What Is Emotional Dysregulation? A Psychologist Explains

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If you have ever felt like your emotions move faster, hit harder, or last longer than they seem to for other people — if you have been told you are "too sensitive" or "too intense," or if you have noticed that your emotional responses sometimes feel out of proportion to what triggered them — you may have encountered the concept of emotional dysregulation.

It is a term that gets used frequently in clinical settings, but it rarely gets explained in a way that is actually useful. This post is an attempt to do that: to clarify what emotional dysregulation is, what it is not, where it tends to come from, and what the research says about what helps.

What Emotional Dysregulation Is

Emotional dysregulation is not a diagnosis. It is a description of a pattern — specifically, a pattern in which a person has difficulty managing the intensity, duration, or expression of their emotional responses in ways that feel proportionate and functional.

Emotion regulation refers to the processes through which people influence which emotions they have, when they have them, and how they experience and express them. Most of this happens automatically and outside of conscious awareness. We modulate emotional responses constantly — through attention, interpretation, behavioral choices, and the nervous system processes that run beneath them — without thinking about it.

Dysregulation occurs when those processes are not working well. Emotions arrive more intensely than the situation seems to warrant. They take longer to return to baseline once activated. They are more difficult to modulate once in motion. And the strategies people reach for in the moment — avoidance, rumination, emotional suppression, or behavioral impulsivity — often make things worse rather than better.

It is worth saying clearly: emotional dysregulation exists on a spectrum. Everyone experiences it sometimes. The question is frequency, intensity, and the degree to which it interferes with daily life and relationships.

What It Looks Like

Emotional dysregulation does not look the same in every person, which is part of why it can be hard to recognize in oneself. It can present as:

Emotional intensity and reactivity. Responses that feel, from the inside and sometimes from the outside, disproportionate to what caused them. Becoming overwhelmed by feelings that others seem to manage more easily. A hair trigger for emotional activation that makes daily friction feel unmanageable.

Difficulty returning to baseline. Emotions that persist long after the triggering situation has resolved. Ruminating on an upsetting interaction for hours or days. Being unable to "let it go" even when you want to.

Emotional suppression that backfires. Pushing emotions down or away — often as a way of managing relationships or appearing functional — only to find that suppressed emotions surface later, more intensely, or through physical symptoms like tension, fatigue, or disrupted sleep.

Impulsive behavior in response to emotion. Acting in ways that feel driven by the emotional state and that often bring regret later — sending the message you knew you shouldn't, leaving a situation abruptly, making decisions from a state of activation that you would not have made from a calmer place.

Avoidance of emotion-triggering situations. Organizing life around not feeling certain things — avoiding relationships, conversations, or circumstances that might activate strong emotion, in ways that gradually narrow life and deepen the problem.

Relationship instability. Because emotions involving other people — connection, rejection, disappointment, conflict — are among the most activating, emotional dysregulation often shows up most visibly in close relationships. The intensity of response to perceived distance, criticism, or abandonment can be confusing and painful for both people involved.

Where It Comes From

Emotional dysregulation does not arise from weakness or excessive sensitivity. It develops from a combination of temperament, early experience, and the nervous system's adaptation to the environments it grew up in.

Temperament. Some people are born with a nervous system that is more reactive — more sensitive to stimulation, faster to activate, slower to return to baseline. This is not pathology. It is natural variation. But it does mean that the emotional regulation skills that develop easily for others may require more explicit learning and more consistent practice.

Early relational experience. The most significant factor in the development of emotion regulation capacity is the early caregiving environment. Children learn to regulate emotion largely through co-regulation — through having a caregiver who helps them tolerate and make sense of difficult emotional states, models emotional regulation, and provides a reliable return to safety after distress.

When early caregiving was inconsistent, frightening, dismissive of emotional experience, or itself dysregulated, the child does not develop the same internal regulatory capacity. They may learn that emotions are dangerous, that expressing them is unsafe, or that the only way to get needs met is through escalation. Those early learned strategies become the default — and they tend to misfire in adult life.

Trauma. Traumatic experience — particularly repeated or relational trauma — dysregulates the nervous system in ways that can persist long after the trauma has passed. Hypervigilance, emotional reactivity, and difficulty tolerating distress are features of a nervous system that learned, from experience, that threat could arrive at any moment. The nervous system is doing what it was shaped to do. The difficulty is that it is doing it in contexts that are no longer dangerous.

Chronic stress and sleep deprivation. The prefrontal cortex — the region of the brain most responsible for top-down regulation of emotional responses — is highly sensitive to both stress and sleep loss. Chronic stress and inadequate sleep directly impair regulatory capacity, making emotional dysregulation more likely even in people who would otherwise manage well. This is one reason why life periods of high demand tend to produce emotional responses that feel out of character.

Emotional Dysregulation and Mental Health

Emotional dysregulation is not a standalone diagnosis, but it is a central feature of many clinical presentations. It is prominent in borderline personality disorder, where it is considered one of the core features. It is also a significant component of PTSD and complex trauma responses, ADHD, depression, anxiety disorders, and bipolar disorder.

This is clinically important because addressing the emotional dysregulation itself — rather than only the diagnosis it is associated with — is often what produces lasting change. Two people with anxiety disorders may have very different experiences depending on whether emotional dysregulation is part of the picture. The person who becomes overwhelmed quickly, struggles to return to baseline, and reaches for avoidance as a primary strategy is in a different clinical situation than the person whose anxiety is more contained and who has a broader range of coping strategies available.

It is also important to say that emotional dysregulation occurs in people without any psychiatric diagnosis at all. Personality, history, and circumstance can produce significant difficulty with emotion regulation without meeting the threshold for any clinical condition. The absence of a diagnosis does not mean the difficulty is not real or that it does not warrant attention.

What Actually Helps

The most evidence-based treatment for emotional dysregulation is Dialectical Behavior Therapy, developed by Marsha Linehan. DBT was originally developed for borderline personality disorder, but its core skills — mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness — address the mechanisms of dysregulation directly and have been validated across a wide range of presentations.

The emotion regulation module of DBT does something that most people find counterintuitive at first: it begins not with changing emotions, but with understanding them. Identifying what emotion is actually present, what prompted it, what it is communicating, and what function it is serving. Most people with emotional dysregulation have learned to respond to their own emotions reactively — either by being driven by them or by fighting against them. Both responses tend to amplify activation rather than reduce it.

From that foundation, DBT builds specific skills: reducing vulnerability to emotional activation through behavioral foundations like sleep, exercise, and balanced eating; increasing positive emotional experience over time through engagement with meaningful activity; acting opposite to emotion-driven action urges when doing so is warranted; and using distress tolerance skills to get through periods of high activation without making the situation worse.

Alongside DBT, other therapeutic approaches contribute meaningfully. Mindfulness-based interventions build the observational capacity that makes emotion regulation possible — the ability to notice an emotional state without being identical to it. Psychodynamic therapy addresses the relational and historical roots of dysregulation, including the early experiences that shaped the nervous system's current default settings. EMDR and trauma-focused approaches address the dysregulation that originates in traumatic experience specifically.

What most of these approaches share is an underlying orientation: that the goal is not the elimination of emotion, but the development of a different relationship with emotion — one in which strong feelings can be tolerated, understood, and responded to thoughtfully rather than automatically.

A Note on Self-Compassion

One of the most counterproductive patterns that accompanies emotional dysregulation is shame about the dysregulation itself. The experience of responding more intensely than you intended, of saying something you regret, of being overwhelmed by something others appear to take in stride — these experiences are often followed by harsh self-criticism that adds a second layer of suffering to the first.

Research on emotion regulation consistently finds that self-compassion — treating oneself with the same care one would extend to a friend in the same situation — is associated with better emotional regulation outcomes, not worse ones. Self-criticism is not a motivating force for change. It is an additional source of emotional activation that consumes the very resources that regulation requires.

If you have struggled with the intensity or duration of your emotional responses, that struggle is not evidence that something is fundamentally wrong with you. It is evidence that you are working with a nervous system and a set of learned strategies that developed in a particular context — and that, with the right support, those patterns can genuinely change.

A Closing Thought

Emotional dysregulation is common, it is underaddressed, and it is treatable. The skills that support emotion regulation can be learned at any point in life. The nervous system is more plastic than most people believe, and the patterns that developed in early environments are not fixed.

If you recognize the patterns described here — in your own experience, your relationships, or the gap between how you want to respond and how you actually respond under pressure — that recognition is useful information. It points toward something specific that can be worked with.

APA Citations

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.

Neff, K. D. (2011). Self-compassion, self-esteem, and well-being. Social and Personality Psychology Compass, 5(1), 1–12. https://doi.org/10.1111/j.1751-9004.2010.00330.x

Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2–3), 25–52. https://doi.org/10.2307/1166137

Emotional Whiplash and Anxious Attachment: Why the Hot-and-Cold Cycle Is So Hard to Leave

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There is a particular kind of relationship pain that is hard to explain to people who have not experienced it. It is not the clean pain of a clear rejection or a decisive ending. It is the disorienting, exhausting pain of not knowing where you stand — of warmth and withdrawal cycling without pattern, of feeling deeply connected one day and completely uncertain the next.

This is emotional whiplash. And if you have an anxious attachment style, you may be especially vulnerable to it — not just to experiencing it, but to staying in it far longer than makes sense, even when you can see the pattern clearly.

Understanding why requires looking at both emotional whiplash and anxious attachment together, because they interact in ways that make each one more powerful and more difficult to escape.

What Emotional Whiplash Is

Emotional whiplash is the experience of rapid, unpredictable shifts in how someone treats you — from warm, attentive, and affectionate to distant, critical, or unavailable — without clear explanation or apparent cause. The term captures the physical quality of the experience: the psychological equivalent of a sudden jolt that leaves you disoriented and trying to regain your footing.

It is important to distinguish emotional whiplash from the ordinary variability that exists in all relationships. People have difficult days. Communication breaks down and repairs. Intimacy ebbs and flows. None of that is emotional whiplash.

What makes a pattern emotional whiplash is the combination of unpredictability, intensity, and the absence of repair. The shift is not explained or acknowledged. The distance does not come with reassurance that it is temporary. The return to warmth does not address what just happened. The person on the receiving end is left absorbing the impact of each swing without any relational scaffolding to make sense of it.

Over time, the unpredictability itself becomes the central experience. It is not any single incident but the chronic state of not knowing — the hypervigilance, the constant reading of tone and expression and text response time, the exhausting effort of trying to anticipate something that, by its nature, cannot be anticipated.

What Anxious Attachment Is

Attachment theory, developed by John Bowlby and expanded by decades of subsequent research, holds that human beings are biologically wired to seek proximity to attachment figures when under threat. The patterns we develop in early relationships — specifically, what we learn about whether caregivers will be reliably available and responsive — become templates that shape how we relate to close others throughout life.

Anxious attachment develops when early caregiving was inconsistent: sometimes warm and responsive, sometimes unavailable or distracted, without reliable pattern. The child in that environment learns that connection is possible but not reliable — that proximity to the caregiver sometimes produces comfort and sometimes does not, and that the only way to maximize the chances of connection is to stay highly alert to the caregiver's state and to amplify attachment signals.

In adult relationships, this translates into a characteristic pattern: a deep longing for closeness, a low threshold for perceiving threat to the relationship, a tendency toward intense emotional responses when connection feels uncertain, difficulty self-soothing when distressed, and a strong pull to seek reassurance — often in ways that inadvertently create the distance they are trying to prevent.

People with anxious attachment do not choose this. It is not a character flaw or evidence of neediness. It is an adaptive strategy developed in response to an environment that required it. The difficulty is that the strategy, which made sense in childhood, tends to misfire in adult relationships — particularly when it meets a partner whose own attachment patterns create the hot-and-cold dynamic that is most activating for anxious attachment systems.

Why Emotional Whiplash Hooks Anxious Attachment

The relationship between emotional whiplash and anxious attachment is not incidental. They fit together in a way that is, from a psychological standpoint, almost elegant — which is what makes the combination so difficult to escape.

The core of anxious attachment is an attachment system that is chronically activated but inconsistently rewarded. Intermittent reinforcement — the psychological principle behind slot machines, among other things — is one of the most powerful conditioning mechanisms known. When reward is unpredictable, the behavior oriented toward obtaining it becomes more persistent, more intense, and more resistant to extinction than when reward is consistent.

A relationship characterized by emotional whiplash is, from the perspective of the anxious attachment system, an intermittent reinforcement machine. The warmth and connection that periodically return are experienced as profound relief — and that relief, coming after a period of uncertainty and activation, is felt more intensely than it would be in a consistently warm relationship. The nervous system responds to the return of connection the way it responds to the resolution of threat: with a powerful neurobiological reward signal.

This is why people with anxious attachment often describe the good periods in a hot-and-cold relationship as feeling more intense, more real, more meaningful than anything they have experienced elsewhere. It is not a misperception. The contrast effect is real. Relief after threat genuinely feels different from steady-state safety. But it is not an accurate measure of the relationship's health — it is a measure of the attachment system's activation and release.

The practical consequence is that the person with anxious attachment is not simply staying in a painful relationship despite the pain. They are staying in a relationship in which the intermittent reward structure has made leaving feel neurologically impossible, even when leaving is what the situation clearly calls for.

The Hypervigilance Trap

One of the most clinically significant features of the anxious attachment response to emotional whiplash is the hypervigilance it produces — the chronic scanning for signals about the other person's state, availability, and intentions.

When you cannot predict whether warmth or withdrawal is coming, the nervous system's natural response is to increase surveillance. Every text message, every tone of voice, every shift in body language becomes data to be processed for what it might mean about where you stand. The cognitive resources this consumes are enormous. People describe feeling exhausted by their own minds — unable to stop analyzing, unable to be present in other areas of their lives because so much mental bandwidth is occupied by the relationship.

This hypervigilance also tends to produce a phenomenon that compounds the original problem: the anxious partner's responses to perceived distance — the increased bids for reassurance, the intensity of emotional reaction, the pressing for resolution — often feel overwhelming to a partner with avoidant attachment tendencies, who responds by increasing distance. The anxious partner experiences that distance as confirmation of the threat they were monitoring for, increases activation further, and the cycle deepens.

Neither person is malicious in this dynamic. Both are responding to genuine distress through the strategies their attachment systems developed to manage it. But the interaction between them reliably produces the pattern that is most painful for both.

What Makes It Hard to Leave

People on the outside of a hot-and-cold relationship often wonder why someone stays. The pattern is visible. The pain is evident. The logic of leaving seems straightforward.

What this view misses is the neurobiological and psychological architecture of the attachment system. Leaving a primary attachment figure — which is what a romantic partner is for the attachment system, regardless of how the relationship is objectively going — activates the same threat response that the hot-and-cold cycle has been repeatedly triggering. The prospect of loss does not feel like relief. It feels like danger.

For someone with anxious attachment, this is intensified by several factors. The inconsistency of the relationship has made the attachment more, not less, powerful — the intermittent reinforcement effect. The hypervigilance has made the relationship central to cognitive and emotional life in a way that a consistently warm relationship might not be. And often, the periods of warmth have been genuinely meaningful — the good parts were real, and the person is grieving not a fantasy but actual experiences of connection.

There is also, frequently, a self-referential dimension to staying. If the distance and withdrawal are a reflection of something about me, then leaving does not resolve the problem — it just confirms it. The anxious partner's hope is often not simply that this relationship will get better, but that this relationship will be the one that proves they are worth consistently showing up for. That hope is not irrational. It is deeply human. And it makes the pull to stay, and to try harder, feel meaningful rather than simply painful.

