDOCRINOLOGY & METABOLISM. 2009;23(6):723-733. doi:10.1016/j.beem.2009.06.002

41 Ramaswamy S, Siddiqui Z, Saharan S, Gabel TL, Bhatia SC. Quetiapine-induced hypothyroidism. J Psychiatry Neurosci. 2005;30(1):57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC543843/. Accessed Nov 18, 2022.

42 Epure D, Matei M, Nita S, Sandu M, Teleanu D, Teleanu R. SUBCLINICAL HYPOTHYROIDISM AND VALPROIC ACID TREATMENT IN CHILDREN WITH EPILEPSY. Research and science today. Published online 2014:129-.

43 Lambert CG, Mazurie AJ, Lauve NR, et al. Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort. Bipolar Disord. 2016;18(3):247-260. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089566/. Accessed Nov 18, 2022. doi: 10.1111/bdi.12391.  

44 Thyroid disease and anxiety: What you need to know. Psych Central Web site. https://psychcentral.com/anxiety/depressed-or-anxious-check-your-thyroid. Updated 2022. Accessed Nov 18, 2022.

45 Yasuda M, Kumakura J, Oka K, Fukuda K. A case of thyroid storm caused by Graves’ disease misdiagnosed as panic attack due to panic disorder. BioPsychoSocial medicine. 2021;15(1):1-11. doi:10.1186/s13030-021-00211-4

46 Thyroid inflammation linked to anxiety disorders. European Society of Endocrinology | EurekAlert! Web site. https://www.eurekalert.org/news-releases/655029. Updated 2020. Accessed Nov 18, 2022.

47 Endocrinology ESo. Thyroid inflammation linked to anxiety disorders. https://medicalxpress.com/news/2020-09-thyroid-inflammation-linked-anxiety-disorders.html. Updated 2020. Accessed Nov 18, 2022.

48 Siegmann EM, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA psychiatry (Chicago, Ill). 2018;75(6):577-584. doi:10.1001/jamapsychiatry.2018.0190

49 Dayan CM, Panicker V. Hypothyroidism and Depression. European thyroid journal. 2013;2(3):168-179. doi:10.1159/000353777

50  Ibid.

51 Asamoah T. The link between hypothyroidism and depression. Good RX Health Web site. https://www.goodrx.com/conditions/hypothyroidism/depression. Updated 2020. Accessed Nov 18, 2020.