What Helps

Understanding the dynamic is a necessary first step, but it is not sufficient. The attachment system does not update through insight alone. What produces genuine change is a combination of understanding and new relational experience — both within therapy and, over time, in relationships that are structured differently.

Working with the attachment system, not against it. Recognizing that the anxious response is a protective strategy, not a character defect, allows for a more compassionate relationship with one's own reactions. Self-criticism in the midst of activation tends to intensify distress rather than reduce it.

Developing the capacity to tolerate activation without acting on it. Much of the work in therapy involves building the ability to notice the alarm state — the hypervigilance, the urge to seek reassurance, the catastrophic interpretation — without immediately acting from it. This is not suppression. It is the development of a window of tolerance within which the attachment system can be observed and responded to thoughtfully rather than automatically.

Examining what uncertainty actually means. Anxious attachment tends to read ambiguity as threat. Part of therapeutic work involves examining that default interpretation — asking whether uncertainty necessarily means danger, and what other meanings it might hold.

Clarifying what is needed in a relationship and whether this relationship provides it. When emotional whiplash has been the primary relational experience for a long time, it can be genuinely difficult to know what a different kind of relationship would feel like. Therapy can provide a space for exploring what consistency, reliability, and genuine security actually feel like — and what it would mean to hold out for them.

A Closing Thought

Emotional whiplash in the context of anxious attachment is not simply a bad relationship choice that someone keeps making. It is a collision between an attachment system calibrated for inconsistency and a relational pattern that activates that system in its most powerful form.

Getting out of the cycle — genuinely out, not just through distance or the next relationship that replicates the same dynamic — usually requires addressing the attachment patterns themselves, not only the specific relationship. That is work that happens over time, with support, and with the willingness to examine what you have learned to expect from the people you love.

If you recognize yourself in this pattern — the hypervigilance, the intensity, the difficulty leaving something that is hurting you — that recognition is not a reason to feel worse about yourself. It is a starting point. And it is exactly the kind of thing that therapy is built for.

APA Citations

Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. Basic Books.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. https://doi.org/10.1037/0022-3514.52.3.511

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. Guilford Press.

Shaver, P. R., & Mikulincer, M. (2002). Attachment-related psychodynamics. Attachment and Human Development, 4(2), 133–161. https://doi.org/10.1080/14616730210154171

Sroufe, L. A., & Waters, E. (1977). Attachment as an organizational construct. Child Development, 48(4), 1184–1199. https://doi.org/10.2307/1128475

Sex Therapy vs. Couples Therapy: What's the Difference and Which Do You Need?

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When a relationship is struggling and sex is part of the problem, most couples face the same question: do we need therapy for our relationship, or therapy for our sex life? And are those even different things?

The short answer is: yes, they are different — though they overlap more than most people realize, and for many couples, the distinction matters less than simply starting somewhere.

This post is an attempt to clarify what each type of therapy actually involves, what kinds of concerns each is best suited for, and how to think about which one fits your situation.

What Couples Therapy Is

Couples therapy — sometimes called relationship therapy or marriage counseling — is treatment focused on the relational system between two people. It addresses how partners communicate, how they manage conflict, how they navigate differences in values or needs, and the emotional patterns that have developed between them over time.

A couples therapist works with the relationship as the primary unit of concern. The goal is to understand how each person's history, attachment style, and relational patterns interact with their partner's — and to help the couple develop more effective ways of connecting, communicating, and repairing after conflict.

Couples therapy is appropriate for a broad range of concerns: recurring conflict that never fully resolves, difficulty communicating about needs, emotional distance, recovering from an affair or betrayal, navigating a major life transition, or the general sense that the relationship has lost something that used to be there.

Sexual concerns often come up in couples therapy, and a well-trained couples therapist will not avoid them. But the primary frame is relational. Sexual difficulties are explored in the context of the broader relationship — the emotional safety between partners, the communication patterns around intimacy, the history of the dynamic. When sexual problems are primarily symptoms of relational problems, couples therapy is usually the right starting point.

What Sex Therapy Is

Sex therapy is a specialized form of psychotherapy focused specifically on sexual concerns. It can be conducted with individuals or with couples, and it addresses the psychological, relational, and behavioral dimensions of sexual difficulties.

Common reasons people seek sex therapy include low or mismatched sexual desire, difficulty with arousal or orgasm, pain during sex, erectile dysfunction, premature ejaculation, sexual anxiety or avoidance, recovering from sexual trauma, navigating sexual identity questions, or wanting to improve sexual communication and intimacy with a partner.

A sex therapist brings specific clinical training in human sexuality — including knowledge of the psychological, relational, and in some cases physiological factors that contribute to sexual difficulties. The work typically involves direct conversation about sexual experience, history, and function, as well as structured behavioral exercises that partners complete outside of sessions. One of the most well-known of these is sensate focus — a graduated series of touch exercises designed to reduce performance anxiety and rebuild physical connection outside of the pressure of intercourse.

It is important to note that sex therapy is talk therapy. Sessions involve conversation, not physical contact. A licensed sex therapist does not engage in any sexual activity with clients, and any practitioner who suggests otherwise is not practicing ethical clinical care.

Where They Overlap

In practice, the line between couples therapy and sex therapy is often blurry — and that is not a problem. It reflects the reality that sexual and relational functioning are not separate systems.

Relational difficulties affect sexual functioning. When there is unresolved conflict, emotional distance, or a rupture in trust between partners, sexual connection typically suffers. The bed is not neutral territory. It carries everything the relationship carries, and when the relationship is strained, sex is often where that strain first becomes visible.

Sexual difficulties affect relational functioning. When one or both partners is experiencing sexual anxiety, avoidance, or a significant mismatch in desire, the relational system adapts around it — often in ways that create their own problems. The withdrawal, the misattributions, the gradual erosion of physical intimacy and the closeness it provides can damage a relationship that was otherwise solid.

A skilled therapist working in either modality will address both dimensions to some degree. The difference is in emphasis and in the specific clinical tools being used. A couples therapist will work with the relational system and address sexual concerns as they arise within it. A sex therapist will work directly with the sexual concerns and address the relational context that surrounds them.

How to Know Which One You Need

A few questions that can help clarify the right starting point:

Is the primary difficulty relational or sexual? If the central concern is communication, conflict, emotional distance, or trust — and sex is one of several areas where the relationship is struggling — couples therapy is usually the right entry point. If the central concern is specifically sexual — desire, function, arousal, pain, anxiety around sex — sex therapy is more likely to address it directly.

Did the sexual difficulty come before or after the relational difficulty? When sexual problems preceded or exist independently of relational problems, they are more likely to have their own contributing factors that benefit from specialized attention. When relational problems preceded or clearly drove sexual problems, working on the relationship first often produces improvement in the sexual dimension without it being the direct focus.

Is there a specific, named sexual concern? Conditions like vaginismus, erectile dysfunction, anorgasmia, or hyposexual desire disorder have evidence-based treatments within sex therapy that a general couples therapist may not be trained to provide. If there is a specific diagnosable sexual concern, a therapist with specialized sex therapy training is the more appropriate fit.

Has couples therapy not moved the sexual dimension? Many couples who have done meaningful work in couples therapy find that relational patterns have improved but sexual connection has not fully recovered. This is a common and appropriate point to bring in sex therapy as a complement or a next step.

Can You Do Both?

Yes — and for some couples, a coordinated approach makes sense. A couples therapist addressing the relational system, working alongside or in sequence with a sex therapist addressing the sexual concerns directly, can be more comprehensive than either alone.

What is generally not recommended is seeing the same therapist for both simultaneously in a way that blurs the clinical frame. If your couples therapist also has sex therapy training and is integrating both into the same treatment, that can work well when done deliberately. What tends to be less effective is drifting between the two without clarity about what is being addressed and why.

A Note on Shame

One thing worth naming directly: many people wait far longer than they should to seek help for sexual concerns, precisely because those concerns feel more private, more shameful, and more revealing than other relationship difficulties.

Sexual difficulties are common. They are treatable. And they are not a reflection of inadequacy, incompatibility, or the permanent state of a relationship. Seeking help for them is not an admission that something is fundamentally broken. It is an acknowledgment that something important is not working and deserves the same attention you would give any other aspect of your health or your relationship.

Both sex therapy and couples therapy operate under strict confidentiality. What you discuss in either context stays there. The barrier to asking for help is almost always higher than the experience of getting it warrants.

APA Citations

Binik, Y. M., & Hall, K. S. K. (Eds.). (2014). Principles and practice of sex therapy (5th ed.). Guilford Press.

Johnson, S. M. (2008). Hold me tight: Seven conversations for a lifetime of love. Little, Brown.

Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Little, Brown.

McCarthy, B., & McCarthy, E. (2012). Sexual awareness: Your guide to healthy couple sexuality (5th ed.). Routledge.

Weeks, G. R., Gambescia, N., & Hertlein, K. M. (Eds.). (2016). A clinician's guide to systemic sex therapy (2nd ed.). Routledge.

Sleep Apnea and Erectile Dysfunction: The Psychological Side Nobody Talks About

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There is a conversation that happens in therapy rooms that almost never happens in medical offices. Not because it is not clinically relevant, but because neither the patient nor the provider quite knows whose territory it belongs to.

Obstructive sleep apnea and erectile dysfunction frequently co-occur. Research has documented this relationship clearly. What tends to receive far less attention is the psychological dimension: what it does to a man's sense of himself, what it does to a relationship, how shame and avoidance interact with both conditions in ways that make treatment more complicated, and how the psychological sequelae of untreated sleep apnea can persist even after the sleep disorder is addressed.

I am a psychologist, not a physician or a urologist, and I will not be speaking to the physiological mechanisms or medical management of either condition. Those conversations belong with your medical provider. What I can speak to is the psychological experience of navigating these two conditions, the clinical patterns I observe in practice, and what evidence-based psychological support offers.

Why This Conversation Is So Rarely Had

Both conditions carry significant psychological weight, and both are dramatically undertreated relative to their prevalence. The reasons overlap considerably.

Erectile dysfunction affects an estimated 30 million men in the United States, and yet the majority do not discuss it with a physician. The most consistent barrier is shame — the deep, culturally reinforced equation between sexual functioning and masculinity, competence, and worth. Erectile dysfunction does not simply feel like a medical problem. It feels like a verdict.

Obstructive sleep apnea is similarly undertreated. An estimated 80 percent of cases are undiagnosed. Men in particular tend to dismiss the symptoms as minor inconveniences rather than signs of a condition with meaningful health consequences.

When these two conditions co-occur, the shame compounds. Acknowledging the sleep apnea means acknowledging its potential role in the sexual difficulty, which requires talking about the sexual difficulty, which most men are not discussing with anyone. The silence that results is not simply uncomfortable. It is clinically costly.

What Untreated Sleep Apnea Does Psychologically

The physiological effects of untreated obstructive sleep apnea are the domain of sleep medicine and internal medicine. What I can speak to is the psychological consequences of chronic sleep deprivation, which is what untreated sleep apnea produces night after night.

Chronic sleep deprivation increases irritability and emotional reactivity. It reduces the capacity for empathy and attunement that sustains close relationships. It impairs the prefrontal cortical function responsible for patience, perspective-taking, and thoughtful response — leaving people more reactive, more easily overwhelmed, and less able to access the relational resources their relationships depend on.

For a man whose sleep has been fragmented for months or years, these effects are not episodic. They are the baseline. He is not having an off day. He is living in a chronic state of cognitive and emotional depletion that affects everything: his work, his relationships, his sense of himself, his energy for the activities that once mattered to him.

The Psychology of Sexual Performance Anxiety

When erectile difficulties arise, regardless of their origin, a predictable psychological process tends to follow — and it significantly complicates recovery regardless of what medical interventions are pursued.

The first episode of erectile difficulty is experienced as a failure. In the context of the cultural meanings attached to male sexual performance, failure is threatening to identity. The response is often some combination of shame, self-criticism, and heightened vigilance about whether the same thing will happen again.

That vigilance is the beginning of performance anxiety, and it is self-fulfilling in a clinically specific way. Sexual arousal is mediated by the parasympathetic nervous system — the system that is suppressed when the body is in a state of threat activation. When a person approaches sexual activity with heightened anxiety and anticipatory monitoring of their own response, they are activating precisely the sympathetic threat-response that inhibits the parasympathetic functioning sexual arousal requires. The anxiety about not being able to perform makes performance less likely, which confirms the anxiety, which worsens the next encounter.

This cycle can establish itself and maintain itself independently of whatever originally caused the erectile difficulty. This is why, in a meaningful number of cases, addressing the underlying sleep disorder does not fully resolve the sexual difficulty. The psychological pattern has taken on a life of its own.

What This Does to Relationships

For the partner of someone with erectile dysfunction, the experience is frequently one of self-doubt: wondering whether the difficulty is about them, whether they are no longer desirable, whether something has changed in the relationship. In the absence of direct communication — which shame makes extremely difficult — these attributions tend toward the partner's own self-worth rather than toward external causes.

The relational consequence is often a gradual withdrawal from sexual initiation on the part of both partners. The man avoids situations that might lead to sexual activity because they have become associated with the possibility of failure. The partner stops initiating because they have learned that rejection, whatever its cause, is the likely outcome.

What accumulates over months or years of this pattern is emotional distance that extends well beyond the bedroom. The accurate information does not get shared because having the conversation requires naming the difficulty — which brings shame back into the room.

The CPAP Compliance Problem

CPAP therapy — the primary treatment for obstructive sleep apnea — has a significant compliance problem. Estimates suggest that between 30 and 60 percent of patients use it inadequately or abandon it entirely. The reasons include discomfort with the mask, noise, and the disruption to shared sleep.

That last point deserves its own attention. For a couple already navigating sexual difficulty and emotional distance, the introduction of CPAP is not simply a medical intervention. It changes how a person looks and feels in bed with their partner. It requires conversations that have often not been happening. And for some men, the vulnerability of wearing the apparatus adds to an already significant burden of self-consciousness and shame.

Understanding CPAP non-compliance as partly a psychological and relational phenomenon opens clinical interventions that address the actual barriers — couples therapy that addresses the CPAP introduction as a relational transition, individual therapy that addresses shame and self-consciousness, and psychoeducation for both partners about what the treatment involves.

What Psychological Support Offers

A space to name what has not been named. Therapy provides a relationship in which naming becomes possible, and in which the material can be held without judgment.

Direct treatment for performance anxiety. The psychological pattern of sexual performance anxiety responds well to evidence-based treatment, including CBT-based approaches and sensate focus therapy, which address the anxiety and avoidance directly.

Support for treatment adherence. Therapy that explicitly targets the shame and relational disruption associated with CPAP use can meaningfully improve adherence — which has downstream effects on mood, energy, cognitive function, and over time, sexual functioning.

Relational repair. The damage that months or years of untreated sleep apnea, sexual difficulty, and communication avoidance do to a relationship does not automatically reverse when the medical conditions are addressed. Couples therapy provides a structured context for addressing what has formed around the difficulty.

If you or your partner are navigating sleep apnea, erectile dysfunction, or the relational and psychological difficulties that tend to accompany both — you do not have to address this exclusively in a medical context. The psychological dimension is real, it is treatable, and it is often the piece that is missing when medical treatment alone does not produce the full recovery that was anticipated.

Seeking psychological support is not an admission that the problem is "all in your head." It is an acknowledgment that physical health and psychological health are not separate systems — and that effective treatment often requires attending to both.

Citations:

Atlantis, E., & Sullivan, T. (2012). Bidirectional association between depression and sexual dysfunction: A systematic review and meta-analysis. Journal of Sexual Medicine, 9(6), 1497–1507.

Kohn, T. P., & Pastuszak, A. W. (2017). Erectile dysfunction in men with obstructive sleep apnea: Clinical implications and treatment options. Current Sexual Health Reports, 9(4), 197–205. https://doi.org/10.1007/s11930-017-0128-z

McCabe, M. P., et al. (2016). Risk factors for sexual dysfunction among women and men. Journal of Sexual Medicine, 13(2), 153–167. https://doi.org/10.1016/j.jsxm.2015.12.015

The Underrated Mental Health Tool You Already Have: A Regular Daily Routine

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There is a category of mental health intervention that tends to get overlooked precisely because it is not dramatic. It does not require a prescription, a therapist, or a significant life overhaul. It is not exciting. It does not trend on social media. And yet the research on its effects is genuinely compelling.

A new study from the University of Missouri, published in the Journal of Behavioral Medicine, found that maintaining a consistent daily routine — regular times for waking, eating, socializing, and sleeping — was associated with significantly less physical pain and fewer symptoms of depression. What makes the finding particularly interesting is that the benefit held regardless of sleep quality. Even among participants who had insomnia, those with regular daily routines reported lower pain and depression than those without.

This is worth paying attention to, because it shifts the conversation about sleep and mental health in a direction that is clinically meaningful and practically useful.

What the Study Found

Researcher Eunjin Tracy and colleagues at the University of Missouri examined survey responses from 67 older adults, of whom 37 had insomnia. As expected, participants with insomnia generally reported more pain and stronger symptoms of depression than those without. But across the full group, a distinct pattern emerged: participants who maintained regular daily routines tended to experience less pain and depression regardless of how well they slept.

"Regardless of sleep quality, those who reported having a regular daily routine had lower levels of physical pain and less depression compared to those without a daily routine," Tracy said. "If we are consistent with when we wake up, eat, work or study, interact with others and go to bed, those time cues help synchronize our internal body clocks. Over the long term, that seems to be linked with improved health outcomes."

The finding is not that sleep does not matter — it does, and the study confirms this. It is that the temporal structure of the full day, not just the nighttime hours, contributes meaningfully to wellbeing in ways that are independent of sleep quality. This is a meaningfully different frame than the one most people bring to conversations about sleep and mental health.

The Circadian Dimension: Why the Body Clock Matters

To understand why routine exerts these effects, it helps to understand what the study is pointing at: the circadian rhythm — the body's internal 24-hour timing system.

The circadian rhythm regulates far more than sleep. It orchestrates hormone release, metabolism, immune function, pain sensitivity, and mood across the day. And it is entrained — kept on time — primarily through regular, predictable behavioral and environmental cues. Light and darkness are the most potent of these cues, but they are not the only ones. The timing of meals, physical activity, social interaction, and yes, the timing of sleep and waking all provide signals that help the internal clock stay synchronized.

When those cues are irregular — when sleep and wake times vary significantly from day to day, when meals are eaten at unpredictable times, when the rhythm of the day lacks consistency — the internal clock drifts. The body's systems, which are designed to anticipate and prepare for predictable events, are forced to operate reactively rather than proactively. The result, over time, is a kind of biological inefficiency that affects everything from energy levels and concentration to pain perception and mood regulation.

Tracy describes it directly: "When we regulate our circadian rhythm well, our bodies function well, but if it gets too distracted, our bodies don't function as well."

Social Jet Lag: The Hidden Cost of an Irregular Schedule

The study also highlights a concept that is gaining increasing clinical attention: social jet lag.

Social jet lag refers to the misalignment between a person's biological clock and their actual daily schedule — most commonly experienced as the difference between the sleep-wake timing people maintain on weekdays versus weekends. Someone who sleeps until 9am on weekends but wakes at 6:30am on weekdays is effectively flying across several time zones and back every week, without leaving their bedroom. The physiological consequence is similar to actual jet lag: disruption to the internal clock, impaired sleep quality, and downstream effects on mood and cognitive function.

Research on social jet lag has found associations with increased depression, poorer metabolic health, and reduced cognitive performance. The University of Missouri study extends this picture by suggesting that the disruption is not limited to sleep timing — irregularity in other daily behaviors compounds the effect on the internal clock and on wellbeing.

Tracy argues that maintaining a similar routine throughout the entire week — not just on weekdays — may reduce these disruptions and help the body remain more synchronized. This is consistent with one of the most fundamental recommendations in CBT-I: that a consistent wake time, maintained seven days a week, is the single most powerful behavioral anchor for the circadian system. The new research expands this principle from wake time specifically to the full temporal architecture of the day.

The Psychological Dimension: Structure as Scaffolding

From a clinical psychology standpoint, the finding maps onto something I observe consistently in practice: routine is not just a circadian phenomenon. It is a psychological one.

For people managing depression, anxiety, or chronic stress, the structure of a day does significant psychological work that goes beyond its biological effects. It reduces decision fatigue — the accumulating cognitive load of having to decide, repeatedly and without clear anchors, what to do next. It provides a reliable sequence of small accomplishments that, accumulated across a day, generate a sense of agency and forward movement. It creates predictability in an environment that may otherwise feel unpredictable or out of control. And it reduces the cognitive space available for rumination, by keeping the mind engaged with the next structured activity rather than circling back to unresolved worry.

In CBT for depression, behavioral activation is one of the most evidence-supported components of treatment — and behavioral activation is, at its core, the scheduling of predictable activity. Not because the activities themselves are transformative, but because engaging in them at regular, anticipated times produces the mood and energy improvements that, in depression, precede rather than follow motivation. The structure comes first. The motivation follows.

This is also why the disruption of routine — whether through major life transitions, periods of unemployment, remote work without clear daily structure, or the formlessness of summer without school — tends to worsen mood and increase anxiety even when the disruption is ostensibly welcome. Structure is not the opposite of freedom. For the nervous system, it is one of the conditions under which freedom becomes available.

What This Means for People With Insomnia

The clinical implication of this study for people with insomnia is worth naming directly, because it runs counter to how many people approach their sleep difficulties.

The typical response to insomnia is to focus intensively on the night: the sleep environment, the wind-down routine, the supplements, the sleep hygiene checklist. All of these have their place. But what this research suggests — and what CBT-I has long recognized — is that what happens during the day matters as much as what happens at night. The nighttime sleep is not a discrete event that occurs independently of the preceding 16 waking hours. It is the culmination of a 24-hour biological process.

Specifically: consistent wake time anchors the circadian clock, which improves the timing of sleep onset. Regular mealtimes provide additional zeitgebers — time cues — that reinforce circadian alignment. Consistent timing of social interaction and physical activity provides further structure to the day's rhythm. The person who creates a predictable 24-hour template is creating the biological conditions under which sleep is most likely to occur at the right time and with the right architecture.

Tracy puts it well: "Since one-third of our lives will be spent sleeping, I think health and well-being research should be looked at holistically from a 24-hour perspective and not just focus on when we are awake."

This is exactly the frame CBT-I brings to insomnia treatment — and it is the frame that distinguishes effective clinical intervention from sleep hygiene tips that address only the surface of the problem.

Pain and Routine: An Underappreciated Connection

The finding about physical pain is worth highlighting, because it is less intuitive than the depression finding and points at something clinically important.

Pain perception is not a fixed property of a physical stimulus. It is a complex, context-dependent experience that is modulated by multiple factors — including sleep quality, mood, stress, and, as this research suggests, the regularity of daily biological rhythms. The circadian system regulates pain sensitivity across the day, and disruption to circadian timing has been associated with increased pain sensitivity and reduced pain tolerance.

For people managing chronic pain alongside depression or sleep difficulties — a combination that is extremely common and mutually reinforcing — the finding that routine independently reduces both pain and depression is clinically significant. It suggests an intervention that addresses multiple interconnected problems through a single mechanism: circadian stabilization. That mechanism is accessible, free, and does not require any particular medical condition to be managed first before it becomes available.

What This Looks Like in Practice

Translating this research into daily life is more straightforward than most mental health interventions:

Wake at the same time every day. This is the single most powerful circadian anchor. Not an aspiration but a daily non-negotiable, including weekends. The discomfort of waking early on a Saturday is real and temporary; the circadian benefit accumulates over weeks and months.

Eat at consistent times. Meal timing is one of the stronger peripheral zeitgebers — behavioral cues that reinforce the internal clock independently of light. Eating at wildly different times on different days is a form of social jet lag that receives less attention than sleep timing but contributes to circadian disruption.

Schedule social contact. The study specifically includes socializing as a routine behavior linked to better outcomes — which is consistent with the broader literature on social connection and health. A standing call with a friend, a regular coffee with a neighbor, a predictable weekly gathering all contribute to the rhythm of a week in ways that matter beyond the social benefit alone.

Protect consistent bedtime, but anchor on wake time first. In CBT-I, wake time is the primary lever because it is more controllable than sleep onset. Bedtime follows from wake time and sleep drive; if you anchor wake time consistently, bedtime tends to regulate itself over weeks.

Think in weeks, not nights. The benefit of routine accumulates over time. A single day of consistency does not produce measurable circadian alignment. Several weeks of consistency does. This is a gradual intervention that rewards patience more than intensity.

Citations

Tracy, E. L., So, C. J., Chin, B., Xie, Y., Lehrer, H. M., Kanaley, J. A., Hasler, B. P., & Buysse, D. J. (2026). Behavioral-social rhythms and insomnia symptoms: Associations with pain, body mass index, and depressive symptoms among older adults. Journal of Behavioral Medicine, 49(3), 551. https://doi.org/10.1007/s10865-026-00646-6

Jankowski, K. S. (2017). Social jet lag: Sleep-corrected formula. Chronobiology International, 34(4), 531–535. https://doi.org/10.1080/07420528.2017.1299162

Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinical guide to assessment and treatment. Springer.

Wittmann, M., Dinich, J., Merrow, M., & Roenneberg, T. (2006). Social jetlag: Misalignment of biological and social time. Chronobiology International, 23(1–2), 497–509. https://doi.org/10.1080/07420520500545979

University of Missouri-Columbia. (2026, July 30). Scientists find a simple routine linked to less pain and depression. ScienceDaily. https://www.sciencedaily.com/releases/2026/07/260729010705.htm

When You Envy Your Friends: The Psychology of a Feeling Nobody Admits

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You hear your friend's good news — the promotion, the relationship, the apartment, the opportunity — and you feel something that is not quite what you wish you felt. There is something genuine there, some version of happiness for them. But alongside it, quietly, there is something else: a tightening in the chest, a flicker of comparison, an awareness of the gap between where they are and where you are that lands harder than you expected.

You do not say this out loud. You congratulate them warmly, and you mean it. But the other feeling was there too, and you are not entirely sure what to do with it.

Envy toward friends is one of the most common and least openly discussed experiences in adult relationships. It is common enough that researchers have studied it extensively, found it in the majority of people who are asked, and identified it as a normal feature of close relationships — not a sign of bad character, and not something that has to damage a friendship. But it is genuinely complex, and worth understanding in some depth rather than just pushing past.

Why Friendship Is Especially Fertile Ground for Envy

Envy, in psychological terms, is the painful awareness of another person's advantage combined with the desire to possess that advantage. It is distinguished from jealousy — which involves a threat to something you already have — by the fact that envy concerns something you lack and someone else has.

What makes friendship a particularly potent context for envy is the same thing that makes friendship valuable: proximity and similarity. We compare ourselves to people who are like us, and we compare ourselves to people we care about and interact with regularly. Friends tend to be both. They share our reference class — our stage of life, our professional context, our aspirations and concerns. That similarity is what makes their successes so directly relevant to our self-assessment.

Social Comparison Theory holds that humans have a fundamental drive to evaluate themselves by comparing with others — and that we are most motivated to compare with people who are similar to us. When a friend achieves something in a domain we care about, the achievement illuminates exactly where we stand in relation to it, in a way that a stranger's achievement does not.

Research bears this out: studies consistently find that non-family relationships — close friends, casual friends, acquaintances — are more likely to elicit envy than family relationships. The person who triggers envy is almost always someone whose life overlaps with ours enough to make the comparison feel pointed.

The Two Kinds of Envy — and Why the Difference Matters

Not all envy is the same. Psychological research distinguishes between two forms with meaningfully different effects on both the person experiencing them and on the friendship itself.

Benign envy is characterized by the desire to achieve what the envied person has through one's own effort. It is oriented toward the self — toward closing the gap — rather than toward the friend. When a friend's success triggers benign envy, the response it generates is motivational: I want what they have, and I am going to work toward it. Research has found that benign envy is positively associated with goal-setting, improved performance, and wellbeing. People experiencing benign envy toward a friend have been found to be warmer and more engaged in subsequent interactions — as though the admiration embedded in the envy activates prosocial orientation.

Malicious envy is the more corrosive form. Rather than motivating the self to rise to the friend's level, it generates the desire for the friend to lose what they have. It is associated with resentment, passive-aggressive behavior, withdrawal, and in more extreme forms, subtle sabotage. It is the form most likely to damage or end a friendship.

Research suggests which form arises depends on two factors: whether the friend's success feels deserved, and whether it feels attainable. When a friend's advantage is perceived as the result of legitimate effort, benign envy is more likely. When it feels undeserved — when there is a sense that the friend got something they did not earn — malicious envy tends to follow. And when the gap feels bridgeable, benign envy is more accessible. When it feels permanently out of reach, malicious envy is more likely to arise.

Why Envy Is So Hard to Acknowledge

Envy is one of the most stigmatized emotions in most cultures. To admit to envying a friend is to simultaneously admit to feeling inadequate and to wishing something different for someone you care about. That combination is genuinely difficult for most people to acknowledge, even privately.

Because of this, envy rarely expresses itself directly. It disguises itself — as criticism of the friend's choices, as a sudden awareness of their flaws, as a vague discomfort that is hard to name. It can present as withdrawal — the friend whose calls you stop returning after they got the promotion. It can present as a subtle competitiveness that creeps into interactions that used to feel easy.

The disguise creates its own problems. When envy is not acknowledged, it cannot be examined or worked with. It operates below the surface, shaping behavior in ways neither person in the friendship quite understands. The friend being envied may sense something has shifted without being able to name it. The person experiencing envy may feel guilty about something they cannot fully identify.

Naming it — at least to oneself — is the beginning of something more useful.

What Envy Is Actually Telling You

One of the most clinically useful reframes for envy is to treat it as information rather than as a verdict on your character.

Envy, at its core, is a signal about what you want. You cannot envy something you do not care about. When a friend's success in a particular domain triggers a significant emotional response, that response is pointing at something in your own aspirational landscape — a goal you have not yet pursued, a direction you have been moving toward without fully committing to it, a value that matters to you more than your current life choices reflect.

This is why benign envy as information is clinically useful. Sitting with the feeling long enough to ask "what does this tell me about what I want?" is often more productive than either suppressing the feeling or feeling ashamed of it. The envy is not the problem. It is the signal. What you do with it is the question.

Envy in the Age of Social Media

Social media has changed the landscape of comparison in ways that are worth understanding clearly.

In previous eras, friends shared major life updates during in-person gatherings — interactions bounded in frequency and embedded in the full, unedited texture of a relationship. Social media removed that context. What it provides instead is a continuous broadcast of curated highlights — achievements, milestones, announcements — delivered without the relational texture that would otherwise surround them. The result is a comparison environment that is structurally more activating than what preceded it: more frequent, more visible, and more stripped of the context that would normally modulate envy.

Research consistently finds that social media use is associated with increased upward social comparison and decreased wellbeing. You are measuring your full experience against someone else's highlight reel — and the gap is almost always going to feel larger than it would if the comparison were more complete.

The envy that social media generates is often not a signal about real aspiration. It is a response to an artificial comparison environment engineered to maximize engagement — including through the emotional activation that comparison produces.

When Envy Is a Symptom of Something Else

Chronic or intense envy of friends — the kind that significantly disrupts relationships or reflects a persistent sense of being at the back of the pack — is often a symptom of something that extends beyond the friendship.

Underlying depression can produce a generalized sense that others are thriving while one is not, making any friend's success feel like additional evidence of a painful contrast. Anxiety about one's own life path can make the apparent clarity of a friend's success feel particularly destabilizing.

Perfectionism and high-functioning anxiety can produce a specific kind of envy: the acute envy of someone who is doing well by most measures and finds it particularly painful to encounter evidence that someone else is doing better. This is the envy of high achievers, and it is often the least socially permissible — which makes it more difficult to acknowledge and more likely to fester.

In all of these cases, the envy is worth taking seriously not primarily as a relational problem but as clinical information about the person's own psychological state.

What to Do With It

Name it to yourself first. The instinct is to move quickly past the feeling. Sitting with it long enough to identify it as envy, without judgment, creates the possibility of examining it.

Ask what it is telling you. What does this person have that I want? Is this pointing at something in my own life that needs attention? This inquiry is about you, not the friend.

Separate the envy from the friendship. Feeling envious of a friend does not make you a bad friend or a bad person. The feeling and the behavior are different. What you do with the feeling is the question.

Consider whether the comparison is fair. Social media comparisons rarely are. The friend's success as broadcast is not their full life. Widening the frame almost always moderates the intensity.

Bring it to therapy if it is persistent. Chronic envy that significantly affects your relationships or your sense of yourself is worth examining clinically — not because something is wrong with you, but because it is usually pointing at something specific worth understanding.

A Closing Thought

Envy toward friends is not a failure of character or love. It is a normal feature of close relationships between people who exist in the same world and compare themselves to each other — as all humans do.

What makes the difference is not whether you feel it, but whether you can acknowledge it, examine what it is telling you, and choose how to respond — rather than allowing it to operate unseen and shape the relationship in ways neither person can address.

The feeling, held honestly, is information. What you build from that information is a choice.

Citations

Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7(2), 117–140. https://doi.org/10.1177/001872675400700202

Fassl, F., Hofleitner, M., Wunsch, A., Lange, J., Tran, U. S., & Lüftenegger, M. (2026). Influence of friendship on benign and malicious envy among secondary school students. British Journal of Educational Psychology. https://doi.org/10.1111/bjep.70095

Smith, R. H., & Kim, S. H. (2007). Comprehending envy. Psychological Bulletin, 133(1), 46–64. https://doi.org/10.1037/0033-2909.133.1.46

van de Ven, N., Zeelenberg, M., & Pieters, R. (2011). Why envy outperforms admiration. Personality and Social Psychology Bulletin, 37(6), 784–795. https://doi.org/10.1177/0146167211400421

The New York Times. (2026, August 14). When your friends' success makes you feel worse. The New York Times. https://www.nytimes.com/2026/08/14/well/mind/envy-friends.html

People Pleasing: Why It Happens—and a Behavioral Experiment to Help You Stop

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Do you find yourself saying yes when you really want to say no? Do you spend too much time worrying about whether someone is disappointed in you, upset with you, or thinks poorly of you?

People pleasing can look like kindness, flexibility, or generosity from the outside. But when it becomes a pattern, it can leave you feeling anxious, resentful, depleted, or disconnected from what you actually want.

Many people who struggle with people pleasing and anxiety are not simply “too nice.” Often, they have learned—sometimes over many years—that keeping other people happy feels safer than risking conflict, disapproval, or disappointment. Saying yes can feel like a way of maintaining relationships, avoiding difficult conversations, or reducing anxiety in the moment.

The good news is that people pleasing is a behavior. And behaviors can change.

What Is People Pleasing?

People pleasing is the tendency to prioritize other people’s preferences, reactions, or comfort at the expense of your own needs.

It can show up in many different ways. You might agree to plans you do not really want to make, take on extra work because you are afraid to say no, or apologize even when you have done nothing wrong. You might avoid expressing a different opinion, change your behavior to prevent someone from becoming upset, or feel responsible for managing other people’s emotions.

Sometimes people pleasing is less obvious. You may spend hours replaying a conversation and wondering whether you came across the wrong way. You may analyze the tone of a text message or look for signs that someone is annoyed with you.

People pleasing often overlaps with anxiety, perfectionism, difficulty setting boundaries, and fear of rejection.

The immediate payoff is easy to understand. If you accommodate someone, you may avoid an uncomfortable interaction. You may experience a sense of relief because you have reduced the possibility of conflict or disappointment.

The problem is that this relief can actually reinforce anxiety.

Every time you automatically say yes because you are afraid of what might happen if you say no, your brain can learn something like, “Good thing I agreed. Saying no might have been dangerous.”

And because you avoided the situation, you never get the opportunity to discover whether your prediction was actually accurate.

Why People Pleasing Can Be Hard to Change

A common fear underneath people pleasing is, “If I disappoint someone, something bad will happen.”

Sometimes the feared consequence is obvious. You might worry that someone will become angry or upset. Other times, the fear is more subtle. You might think, They will think I am selfish. They will stop liking me. I will seem difficult. I will damage the relationship. I will feel guilty. They will talk about me negatively. I should be able to accommodate them.

These thoughts can feel like facts, particularly when you have spent years responding to them automatically.

This is where Cognitive Behavioral Therapy (CBT) can be helpful. Rather than automatically believing or obeying these predictions, CBT encourages us to become curious about them.

Instead of asking, “How can I make sure no one is disappointed in me?” we can begin asking, “What actually happens when I allow another person to be mildly disappointed?”

That is where a behavioral experiment can be particularly useful.

A Behavioral Experiment: Practice a Small “No”

In Cognitive Behavioral Therapy, a behavioral experiment is a structured way of testing a belief in real life. Rather than simply telling yourself that your fears may not come true, you gather your own evidence.

If you are working on people pleasing, start small. The goal is not to suddenly become confrontational or stop caring about other people. It is to practice tolerating the discomfort that can come with having your own preferences and setting boundaries.

Start by choosing a low-stakes situation—something that feels mildly uncomfortable rather than overwhelming.

Perhaps a friend suggests a restaurant you do not want to go to. Maybe a colleague asks whether you can take on an additional task. Someone might ask you to change plans when you would rather keep the original arrangement. Or perhaps you receive an invitation that you genuinely do not want to accept.

Before responding, pause and ask yourself: “What am I afraid will happen if I don't accommodate this person?”

Try to be specific. For example, you might think, “If I say I can’t go, she will think I don’t value the friendship.”

Now rate how strongly you believe that prediction, from 0 to 100%.

Next, respond in a brief and respectful way without automatically over-explaining. You might say, “Thanks for asking. I’m not able to make it.” Or, “I’d rather keep our original plan.”

Notice the urge to add a long explanation, excessive apology, or justification. You do not necessarily need to eliminate that urge. Simply notice it and experiment with not acting on it.

Then observe what actually happens.

Did the person become angry? Did the relationship change? Was there simply a moment of awkwardness? Did they say, “No problem”? And perhaps most importantly, could you tolerate the discomfort even if the other person was slightly disappointed?

Afterward, compare your prediction with reality.

You might discover, “I predicted she would be very upset. She seemed mildly disappointed for about thirty seconds, and then we moved on.”

Or perhaps, “He did push back, but I was able to hold my boundary.”

Both outcomes provide useful information.

The goal of a behavioral experiment is not to prove that everyone will always respond perfectly. They won’t. Sometimes people will be disappointed. Sometimes they may disagree with you. And occasionally, someone may react more strongly than you expected.

The goal is to learn that you can tolerate other people having reactions without automatically changing your behavior to manage those reactions.

Boundaries Are Not the Same as Rejection

One reason people pleasing can be so difficult to change is that boundaries may initially feel unkind.

If you are accustomed to prioritizing other people’s needs, saying no can feel selfish. Expressing a preference can feel uncomfortable. Allowing someone to be disappointed can feel like you are doing something wrong.

But setting a boundary does not mean rejecting another person.

You can care about someone and still decline a request. You can be generous without always being available. You can be a thoughtful colleague without agreeing to every task. You can love someone without taking responsibility for their feelings.

Healthy relationships need room for two people to have different needs, preferences, and opinions.

In fact, learning to communicate those differences can create more honest and sustainable relationships. When you are constantly saying yes to avoid disappointing someone, the other person may not actually know what you want or need.

Notice the Urge to Explain

One particularly useful place to practice is with over-explaining.

A simple, “I can’t make it,” can suddenly become:

“I’m so sorry. I’ve just had such a crazy week, and I really wanted to come, and normally I absolutely would…”

Sometimes an explanation is appropriate. There are situations where providing context is thoughtful and helpful.

But sometimes over-explaining becomes another form of reassurance seeking. The underlying message can be, “If I give you a good enough reason, maybe you won’t be upset with me.”

Try experimenting with saying a little less.

Notice what feelings arise when you do not provide a detailed justification. You may experience guilt, anxiety, or uncertainty. You may feel an urge to send another message explaining yourself.

That discomfort is not necessarily a sign that you have done something wrong.

It may simply be the discomfort of doing something differently.

And learning to tolerate that discomfort is an important part of changing people-pleasing behavior.

People Pleasing and Anxiety

For some people, people pleasing is primarily a boundary-setting problem. For others, it is part of a broader anxiety pattern.

You may find yourself constantly scanning for signs that someone is annoyed with you, analyzing texts for changes in tone, or mentally reviewing interactions to determine whether you said the “right” thing.

These behaviors can provide temporary reassurance. You may feel better for a few minutes after deciding that someone probably isn't upset with you.

But the relief can reinforce the cycle.

Your brain learns that checking, analyzing, apologizing, or accommodating is what made the anxiety go away. As a result, you may feel an even stronger urge to do those things the next time uncertainty arises.

CBT can help identify the thoughts and behaviors that maintain this cycle and create opportunities to respond differently.

A Different Goal: Be Respectful, Not Universally Liked

Trying to make sure everyone approves of you is an impossible assignment.

There will be times when someone is disappointed with you. There will be situations where someone disagrees with your decision. And there may be moments when you feel misunderstood.

A more realistic goal might be:

“I want to behave in a way that is thoughtful, respectful, and consistent with my values—even when someone else would prefer that I do something differently.”

That shift can be surprisingly freeing.

You do not need to stop being kind.

You may simply need to stop using kindness as a strategy for preventing every uncomfortable reaction.

Learning to set boundaries does not mean becoming less caring. It means making room for your needs alongside the needs of the people you care about.

And, like most behavioral changes, this gets easier with practice.

Start small. Notice the prediction. Try something different. Pay attention to what actually happens.

You may discover that disappointing someone occasionally is not nearly as dangerous—or as relationship-changing—as your anxiety predicted.

What Makes Behavior Change Stick? The Psychology Behind Getting Unstuck

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Most people who want to change something about their behavior already know what they should do.

They know they should exercise more. Sleep earlier. Drink less. Stop checking their phone at midnight. Have the difficult conversation they have been putting off. Set the boundary they keep meaning to set.

The information is not the problem. And yet the behavior does not change — or it changes briefly and then returns to its previous state. This experience is so common that it is often treated as evidence of a personal failing: a lack of discipline, a weakness of will, a fundamental inability to do what needs to be done.

The psychology of behavior change suggests a different explanation — and a different set of questions to ask.

Why Knowing What to Do Is Not Enough

The gap between knowing what to do and actually doing it is one of the most studied phenomena in behavioral psychology, and the research is clear: providing people with accurate information about what would benefit them rarely, on its own, produces lasting behavioral change.

This is not a new discovery. Public health campaigns have known for decades that knowledge does not reliably translate to behavior. Smokers know smoking causes cancer. People with poor sleep habits know they need more sleep. The knowledge is present. The behavior persists anyway.

Why? Because behavior is not primarily driven by information. It is driven by motivation, habit, identity, the weight of competing priorities, and — perhaps most importantly — the psychological meaning the behavior holds for the person engaging in it.

Telling someone what they should do treats behavior change as an information problem. The clinical frameworks that actually work treat it as a motivational and psychological one.

The Ambivalence at the Center of Most Stuck Behavior

One of the most important concepts in the psychology of behavior change is ambivalence — the simultaneous presence of motivation to change and motivation to stay the same.

Ambivalence is not confusion or indecision. It is a coherent psychological state in which both sides of a tension have real weight. The person who wants to exercise more and keeps not doing it is not simply lazy. They also, at some level, do not want to exercise — or want the things that conflict with exercise more than they want exercise itself: the rest, the time, the relief of not adding another demand to an already demanding day.

Both sides are real. And this is where most behavior change efforts go wrong: they treat the desire to change as the only relevant motivation and the resistance as an obstacle to be overcome rather than as meaningful information about what the person actually wants and values.

Motivational Interviewing — a clinical approach developed by psychologists William Miller and Stephen Rollnick — is built on the observation that ambivalence is the normal state for most people trying to change, and that trying to argue someone out of their ambivalence tends to produce the opposite of the intended effect. When a clinician pushes for change, the client tends to push back — articulating the reasons not to change more forcefully than they would have otherwise. The resistance is not stubbornness. It is a natural response to feeling pressured.

What works better is helping the person articulate their own reasons for change — their own values, their own concerns, their own vision of what they want their life to look like — and then exploring, without pressure, the gap between where they are and where they want to be. Change talk that comes from the person rather than being imported by the clinician is far more likely to translate into actual behavior.

The Questions That Actually Help

This is where small questions become clinically powerful. Not leading questions, not questions that assume the person should change, but genuinely curious questions that help the person examine their own experience and motivation.

A few that are particularly useful in clinical work:

"What would be different if this changed?" This question invites the person to articulate their own vision of what change would actually produce — not an abstract sense that things would be better, but a specific, grounded picture of difference. The specificity matters. "I'd feel better" is less motivationally potent than "I'd have the energy to be present with my kids after work instead of just collapsing on the couch."

"What's keeping things the way they are?" This question takes the resistance seriously rather than treating it as an obstacle. The answer is always informative. Sometimes it surfaces practical barriers that can be addressed directly. More often it surfaces the competing motivations, the fears, the beliefs about what change would require that are actually driving the stuckness.

"On a scale of one to ten, how important is this to you right now — and what would have to be different for it to be higher?" This is a classic Motivational Interviewing technique, and it works because it quantifies the ambivalence without judging it and then, in the second part, invites the person to identify what would actually move the needle. The answer to "what would have to be different" is often the most clinically useful thing said in the conversation.

"What have you already tried?" This question respects the person's prior effort and often surfaces important information about what has and has not worked, and why. It also positions the clinician as a collaborator rather than an expert dispensing solutions the person has never considered.

"What's one small thing that would feel manageable?" This question reflects something important that the research on behavior change consistently supports: that small, specific, achievable steps are more likely to produce lasting change than large, ambitious overhauls. Not because big changes are impossible, but because small changes build the behavioral momentum, the confidence, and the identity shifts that make larger changes possible over time.

The Role of Identity in Behavior Change

One of the most important — and most underappreciated — findings in the psychology of behavior change is the role of identity. People do not just change behavior in the abstract. They change behavior in a way that is consistent with their self-concept, and they maintain behavior change to the extent that the new behavior becomes part of how they understand themselves.

James Clear, drawing on a substantial body of research, describes this as the difference between outcome-based change and identity-based change. Outcome-based change says: I want to run a half-marathon, so I will follow a training plan. Identity-based change says: I am becoming someone who runs. The first is fragile. The second is self-sustaining.

In clinical practice, this distinction matters because it changes the focus of the conversation. Rather than asking only "what will you do differently?" it becomes worth asking "who are you becoming?" — and helping the person connect behavioral change to a self-concept that is genuinely motivating rather than externally imposed.

This is also why behavior change that is driven by values tends to be more durable than behavior change driven by fear or external pressure. When the behavior is connected to something the person genuinely cares about — being present for the people they love, living consistently with their own sense of who they are, moving toward a life that feels meaningful — it has an internal engine. When the behavior is driven only by what someone else thinks they should do, or by fear of consequences, it tends to depend on the continued presence of that external pressure to sustain itself.

The CBT Perspective: What Thoughts Get in the Way

Cognitive Behavioral Therapy offers a complementary lens on the behavior change problem. Where Motivational Interviewing focuses on motivation and ambivalence, CBT focuses on the cognitions that interfere with behavior change — the thoughts and beliefs that maintain stuck patterns even when the person genuinely wants to change.

These often take recognizable forms.

All-or-nothing thinking. "If I can't do this perfectly, there's no point in doing it at all." This belief sets a standard that is impossible to maintain and then uses any deviation from it as evidence that the effort should be abandoned. The person who exercises three times a week but misses one week decides they have "failed" and stops entirely. The person who eats well for a month has one difficult week and concludes the effort was worthless. All-or-nothing thinking collapses the distance between imperfection and failure — and it is one of the most common obstacles to lasting behavior change.

Fortune-telling. "I've tried this before and it hasn't worked, so it won't work now." Prior unsuccessful attempts at change become evidence not that the approach needs adjustment but that change itself is not possible. This belief forecloses the possibility of trying differently, which is the actual prerequisite for a different outcome.

Emotional reasoning. "I don't feel like doing it, so I shouldn't have to." Motivation tends to follow action rather than precede it — which is to say that waiting to feel ready or motivated before beginning is often a reliable way to never begin. The behavioral activation approach in CBT operates on exactly this principle: behavior first, mood shift second.

Catastrophizing the difficulty. "This is going to be so hard." Overestimating the difficulty of a change, and underestimating one's capacity to manage it, produces avoidance that prevents the person from discovering that the actual experience is often more manageable than anticipated. Exposure to the feared difficulty — beginning — is itself the intervention.

Working with these cognitions in therapy does not mean arguing the person out of them. It means helping them examine the evidence for and against them, consider alternative interpretations, and experiment with behavior that tests the belief rather than confirms it.

Why Small Steps Are Not a Compromise

There is a cultural narrative about behavior change that prizes dramatic transformation — the total overhaul, the complete reinvention, the fresh start that leaves the old self behind. This narrative is compelling, and it is largely inconsistent with how behavior change actually works.

Research on habit formation, self-efficacy, and behavioral momentum consistently finds that small, sustainable changes build the psychological infrastructure for larger ones. Each small success produces evidence that change is possible, which increases confidence and willingness to attempt the next step. Each small success also contributes to the identity shift — the emerging self-concept as someone who does the new thing — that eventually makes the behavior feel natural rather than effortful.

Starting small is not a concession to limitation. It is a strategy that reflects an accurate understanding of how lasting change is actually built.

This has direct implications for how goals are set in clinical work. A goal that is too large — too vague, too ambitious, too dependent on sustaining a level of motivation that cannot be maintained indefinitely — is not an inspiring goal. It is a setup for the failure experience that confirms the belief that change is not possible. A goal that is specific, small, and achievable in the near term is not an unambitious goal. It is the beginning of a chain that builds toward something larger.

When Behavior Change Requires More Than a Plan

Not all stuck behavior is simply a matter of finding the right strategy or asking the right questions. Sometimes what maintains a pattern of behavior is something that a plan cannot reach: unprocessed grief, unexamined anxiety, a relationship dynamic that is keeping the person in a role they have outgrown, a belief about themselves that predates any conscious awareness of it.

This is where the distinction between coaching and therapy becomes clinically relevant. Goal-setting and accountability structures can produce meaningful change when the primary obstacle is motivational or practical. When the primary obstacle is psychological — when the stuckness is connected to something deeper that a plan is not going to touch — the work requires a different kind of engagement.

Therapy provides the space to examine not only what someone wants to change but what the stuck behavior is doing — what it is protecting against, what it would mean to give it up, what beliefs about the self and the world it is maintaining. This kind of examination is often what makes the difference between change that is sustained and change that is temporarily achieved and then quietly abandoned.

CITATIONS

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

Clear, J. (2018). Atomic habits: An easy and proven way to build good habits and break bad ones. Avery.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390

Wood, W., & Neal, D. T. (2007). A new look at habits and the habit-goal interface. Psychological Review, 114(4), 843–863. https://doi.org/10.1037/0033-295X.114.4.843

Summer Anxiety: Why the "Best Season" Can Feel Like the Hardest

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Summer arrives with a particular set of cultural expectations. It is supposed to be the easy season — the reward after a long year, the time for rest, travel, connection, and something loosely approximating joy. The imagery of summer is all brightness and ease: long evenings, open water, people who appear to be thriving effortlessly.

For a significant number of people, the reality of summer does not match this image. Instead of ease, there is a low-grade restlessness. Instead of rest, there is a strange pressure that is difficult to name. Instead of the joy that the season seems to require, there is anxiety — sometimes sharper than anything felt during the rest of the year.

If this is familiar, you are not alone, and you are not irrational. Summer has a specific psychological profile, and understanding it can make the gap between expectation and experience considerably less disorienting.

The Structure Problem

One of the most underappreciated drivers of summer anxiety is the collapse of structure.

For most adults, the workweek provides an architecture that organizes time, directs attention, provides small daily accomplishments, and creates a reliable rhythm of social contact. This structure is not always experienced as pleasant — commutes, meetings, deadlines — but it provides something psychologically important: predictability. The nervous system knows what to expect. Each day has a shape.

Summer, particularly for people with children, flexible work, or significant vacation time, disrupts this architecture. Days become less predictable. The structure that was organizing time and attention is suddenly absent or significantly altered. And while this might sound like freedom, for many people it produces the opposite of relaxation.

Research on the psychology of unstructured time is consistent: people are significantly less happy during unstructured leisure than during activities with a clear purpose or goal, even when they anticipated that the unstructured time would feel good. The mind, freed from external direction, tends to default toward rumination and self-evaluation — exactly the cognitive territory where anxiety lives.

This is compounded by what psychologists call ego depletion in planning: the cognitive load of deciding how to spend unstructured time, day after day, is itself fatiguing. Decision fatigue accumulates. The summer that was supposed to feel restful becomes an ongoing series of choices — where to go, what to do, how to make the most of it — that quietly depletes rather than restores.

The Comparison Engine

Summer is also one of the most socially comparative seasons, and social comparison is one of the most reliable drivers of anxiety.

Social media in summer becomes a continuous broadcast of other people's vacations, bodies, families, and apparent ease. The photographs are curated. The captions suggest effortless enjoyment. The visible experiences are the highlight reel of other people's summers, compressed and filtered, and presented against the unedited reality of your own.

This gap — between what other people's summers appear to be and what your own summer feels like from the inside — is a reliable generator of what psychologists call upward social comparison: measuring yourself against people who appear to be doing better. Upward social comparison consistently predicts decreased self-esteem, increased anxiety, and decreased life satisfaction.

The body dimension of summer adds a particular layer of this. Summer is, culturally, a high-exposure season in the literal sense — more of the body is visible, in more contexts, than at any other time of year. For people who carry body image concerns, this seasonal shift can produce a significant increase in self-consciousness and avoidance. For people who do not identify as having body image difficulties, the ambient cultural pressure of summer body culture can still produce a background hum of evaluation and comparison that adds to the season's psychological weight.

Heat, Disrupted Sleep, and Their Psychological Effects

There are also biological dimensions to summer anxiety that are worth naming, because they are often overlooked.

Heat has a direct effect on mood, cognition, and emotional regulation. Research has consistently found associations between high temperatures and increased irritability, aggression, and emotional reactivity. The mechanisms are not fully established, but they involve disruption to sleep, increased physiological arousal, and the cognitive load of managing thermal discomfort. A summer that is hotter than usual — which, in many cities, describes most recent summers — is a summer in which the physiological conditions for emotional regulation are somewhat degraded.

Sleep in summer is also frequently disrupted. Longer daylight hours delay the onset of melatonin production. Heat interferes with the drop in core body temperature that supports deep sleep. Later sunsets encourage later bedtimes. The result, for many people, is a gradual accumulation of sleep deficit across the summer months — which, as I have written about elsewhere on this blog, has direct downstream effects on mood, anxiety, and cognitive function. The summer flatness or edginess that many people experience is often, in significant part, the psychological expression of two months of compromised sleep.

The "Making the Most of It" Pressure

Summer carries a specific and somewhat underrecognized anxiety of its own: the pressure to use it well.

Summer is finite and culturally loaded with significance. It is the season most associated with freedom and pleasure. It is the season people reference when they talk about what they want their lives to be. This gives summer a quality that other seasons do not have: the sense that time spent badly is time that particularly matters.

This produces what might be called the tyranny of the optimal summer — a persistent, low-grade anxiety about whether the summer is being used well enough, whether enough is being done, whether the experiences being had are sufficiently memorable or meaningful. Vacations become subjects of advance research and ongoing evaluation. Weekend plans carry a weight of expectation that weekday plans do not. The pressure to feel the season, to extract its value, can paradoxically make the season feel more pressured than enjoyable.

This dynamic is closely related to what we have discussed on this blog in the context of maximizing: the tendency to evaluate experiences against an imagined optimal alternative, rather than simply inhabiting them. Summer is the season where this tendency is most activated — and where it most reliably undermines the enjoyment it is ostensibly trying to protect.

For People With Anxiety Disorders

Everything described above applies broadly. For people with pre-existing anxiety disorders, summer has additional specific risks worth naming.

The disruption of routine can destabilize the behavioral structures that support symptom management. Many people with anxiety rely on consistent sleep schedules, regular exercise, and predictable routines as a foundation for their wellbeing. Summer disrupts all three. What feels like an enjoyable break from routine to some people feels like the removal of a stabilizing scaffold to others.

Social demands increase in summer in ways that can be particularly taxing for people with social anxiety. More events, more gatherings, more situations where bodies and conversations are on display. The summer social calendar can feel less like opportunity and more like an extended exposure to the situations that already feel threatening.

For people who are in therapy or using CBT skills to manage anxiety, the disruption of routine can also disrupt the practice of those skills. This is worth naming in session: the summer is not a break from mental health maintenance. It is often a time when that maintenance requires more deliberate effort, not less.

What Helps

Create structure deliberately. The summer anxiety that comes from unstructured time responds directly to structure. This does not mean filling every day with scheduled activities — it means identifying a few anchoring points in each week that provide rhythm and purpose. A consistent wake time, a regular exercise slot, one or two scheduled social commitments. These anchors do not have to be elaborate. They have to be consistent.

Reduce social comparison inputs. This is easier said than done, but the mechanism is direct: the more time spent consuming curated images of other people's summers, the more the upward comparison effect operates. This is a concrete, modifiable variable. Spending less time on platforms that broadcast highlight reels during a season already prone to comparison is not deprivation — it is protective.

Protect sleep. Blackout curtains, consistent sleep and wake times, a cooler sleeping environment, and limiting blue light in the evening matter more in summer than in any other season. The emotional and cognitive benefits of adequate sleep are available regardless of the heat outside.

Lower the expectation load. Much of summer anxiety is generated by the gap between what summer is supposed to feel like and what it actually feels like. Reducing the size of that expectation — giving yourself permission to have an ordinary summer rather than an optimal one — removes a significant source of the pressure. A summer that is simply lived, without constant evaluation of whether it is being lived well enough, is often more enjoyable than one held to an imagined standard.

Name it. The relief that comes from recognizing that what you are experiencing has a name — that summer anxiety is real, that other people experience it, that there are understandable reasons why a season with high expectations might produce anxiety rather than ease — is itself clinically useful. Recognition interrupts the secondary layer of anxiety about the anxiety. It allows the experience to be held with more curiosity and less alarm.

If summer is reliably a difficult season for you — if the pattern of disrupted sleep, increased anxiety, and a sense of pressure or flatness recurs year after year — that is worth examining rather than waiting out.

Seasonal patterns in anxiety and mood are very treatable, and understanding the specific mechanisms driving the pattern makes the treatment more targeted and more effective.

APA CITATIONS

Hsiang, S. M., Burke, M., & Miguel, E. (2013). Quantifying the influence of climate on human conflict. Science, 341(6151), 1235367. https://doi.org/10.1126/science.1235367

Mogilner, C., Chance, Z., & Norton, M. I. (2012). Giving time gives you time. Psychological Science, 23(10), 1233–1238. https://doi.org/10.1177/0956797612442551

Quoidbach, J., Dunn, E. W., Petrides, K. V., & Mikolajczak, M. (2010). Money giveth, money taketh away: The dual effect of wealth on happiness. Psychological Science, 21(6), 759–763. https://doi.org/10.1177/0956797610371963

Suls, J., & Wheeler, L. (Eds.). (2000). Handbook of social comparison: Theory and research. Springer.

Wilson, T. D., Reinhard, D. A., Westgate, E. C., Gilbert, D. T., Ellerbeck, N., Hahn, C., Brown, C. L., & Shaked, A. (2014). Just think: The challenges of the disengaged mind. Science, 345(6192), 75–77. https://doi.org/10.1126/science.1250830

The Vagus Nerve and Anxiety: What the Science Actually Says

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The vagus nerve has had an unusual journey from anatomy textbook to wellness trend. In the past few years, it has acquired a significant following on social media, where content about "vagus nerve stimulation" — cold water on the face, humming, gargling, specific breathing patterns — has accumulated hundreds of millions of views. It has become one of the most searched terms in the wellness and mental health space in 2026.

Some of what circulates online is reasonably grounded in science. Some of it is not. And the gap between the two is wide enough to be worth navigating carefully — because the vagus nerve is genuinely important for understanding the relationship between the body and anxiety, and that importance is worth taking seriously without the hype that tends to distort it.

What the Vagus Nerve Actually Is

The vagus nerve is the longest cranial nerve in the body — a complex, bidirectional highway running from the brainstem down through the neck, heart, lungs, and abdominal organs. It is the primary component of the parasympathetic nervous system, the system responsible for what is often called the "rest and digest" state — the physiological counterpart to the "fight or flight" response.

In practical terms, the vagus nerve is the primary mechanism by which the brain communicates with the body's major organ systems — and by which those organ systems communicate back to the brain. It carries signals that slow the heart rate, reduce blood pressure, regulate digestion, modulate the immune response, and influence the production of neurotransmitters including serotonin and GABA.

Approximately 80 percent of the nerve's fibers carry information upward — from the body to the brain — rather than downward. This is a detail with significant implications: the vagus nerve is less a control line from brain to body than it is a reporting line from body to brain. What is happening in the gut, the lungs, the heart, is being continuously communicated upward, where it influences mood, cognition, and emotional experience in ways that are only beginning to be fully understood.

What Vagal Tone Means

You may have encountered the phrase "vagal tone" in wellness content, where it is often used somewhat loosely. In clinical and research contexts, vagal tone refers to the degree of parasympathetic activity mediated by the vagus nerve, typically measured through heart rate variability — the natural variation in the interval between heartbeats.

Higher heart rate variability generally indicates greater vagal tone — a more active and responsive parasympathetic system. Lower heart rate variability indicates lower vagal tone — a system that is less able to modulate the physiological stress response.

Why does this matter? Because vagal tone appears to be meaningfully related to emotional and psychological health. Higher vagal tone is associated with better emotional regulation, greater resilience in the face of stress, and lower rates of anxiety and depression. Lower vagal tone is associated with reduced capacity to recover from stressful events, greater emotional reactivity, and higher rates of mood and anxiety disorders.

This is not simply a correlation. Research by psychologist Stephen Porges, whose Polyvagal Theory has been influential both in clinical circles and in the broader trauma and somatic therapy world, suggests that the vagus nerve plays a central role in the nervous system's capacity to shift between states — from mobilization and threat response, to calm engagement, to social connection. When the vagus nerve is functioning well, the nervous system can move flexibly between these states in response to changing circumstances. When it is not, people can become stuck in states of chronic activation or chronic shutdown that are the physiological basis of anxiety and depression respectively.

The Anxiety Connection

For anyone who experiences anxiety, the vagus nerve framework offers a useful way to understand what is happening physically during an anxiety episode — and why certain interventions help.

When the threat-detection system activates — whether in response to an actual danger or to a perceived one — the sympathetic nervous system takes over. Heart rate increases. Breathing becomes shallow and fast. Digestion slows. The body mobilizes for action. The prefrontal cortex is partially downregulated in favor of rapid reactive processing.

The vagus nerve is the mechanism by which the body comes back down from this state. A well-functioning vagal response signals safety to the nervous system: heart rate slows, breathing deepens, digestion resumes, the prefrontal cortex comes back online. The activation resolves and the system returns to baseline.

In chronic anxiety, this return-to-baseline process is impaired. The system activates in response to perceived threat, but the vagal brake — the mechanism that would ordinarily signal that the threat has passed — either fails to engage fully or is insufficient to counteract the level of activation. The result is prolonged physiological arousal: the body remains in a state of readiness even when the situation no longer warrants it. Over time, this becomes the physiological baseline — which is what chronic anxiety feels like from the inside.

Low vagal tone, in this framework, is not just a correlate of anxiety. It is part of the mechanism by which anxiety maintains itself.

What the Research Says About Improving Vagal Tone

Here is where the science and the wellness content diverge most significantly. The wellness landscape is full of claims about specific techniques — cold plunges, gargling, specific yoga poses, humming — that are presented as direct, reliable interventions for vagal tone. The actual research evidence is considerably more nuanced.

Slow, diaphragmatic breathing has the strongest and most consistent evidence base of any behavioral intervention for vagal tone. Breathing at approximately five to six breaths per minute, with extended exhalations, reliably activates the vagal brake and increases heart rate variability. This is the mechanism behind many established relaxation techniques, including box breathing and the physiological sigh. It is not a hack or a trend — it is one of the most direct behavioral access points to the parasympathetic nervous system available to most people.

Exercise has robust evidence for improving vagal tone over time, particularly aerobic exercise practiced consistently. The mechanism is not fully elucidated, but the heart rate variability improvements associated with regular exercise are well documented and clinically meaningful.

Meditation and mindfulness practices are associated with increased heart rate variability and improved vagal tone, particularly practices that emphasize slow, rhythmic breathing. The evidence here is reasonably strong, though the specific mechanisms are still being studied.

Social connection and positive social interactions have been found to increase vagal tone — a finding that aligns with Porges's emphasis on the vagus nerve as a social engagement system. Warm, safe human contact appears to directly activate the parasympathetic branch of the nervous system in ways that go beyond the psychological experience of feeling supported.

Cold water exposure — the face-in-cold-water technique popular on social media — does have a physiological basis. The diving reflex, triggered by cold water on the face, activates the vagus nerve and produces a rapid decrease in heart rate. It is a real effect. Whether it produces lasting improvements in vagal tone with repeated use is less clear, and for people with cardiac conditions, it carries risks that are not discussed in most social media presentations.

Humming, chanting, and singing stimulate the vagus nerve through vibration of the muscles of the throat, which are innervated by vagal branches. This is a real mechanism, not pseudoscience. Whether it produces clinically significant changes in vagal tone sufficient to affect anxiety symptoms is a more open question.

The honest summary is this: slow breathing, regular exercise, consistent mindfulness practice, and meaningful social connection have the strongest evidence for improving vagal tone over time. They are also, not coincidentally, the interventions with the broadest evidence base for anxiety treatment generally. The vagus nerve framework provides a physiological explanation for why these things work — it does not replace them with something newer or easier.

Where the Hype Overreaches

A few things worth naming directly.

Vagal tone is not something you can dramatically improve with a single technique done once. It is a relatively stable physiological trait that changes gradually with sustained behavioral change — not a setting you can flip with five minutes of cold water or ten minutes of humming. Social media content that implies otherwise is overstating what the science supports.

Polyvagal Theory, while influential and clinically generative, is also contested in parts of the scientific literature. Some of Porges's specific claims about the evolutionary architecture of the nervous system have been questioned by researchers. The theory is useful as a clinical framework for understanding states of arousal and connection, but it should be held with some epistemic humility rather than treated as settled neuroscience.

Vagal tone interventions are not a substitute for evidence-based anxiety treatment. For people with significant anxiety disorders, breathing exercises and cold showers are useful adjuncts, not primary treatments. CBT, exposure therapy, and other evidence-based approaches have decades of rigorous research supporting their efficacy. Vagal interventions belong in a toolkit alongside these approaches, not instead of them.

The Useful Takeaway

Strip away the hype, and the vagus nerve framework offers something genuinely valuable for understanding anxiety: a physiological account of why the body gets stuck in threat-response states, and a set of behavioral practices that can help the nervous system shift out of them.

Slow, extended breathing is the most accessible and most evidence-supported of these practices. Doing it consistently — not as an emergency intervention when anxiety is acute, but as a regular practice that gradually improves the nervous system's baseline regulatory capacity — produces real effects over time.

If you are managing chronic anxiety and want to understand the physiological dimension of what is happening, the vagus nerve framework is a useful lens. If you are looking for a shortcut that will resolve anxiety without the slower work of behavioral change and, when needed, psychotherapy — that shortcut does not exist, whatever the wellness industry is currently selling.

APA CITATIONS

Grossman, P., & Taylor, E. W. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology, 74(2), 263–285. https://doi.org/10.1016/j.biopsycho.2005.11.014

Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116–143. https://doi.org/10.1016/j.biopsycho.2006.06.009

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. Norton.

Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart-brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience and Biobehavioral Reviews, 33(2), 81–88. https://doi.org/10.1016/j.neubiorev.2008.08.004

"Brain Rot" Is Real — Here's What's Actually Happening

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If you have spent any time on social media recently, you have probably encountered the phrase — or experienced the feeling it describes. A kind of mental mushiness. Difficulty concentrating on anything that requires sustained effort. A strange flatness after hours of scrolling. The sense that your attention span has quietly shrunk and your capacity for boredom has disappeared, replaced by a low-grade restlessness that reaches immediately for a screen the moment anything feels dull.

"Brain rot" is the informal name a generation has given to this experience. Oxford University Press named it Word of the Year for 2024, defining it as the "supposed deterioration of a person's mental or intellectual state as a result of overconsumption of material considered to be trivial or unchallenging." It has since become one of the most searched mental health terms in 2026.

The phrase is casual, even self-deprecating. But the experience it points at is real, and the neuroscience behind it is worth understanding — both because it explains what is happening and because understanding it changes what to do about it.

What "Brain Rot" Actually Describes

Brain rot, as most people use the term, is not a clinical diagnosis. It is a description of a functional state: the cognitive and emotional aftermath of sustained exposure to high-stimulation, low-demand content. The experience typically includes some combination of the following: difficulty focusing on tasks that require sustained attention, a reduced threshold for boredom, a compulsive pull toward screens even when the person is not enjoying what they are consuming, difficulty with reading or other cognitively demanding activities, a general sense of mental fog, and emotional flatness or low-grade irritability.

What is notable about this list is how closely it maps onto the symptom profiles of conditions that psychologists already know well: attention difficulties, anhedonia, dysthymia, and what researchers call "attentional fatigue." Brain rot may be a new phrase, but the underlying experience is not new. What is new is the scale at which it is being produced and the age at which it is beginning.

What Excessive Screen Time Actually Does to the Brain

The neuroscience here is not speculative. Several well-established mechanisms explain why sustained exposure to algorithmically optimized, high-stimulation content produces the experience people are describing as brain rot.

The dopamine system gets recalibrated. Dopamine is the neurotransmitter most associated with motivation, reward anticipation, and the drive to pursue goals. Social media platforms, as I have written previously on this blog, are specifically engineered to generate frequent, small dopamine releases through likes, novel content, and the near-satisfaction of the scroll. Over time, repeated exposure to this kind of rapid, low-effort reward recalibrates the dopamine system's baseline. Activities that produce slower, more effortful rewards — reading a book, working on a project, having a sustained conversation — begin to feel less compelling by comparison. Not because they are less valuable, but because the brain's reward threshold has shifted.

Attentional networks are weakened by disuse. The capacity for sustained, focused attention is not fixed — it is a cognitive skill that is strengthened through practice and weakened through disuse. When the majority of a person's attentional experience involves rapid switching between short pieces of content, the neural networks that support sustained focus are not being exercised. Research on neuroplasticity suggests that cognitive capacities that go unpracticed become less available over time. The difficulty concentrating that many people describe is not a character flaw — it is the predictable result of spending significant cognitive time in a mode that does not require concentration.

The default mode network is disrupted. The default mode network activates during rest, mind-wandering, and self-reflection. It is associated with creativity, future planning, emotional processing, and the consolidation of identity and meaning. Healthy DMN activity requires periods of genuine cognitive rest — time when the mind is not being fed external stimulation. Continuous screen use, by filling every available moment of potential rest with content, suppresses DMN activity. The result is a mind that is perpetually occupied but rarely genuinely reflective — which is one reason people who spend significant time on screens often describe feeling simultaneously overstimulated and somehow empty.

Sleep architecture is disrupted. Blue light exposure suppresses melatonin production. Evening screen use delays sleep onset and reduces slow-wave sleep. And as I have described elsewhere, disrupted sleep amplifies emotional reactivity, worsens attentional capacity, and reduces the brain's ability to regulate mood the following day. The cognitive fogginess of brain rot is partly the accumulated effect of chronically compromised sleep.

Why It Feels So Hard to Stop

One of the most important things to understand about brain rot is that the difficulty stopping is not a willpower problem. It is a design problem.

As I wrote in a previous post on this blog, social media platforms were engineered using the same techniques developed by the casino industry to maximize engagement and minimize disengagement. Infinite scroll, autoplay, algorithmically personalized content, and the removal of all natural stopping points combine to produce what researchers call "dark flow" — a trance-like state of absorption that is structurally similar to the machine zone that slot machines generate.

The person who cannot put down their phone is not lacking self-discipline. They are responding to a system that has been specifically optimized to resist their attempts to disengage. Understanding this is not an excuse for inaction — but it does clarify that the solution requires changing the system, not simply applying more willpower to the same conditions.

The Mental Health Overlap

Brain rot sits at an interesting clinical intersection because it both resembles and contributes to several recognized mental health conditions.

The attentional difficulties it produces overlap with ADHD symptomatology — which has led some researchers to ask whether rising rates of ADHD diagnoses in young adults partly reflect a neurological response to the attentional environment rather than purely an increase in the underlying condition. This is not settled science, but it is a clinically meaningful question.

The emotional flatness and motivational depletion it produces overlap with depression and dysthymia. The compulsive quality of the scrolling overlaps with behavioral addiction. The disrupted sleep it generates worsens anxiety.

What makes brain rot particularly worth clinical attention is that it can function as both a symptom and a cause. People who are anxious, depressed, or struggling to manage their emotional experience are more likely to turn to screens as a coping mechanism — and sustained screen use then worsens the conditions that prompted it. This bidirectional relationship is one of the reasons it can be difficult to interrupt without support.

What Actually Helps

A few things that research and clinical experience both support:

Rebuild attentional capacity deliberately. The brain's capacity for sustained focus is a skill, and skills are rebuilt through practice. This means deliberately engaging in activities that require sustained attention — reading, writing, extended conversation, creative work — even when they initially feel effortful or boring. The discomfort is the neurological equivalent of the burn of a muscle being exercised after a period of disuse. It is the sensation of the capacity returning.

Reintroduce genuine boredom. Boredom is not a problem to be solved with a phone. It is a neurological state that has real value — it activates the default mode network, prompts creativity, and allows the mind to process experience that has not had space to settle. Tolerating boredom without reaching for stimulation is one of the more counterintuitive and effective interventions available.

Restructure access rather than rely on willpower. As with any behavioral pattern driven by a well-engineered system, changing the environment produces more durable results than repeated acts of self-restraint against the same conditions. This means physical distance from the phone, app timers, grayscale screen settings, and the deliberate creation of phone-free times and spaces.

Address what the scrolling is managing. For many people, excessive screen use is not primarily about the content. It is about avoidance — of boredom, of anxiety, of difficult emotions or tasks that feel harder to face. Identifying what the phone is being used instead of is often the most clinically productive question.

A Note on Not Pathologizing Yourself

Brain rot is a real experience with a real neurological basis. It is also worth keeping in perspective. The human brain is remarkably adaptive, and the changes that excessive screen use produces are largely reversible with intentional behavior change. This is not a permanent condition. It is a functional state that responds to different inputs.

If the experience is significantly interfering with your ability to work, enjoy things, maintain relationships, or feel like yourself — if the fog has become the background of your daily life rather than an occasional experience — that is worth addressing directly, potentially with clinical support. But for many people, recognition alone is the beginning of change. Naming what is happening, understanding the mechanism, and making a few deliberate adjustments to the environment can produce meaningful improvement without anything more intensive. The brain that consumed its way into brain rot is the same brain that can consume its way back out — it just requires a different diet.

APA CITATIONS

Kushlev, K., & Dunn, E. W. (2019). Smartphone use reduces feelings of social connectedness, even when engaging in social interactions. Social Psychology, 50(4), 237–246. https://doi.org/10.1027/1864-9335/a000387

Mrazek, M. D., Franklin, M. S., Phillips, D. T., Baird, B., & Schooler, J. W. (2013). Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering. Psychological Science, 24(5), 776–781. https://doi.org/10.1177/0956797612459659

Ophir, E., Nass, C., & Wagner, A. D. (2009). Cognitive control in media multitaskers. Proceedings of the National Academy of Sciences, 106(37), 15583–15587. https://doi.org/10.1073/pnas.0903620106

Twenge, J. M., & Campbell, W. K. (2019). Media use is linked to lower psychological well-being: Evidence from three datasets. Psychiatric Quarterly, 90(2), 311–331. https://doi.org/10.1007/s11126-019-09630-7

Radical Acceptance: What It Actually Means and Why It's So Hard

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There is a particular kind of suffering that has nothing to do with the original painful event. It is the suffering that comes from fighting the fact that the event happened at all.

A relationship ends and the pain is real — but layered on top of it is the relentless mental loop: this shouldn't have happened, this isn't fair, if I had done something differently it would have been different, I can't accept this. The situation is painful. The refusal to accept it is its own additional torment, running continuously alongside the original wound.

This distinction — between the pain that is inherent in a difficult reality and the additional suffering generated by refusing to accept that reality — is at the heart of one of the most clinically useful and most commonly misunderstood concepts in modern psychotherapy: radical acceptance.

What Radical Acceptance Is Not

Because the phrase gets used loosely, it is worth starting with what radical acceptance is not.

It is not approval. Accepting that something happened is not the same as deciding it was okay, deserved, or acceptable. You can fully accept that you were treated unjustly while also knowing that the treatment was wrong. Acceptance is a statement about reality, not a moral verdict on it.

It is not giving up. Accepting a situation does not mean you stop trying to change it, stop advocating for yourself, or resign yourself to a future in which nothing is different. It means you stop arguing with the present moment — which is the only place from which effective action is actually possible.

It is not the same as feeling okay about something. Radical acceptance does not require the absence of grief, anger, or pain. In fact, it often allows those feelings to be experienced more fully, because energy is no longer being spent on the fight against reality.

It is not a one-time decision. People often expect acceptance to arrive and stay. It does not work that way. Radical acceptance is a practice — something that has to be returned to, sometimes many times, because the mind's tendency to resist painful reality is strong and persistent.

Where It Comes From

The concept of radical acceptance as a clinical tool is most closely associated with psychologist Marsha Linehan, who developed Dialectical Behavior Therapy in the late 1980s. DBT was originally designed for people with borderline personality disorder — a population characterized by intense emotional dysregulation, difficulty tolerating distress, and a chronic tendency toward crisis. Radical acceptance became one of DBT's core distress tolerance skills because Linehan recognized that much of the suffering her patients experienced was amplified not by their circumstances alone but by their inability to accept circumstances as they were.

The philosophical roots of the concept run considerably deeper. Acceptance of what cannot be changed is central to Stoic philosophy — Marcus Aurelius and Epictetus both wrote extensively about distinguishing between what is within our control and what is not, and the freedom that comes from releasing the fight against the latter. Buddhist teaching has long centered the relationship between suffering and resistance to impermanence. The Serenity Prayer, familiar to anyone who has encountered twelve-step programs, asks for acceptance of things that cannot be changed as explicitly as it asks for the courage to change things that can.

Linehan formalized these ideas into a clinical skill and placed them within a structured therapeutic framework. But the insight they encode is ancient: fighting reality does not change it. It only adds to the cost.

The Pain vs. Suffering Distinction

The clinical logic of radical acceptance rests on a distinction that is simple to state and genuinely difficult to internalize.

Pain is inevitable. Loss, illness, disappointment, failure, the death of people we love, the end of things we valued — these are not aberrations in an otherwise smooth life. They are part of what a human life contains. No amount of preparation, self-improvement, or correct decision-making insulates a person from them entirely.

Suffering, in the clinical sense, is what happens when pain is met with nonacceptance. This should not be happening. I cannot bear this. If only things were different. Why is this happening to me. These are not simply responses to the painful situation — they are an additional layer of distress generated by the mind's refusal to allow reality to be what it is.

Linehan expressed this as a formula that has become one of the more memorable in clinical psychology: Pain x Nonacceptance = Suffering. The pain is fixed. What the person can influence is the nonacceptance multiplier. Radical acceptance, in this framework, is not the elimination of pain. It is the removal of the additional suffering that nonacceptance generates.

This is why radical acceptance is sometimes described as the most compassionate thing a person can do for themselves. Not because it makes things not hurt, but because it stops adding to the hurt.

What Nonacceptance Actually Looks Like

Because nonacceptance is so common and so automatic, it can be difficult to recognize in oneself. It tends to show up in a few characteristic ways.

Rumination. The mind returns repeatedly to the situation — not to process it or move through it, but to relitigate it. To find the moment where things could have gone differently. To argue, internally, against the fact of what happened. Rumination feels like thinking about a problem, but it is usually the mind's attempt to undo through repeated mental review what cannot actually be undone.

Bitterness and resentment. These are the emotional signatures of sustained nonacceptance. They arise when a person has been fighting a reality for long enough that the fight itself has become a defining feature of their experience. The bitterness is not about the original event anymore — it is the residue of years of refusing to let it be what it was.

Magical thinking about the past. If only I had said something different. If only I had made a different choice. If only things had been different. These thoughts are the mind's attempt to rewrite history — to find the alternate path that would have led somewhere better. They have the feeling of productive reflection but produce no usable information, because the past cannot be changed and the alternate path was never taken.

Avoidance. Sometimes nonacceptance shows up not as active resistance but as refusal to engage with the reality at all — changing the subject, staying busy, not allowing quiet moments where the unwanted truth might surface. This is a more passive form of the same pattern.

Why It Is So Hard

If radical acceptance reduces suffering and is philosophically straightforward, why does it require sustained practice rather than a single decision?

Part of the answer is neurobiological. The brain's threat-detection system treats unresolved problems as open loops that require continued attention. A reality that has not been accepted registers, at some level, as a problem that still needs solving — and the mind keeps returning to it, generating the same nonproductive review, because that is what minds do with unresolved problems. Accepting a painful reality requires the mind to close a loop it has been treating as open, and that closure requires something more than intellectual understanding.

Part of the answer is emotional. Accepting a loss means fully feeling it — allowing grief, anger, or fear to be present without the buffer of the fight against reality. For many people, the nonacceptance is itself a defense: as long as the mind is occupied with arguing against what happened, it does not have to fully arrive at the feelings that accepting it would require. The resistance, paradoxically, is a way of not feeling the thing.

Part of the answer is relational and moral. Accepting something that was genuinely unjust can feel like a betrayal — of oneself, of others who were harmed, of the principle that things should be fair. This is where the distinction between acceptance and approval is most important, and most difficult to hold. You can accept that something happened, and that it cannot be changed, and that continuing to fight it is costing you, while still knowing it was wrong.

What Radical Acceptance Looks Like in Practice

Radical acceptance is not a feeling that arrives. It is a practice that is chosen, often repeatedly, in the presence of the feelings that make it difficult.

It typically begins with acknowledgment — not a cheerful reframe, but a plain statement of what is true. This happened. This is real. This is the situation I am in. Naming reality without editorial is the first step toward accepting it.

It continues with the recognition of what is and is not within control. Some things about a painful situation may be changeable. Many are not. Radical acceptance focuses specifically on what cannot be changed — not as a reason for passivity, but as a reason to stop spending energy on a fight that cannot be won.

It involves turning toward rather than away from the associated feelings. Grief needs to be grieved. Anger needs to be acknowledged. The feelings that nonacceptance was buffering against need to be allowed. This is often the hardest part, and it is the part that most benefits from the support of a therapist.

It requires repetition. The mind will return to nonacceptance. The practice is noticing that return and choosing, again, to accept. Over time, with practice, the return becomes less frequent and the acceptance becomes more available.

When Radical Acceptance Is Most Relevant

Radical acceptance is particularly useful in situations characterized by irreversibility — situations where the painful reality cannot be changed and where the energy spent fighting it is not producing change but only additional suffering.

Grief and loss. The death of someone loved, the end of a relationship, the loss of a health or a capacity — these are realities that cannot be altered. The question is only whether they will be met with acceptance or with sustained resistance that extends the suffering indefinitely.

Chronic illness or pain. Living well with a chronic condition requires, at some level, accepting its presence — not surrendering to it or abandoning medical care, but releasing the exhausting fight against the fact of it.

The actions of other people. Other people's choices, particularly choices that have caused harm, are outside of our control. Radical acceptance of what another person did — while still holding them accountable, if that is possible and appropriate — is often the path out of the bitterness and resentment that sustained nonacceptance produces.

Past mistakes. The inability to accept one's own past decisions is one of the most common presentations in clinical work. The shame and self-criticism that accompany nonacceptance of past behavior are often more debilitating than whatever the original behavior warranted. Accepting what happened — including one's own role in it — is the prerequisite for genuine change, because change requires an accurate assessment of reality.

Radical Acceptance and Therapy

Radical acceptance is not only a DBT skill. It surfaces, in one form or another, across many therapeutic approaches. Acceptance and Commitment Therapy is built substantially around the practice of accepting internal experience rather than fighting it. Psychodynamic work often involves accepting aspects of one's history and character that have been resisted or denied. Grief therapy is, in many ways, the facilitated practice of accepting loss.

What therapy provides that makes radical acceptance more accessible is a relationship in which the painful reality can be held alongside another person — not argued away, not fixed, but witnessed and accepted together. The presence of a therapist who can tolerate the full weight of a difficult reality without flinching, and without rushing toward resolution, creates the conditions in which the patient can begin to do the same.

If you find yourself stuck in a pattern of resistance to something that cannot be changed — returning to the same rueful loops, carrying bitterness about something years old, unable to move forward because some part of you is still fighting the fact of what happened — that is worth exploring in a clinical context. Not because the thing that happened was not significant, but because the cost of continuing to fight it may have exceeded the cost of the thing itself.

APA CITATIONS

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.

Marcus Aurelius. (2002). Meditations (G. Hays, Trans.). Modern Library. (Original work written c. 161–180 CE)

Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623. https://doi.org/10.1037/0022-006X.68.4.615

Chronic Stress vs. Acute Stress: Why the Difference Matters for Your Mental Health

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Most people use the word stress as though it describes a single thing. A deadline is stressful. A difficult conversation is stressful. A year of financial uncertainty is stressful. A medical diagnosis is stressful. The word covers all of it — and in doing so, obscures a distinction that has significant implications for both physical and psychological health.

Not all stress is the same. Stress that is acute — intense but time-limited — and stress that is chronic — lower in intensity but persistent — activate overlapping biological systems in ways that produce meaningfully different effects on the brain and body over time. Understanding the difference is not just academic. It changes what to pay attention to, when to seek support, and what kind of support is likely to help.

The Biology of Stress: What's Actually Happening

When the brain perceives a threat — whether that threat is a car swerving into your lane, a confrontation with a supervisor, or a frightening piece of news — it activates a cascade of biological responses designed to prepare the body to respond quickly.

The hypothalamus signals the adrenal glands to release adrenaline and cortisol. Heart rate and blood pressure increase. Blood flow is directed toward the muscles and away from non-essential systems. Digestion slows. The immune system is temporarily suppressed. Attention narrows to the perceived threat. The prefrontal cortex — the part of the brain responsible for deliberate, measured thinking — is partially downregulated in favor of faster, more reactive processing.

This is the stress response: a biological system that evolved for survival in environments where threats were usually physical, usually immediate, and usually resolvable through rapid action. It is extraordinarily effective at what it was designed to do.

The problem is that it was not designed to run continuously.

Acute Stress: The System Working as Intended

Acute stress is the stress response activated by a specific, time-limited event. The presentation before a large audience. The argument that erupts and then resolves. The near-miss accident. The sudden medical emergency.

Acute stress is intense. It can feel overwhelming in the moment. But it has a natural arc: activation, response, resolution, recovery. When the threat passes or is addressed, the stress response winds down. Cortisol levels return to baseline. Heart rate slows. The prefrontal cortex comes back online. The body moves into a recovery state — and that recovery is itself important, restoring the biological reserves that the acute stress temporarily depleted.

Psychologically, acute stress can actually be useful. Research by stress researcher Firdaus Dhabhar has found that acute stress can enhance immune function, improve certain kinds of memory and attention, and sharpen performance on tasks that require focused effort. The kind of stress that comes from genuine challenge — a stretch goal, a demanding performance, a situation that requires everything you have — can contribute to growth, competence, and a deepened sense of capability.

Acute stress becomes problematic primarily when it is severe, when it involves threat to life or safety, or when it occurs in contexts where the person has no control or capacity to respond. This is the territory of trauma and post-traumatic stress, which is its own clinical landscape.

But for most acute stress, the biology is working as intended. The system activates, does its job, and recovers.

Chronic Stress: When the System Stays On

Chronic stress is what happens when the stress response is activated not by a discrete event but by ongoing, unresolvable conditions. Financial precarity that stretches over months or years. A relationship that is persistently conflicted. A job environment that is consistently demanding or unsafe. Caregiving for someone with a serious illness. Living in a neighborhood or social context characterized by ongoing threat or instability. The slow accumulation of a life that asks more than it gives.

Chronic stress often does not feel as intense as acute stress. There is rarely the spike of adrenaline, the racing heart, the vivid activation of a crisis moment. Instead, there is a persistent elevation of baseline cortisol — a low-grade physiological tension that becomes so familiar it stops registering as stress at all. It just becomes the background of daily experience.

This is what makes chronic stress so clinically significant and so easy to underestimate. It does not announce itself. It does not produce a clear moment of crisis that prompts intervention. It simply continues, quietly degrading the biological and psychological systems it affects, until those effects become impossible to ignore.

What Chronic Stress Does to the Brain

The neuroscience of chronic stress is one of the more important bodies of research in contemporary clinical psychology, and its findings are worth knowing.

The prefrontal cortex shrinks. The prefrontal cortex — responsible for executive function, emotional regulation, decision-making, impulse control, and the capacity to hold multiple perspectives simultaneously — is particularly vulnerable to chronic cortisol exposure. Research using neuroimaging has found that prolonged stress is associated with reduced volume in prefrontal regions. This means that chronic stress literally impairs the brain structures most responsible for managing stress. The more chronically stressed you are, the less access you have to the cognitive resources that would help you respond to stress effectively.

The amygdala becomes hyperreactive. The amygdala, the brain's primary threat-detection center, shows the opposite pattern under chronic stress: it becomes larger and more reactive. The threshold for perceived threat lowers. Situations that would otherwise be experienced as neutral or mildly challenging are processed as dangerous. This produces the hypervigilance, irritability, and emotional reactivity that are hallmarks of chronic stress — and that are also features of anxiety and depression.

The hippocampus is damaged. The hippocampus, critical for memory formation and the ability to contextualize experience in time and space, is directly damaged by sustained cortisol exposure. Research has found reduced hippocampal volume in people with chronic stress-related conditions including depression and PTSD. This damage affects not only memory but the ability to accurately assess current situations — because context and history are encoded in the hippocampus, and when it is impaired, the brain loses some of its capacity to evaluate whether a current situation is actually threatening.

Neurogenesis is suppressed. The hippocampus is one of the few brain regions capable of generating new neurons throughout the lifespan. Chronic stress suppresses this neurogenesis. Antidepressants and effective psychotherapy, conversely, appear to restore it — which offers a biological window into why these treatments work.

What Chronic Stress Does to Mental Health

The neurobiological effects of chronic stress translate directly into the clinical presentations I see most often in practice.

Depression. The relationship between chronic stress and depression is one of the most robust in all of clinical psychology. Sustained cortisol exposure disrupts the very neurotransmitter systems — particularly serotonin and dopamine — that regulate mood, motivation, and the capacity for pleasure. The flattening of affect, the loss of motivation, the anhedonia that characterizes depression are not simply emotional responses to difficult circumstances. They are, in significant part, the psychological expression of a brain that has been running in a high-cortisol environment for too long.

Anxiety. The amygdala hyperreactivity produced by chronic stress is, in essence, a low threshold for threat perception. When the brain is chronically stressed, more things feel threatening. The gap between a neutral stimulus and a perceived danger narrows. This is anxiety — not as a character trait or an overreaction, but as the output of a nervous system that has been calibrated, by sustained experience, to expect threat.

Cognitive difficulties. Difficulty concentrating, memory problems, trouble making decisions, a sense of mental fog — these are among the most commonly reported symptoms of chronic stress, and they have a clear neurobiological basis in the prefrontal and hippocampal changes described above. When patients describe feeling like their brain is not working the way it used to, chronic stress is often a significant contributing factor.

Sleep disruption. Chronic cortisol elevation interferes directly with sleep architecture. Cortisol and melatonin exist in an inverse relationship: cortisol suppresses melatonin production, and sustained cortisol elevation pushes that suppression into the nighttime hours, when melatonin should be at its peak. The result is difficulty falling asleep, frequent nighttime waking, and sleep that is technically present but not restorative. And disrupted sleep, as I have written elsewhere on this blog, amplifies emotional reactivity and worsens the anxiety and depression that chronic stress is already producing.

Physical health consequences. The sustained suppression of the immune system and inflammatory dysregulation that accompany chronic stress have downstream effects on physical health that extend well beyond the psychological: elevated risk of cardiovascular disease, gastrointestinal disorders, autoimmune conditions, and metabolic disruption. The mind-body distinction that has historically separated mental health from physical health is not supported by the biology of stress.

The Normalization Problem

One of the most clinically significant features of chronic stress is how thoroughly it normalizes.

Acute stress is hard to miss. The racing heart, the surge of adrenaline, the sense of crisis — these are difficult to ignore or attribute to something else.

Chronic stress is different. Because it builds gradually, and because the adaptations it produces become the new baseline, people often stop perceiving it as stress at all. The persistent fatigue is attributed to getting older. The irritability is attributed to a busy season at work. The difficulty concentrating is attributed to too much coffee, not enough coffee, a bad night of sleep. The low-grade sense of dread that has been running for two years is attributed to nothing in particular, because it has been present for so long that its absence is difficult to imagine.

This normalization is one of the main reasons chronic stress goes clinically unaddressed for so long. People do not present for treatment of chronic stress. They present for treatment of the depression, the anxiety, the insomnia, the physical symptoms, the relationship difficulties that chronic stress has produced — often without identifying the source.

What This Looks Like in Practice

A few questions worth asking yourself honestly:

How long have you been operating at this level? A stressful week is acute. A stressful year has different implications. Two years begins to describe a chronic condition with the kinds of neurobiological effects outlined above.

Is there a clear endpoint in sight, or is this the indefinite state of your life? Acute stress is time-limited by definition. Chronic stress often has no natural resolution — which is itself part of what makes it chronically activating.

Are the things that used to restore you still working? One of the more telling markers of chronic stress is when ordinary recovery strategies stop providing recovery. Sleep that doesn't refresh. Weekends that don't reset. Vacations from which you return feeling no different. When the recovery system is impaired, the underlying load has exceeded what the system can process.

How is your emotional range? Chronic stress tends to flatten and narrow emotional experience. The highs are less high. Enjoyment is harder to access. Humor lands differently. If the texture of daily emotional experience has become consistently grey, that is information.

Chronic stress is treatable, and the earlier it is addressed, the less neurobiological damage accumulates. This is not a reason for alarm — the brain retains significant plasticity, and the changes chronic stress produces are largely reversible with appropriate intervention. But it is a reason to take the question seriously rather than attributing everything to circumstance and continuing to push through.

If the stress in your life has been ongoing long enough to produce the patterns described here — sleep disruption, mood changes, cognitive difficulties, a persistent sense of flatness or dread — that warrants clinical attention. Not because something is permanently wrong, but because the system has been under a load that recovery strategies alone are unlikely to resolve.

Avoidant Attachment in Adult Relationships: What It Is and What to Do About It

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There is a particular kind of relational pattern that brings people to therapy not because they are unhappy alone, but because the people they care about most keep telling them they are hard to reach.

They are described as emotionally unavailable. Cold when things get intense. Likely to withdraw precisely when a partner needs more closeness. They pull back at the moment a relationship begins to feel serious. They are more comfortable with the idea of intimacy than with its actual demands.

And often — not always, but often — they do not fully disagree with the description. They can feel it themselves: a kind of internal closing when someone gets too close, a preference for self-sufficiency that is so deep it barely registers as a preference at all. It just feels like who they are.

This pattern has a name in attachment theory: avoidant attachment. And understanding where it comes from, what it does in relationships, and whether it can change is among the more useful frameworks available for making sense of the specific kind of relational difficulty it produces.

Where Attachment Patterns Come From

Attachment theory, developed by British psychiatrist John Bowlby and later elaborated by developmental psychologist Mary Ainsworth, proposes that human beings are biologically wired to seek proximity to caregivers when distressed. In infancy and early childhood, the way a caregiver responds to that distress — consistently, inconsistently, or not at all — shapes what the child learns to expect from close relationships.

A child whose distress is met consistently and sensitively learns that other people are reliable sources of comfort: that it is safe to express need, that closeness is rewarding rather than threatening, that depending on another person does not end in abandonment or rejection. Attachment researchers call this a secure base.

A child whose distress is met with emotional unavailability, dismissal, or discomfort — not necessarily through neglect or cruelty, but through a consistent pattern of caregivers who are uncomfortable with emotional expression, who prize self-sufficiency, or who withdraw when the child needs closeness — learns something different. They learn that expressing need does not produce comfort. They learn to deactivate attachment needs — to suppress the pull toward closeness because closeness has not reliably been available.

This adaptation is intelligent. Within the early relational environment that produced it, it reduces distress. The child stops asking for what is not coming. But it is also a template — and templates travel. What was learned in the earliest relationships shapes what is expected, sought, and tolerated in every significant relationship that follows.

What Avoidant Attachment Looks Like in Adults

In adult relationships, the deactivation strategy that served a child in an emotionally unavailable early environment tends to manifest in recognizable ways.

Discomfort with emotional intimacy. Conversations that move toward emotional depth — about needs, fears, the relationship itself — produce a subtle but palpable closing. The person may change the subject, become intellectually analytical when emotional engagement is what the moment calls for, or simply go quiet. This is not performed indifference. It is a genuine activation of the deactivation strategy: the nervous system closing access to material that feels threatening.

Self-sufficiency as identity. People with avoidant attachment often have a strongly held belief — sometimes conscious, sometimes not — that needing other people is weakness, that depending on anyone is dangerous, and that the safest position is one in which they require nothing from anyone. This belief is often ego-syntonic: it feels like strength, not fear. It has often been reinforced by the external world, which tends to reward independence and punish visible need.

Withdrawal under pressure. As a relationship deepens and a partner's need for closeness increases, the avoidantly attached person often feels not warmth but pressure — a pull toward something that activates the old closing reflex. The response is typically to create distance: becoming busier, less communicative, more focused on individual pursuits. This is not conscious cruelty. It is the nervous system doing what it learned to do when closeness felt like a demand it could not meet.

Idealizing independence and devaluing the relationship when threatened. One of the more specific cognitive patterns associated with avoidant attachment is the tendency, when the relationship feels like too much, to mentally catalog its flaws — to suddenly notice everything that is wrong with the partner, to remember other relationships that felt freer, to idealize the idea of being alone. This is a deactivating strategy: the mind generating reasons to move away from the source of activation.

Difficulty expressing needs. Not only do avoidantly attached people struggle to respond to others' needs — they also struggle to express their own. Identifying what they need and asking for it directly is threatening in a particular way: it requires the acknowledgment that they need something, which conflicts with the self-sufficiency identity, and it risks the vulnerability of asking and not receiving.

Relationships that feel more comfortable at a certain distance. Many people with avoidant attachment have relationship histories that include difficulty sustaining intimacy past a certain point. Early stages of relationships — when everything is still somewhat abstract, when closeness is chosen rather than required — often feel good. It is the deepening that produces discomfort. This can generate a confusing pattern: intense attraction followed by a pull to withdraw as the relationship becomes real.

The Anxious-Avoidant Dynamic

Avoidant attachment rarely presents in isolation in the therapy room. It most often presents in the context of a relationship with someone who has an anxious attachment style — and the dynamic between the two deserves its own attention because it is both extremely common and extremely painful for both people involved.

An anxiously attached person's core fear is abandonment — that they are not enough, that closeness will be withdrawn, that the people they love will leave. Their relational strategy involves pursuing proximity: seeking reassurance, monitoring the relationship's temperature, escalating bids for connection when they feel uncertain about the other person's commitment.

This strategy activates the avoidantly attached person's deactivation reflex. The more the anxious partner pursues, the more the avoidant partner withdraws. The more the avoidant partner withdraws, the more the anxious partner pursues. Neither person is acting irrationally. Both are following the relational logic their early experience taught them. But the pattern is self-reinforcing, and without intervention it tends to escalate rather than stabilize.

What makes this dynamic particularly difficult to interrupt is that both people interpret it through their own attachment lens. The anxious partner experiences the avoidant's withdrawal as confirmation of their fear — that they are too much, that love will be taken away. The avoidant partner experiences the anxious person's pursuit as confirmation of their fear — that closeness means being overwhelmed, that relationships ask too much. Each person's response intensifies the other's anxiety, which intensifies the response, which intensifies the anxiety.

What Avoidant Attachment Is Not

It is worth naming a few things that avoidant attachment is often confused with, because the distinction matters for how it is understood and addressed.

Avoidant attachment is not introversion. Introverts may need significant solitude to recharge and may prefer fewer, deeper relationships to many superficial ones. This preference for solitude is not the same as the deactivation of attachment needs. Introverts can be securely attached. The discomfort avoidant attachment produces in close relationships is not about social preference — it is about the specific threat of emotional intimacy and dependence.

Avoidant attachment is not emotional strength or self-sufficiency. The cultural narrative that prizes independence and self-reliance can make avoidant attachment difficult to recognize as an attachment pattern rather than a personality virtue. But the inability to depend on others or allow others to depend on you is not strength — it is a constraint on the range of human experience that is available to you.

Avoidant attachment is not the same as being unfeeling. People with avoidant attachment have the same emotional needs as everyone else. What differs is the degree to which those needs have been suppressed, and the degree to which acting on them feels threatening. Studies using physiological measurement have found that avoidantly attached people show the same levels of physiological arousal in relational stress situations as securely attached people — but they suppress the behavioral and verbal expression of that arousal. The feelings are present. They are not available.

Can Avoidant Attachment Change?

Attachment patterns are not destiny. This is one of the most important things attachment research has established, and it is worth stating clearly.

Attachment patterns are working models — internal representations of what relationships are like, what to expect from other people, and what is safe to want. Working models are not fixed. They are updated, sometimes gradually and sometimes significantly, through accumulated relational experience. A person with avoidant attachment who has repeated experiences of being close to someone and finding that closeness safe — rather than overwhelming, smothering, or ultimately disappointing — is accumulating evidence that revises the working model.

This can happen in significant relationships outside of therapy. A partnership with a securely attached person who is patient, consistent, and capable of tolerating the avoidant person's need for distance without withdrawing in turn can gradually provide the corrective relational experience that shifts the underlying model. This is not a quick process, and it requires both people to understand what is happening.

It also happens in therapy. The therapeutic relationship is particularly well-suited for this kind of work because it provides a consistent, boundaried relationship in which attachment dynamics reliably activate — and in which the clinician can respond in ways that do not confirm the avoidant person's expectation. The therapist who does not withdraw when the client closes, does not take it personally when the client pulls back, and continues to offer a steady and available presence provides precisely the kind of accumulated disconfirmatory experience that revises the working model.

What therapy also offers is the ability to name and examine what is happening explicitly. Many people with avoidant attachment have limited access to the internal experience the pattern is organized around — the early experiences that produced it, the feelings that the deactivation strategy keeps out of awareness, the needs that have been suppressed long enough to feel absent. Bringing that material into awareness, in a relationship that can hold it, is the beginning of genuine change.

Therapist vs. Life Coach: What's the Difference and Which Do You Need?

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If you have been thinking about getting some kind of professional support — for stress, a major life decision, a feeling that something needs to change — you have probably noticed that the options are not as simple as they used to be. Alongside traditional therapy, there is now a sprawling landscape of coaches: life coaches, executive coaches, wellness coaches, mindset coaches, career coaches, relationship coaches. The language overlaps. The marketing overlaps. And if you are trying to figure out what you actually need, the options can be genuinely confusing.

This post is an attempt to make the distinction clear. Not to advocate for therapy over coaching, but to help you make an informed choice — because they are different services with different scopes, different training requirements, and different appropriate uses. What is right for one person may not be right for another, and getting the fit wrong can cost both time and money.

The Most Important Difference: Licensing and Training

The single most important distinction between a therapist and a life coach is not what they do in a session. It is what they are allowed to do — and what qualifies them to do it.

A licensed therapist — whether a psychologist, licensed clinical social worker, licensed mental health counselor, or licensed marriage and family therapist — has completed graduate-level training, typically at the master's or doctoral level, followed by thousands of hours of supervised clinical experience, and has passed licensing examinations. In New York State, that licensing is regulated by the state education department. A licensed psychologist in New York holds a doctoral degree, completed an internship, and passed national and state licensing examinations. Their work is governed by ethics codes, subject to professional oversight, and they can lose their license for practicing outside their scope of competence.

Life coaching has no equivalent regulatory structure. In the United States, anyone can call themselves a life coach without any training, credentials, or oversight. Some coaches have completed certificate programs — some reputable, some not — through organizations like the International Coaching Federation. Some have relevant professional backgrounds in psychology, organizational behavior, or related fields. Others have no clinical or professional training at all. There is currently no licensing board, no standardized training requirement, and no mechanism for professional accountability equivalent to what governs licensed mental health providers.

This is not a criticism of all coaches. Many are skilled, thoughtful, and effective at what they do. It is simply a fact about the current landscape that is important to understand before you decide.

What Therapists Are Trained to Do

Licensed therapists are trained to assess, diagnose, and treat mental health conditions. This includes depression, anxiety disorders, trauma, OCD, personality disorders, grief, insomnia, relationship difficulties, and the full range of conditions described in the DSM. They are trained in evidence-based treatment modalities — Cognitive Behavioral Therapy, EMDR, Dialectical Behavior Therapy, psychodynamic therapy, and others — and they are required to practice within the scope of those competencies.

Therapy is also specifically equipped to work with the past. The patterns that shape how someone relates to others, manages emotions, responds to stress, or perceives themselves do not emerge from nowhere. They develop across a lifetime, often rooted in early experience, and they do not yield easily to goal-setting or accountability structures. Therapy provides the time, the relationship, and the clinical framework to examine those patterns, understand where they come from, and develop genuine alternatives.

Therapists are legally and ethically bound to confidentiality. What you say in a therapy session is protected information, with narrow, well-defined exceptions — imminent danger to self or others, and certain legal requirements. That protection is not incidental. It is foundational to the kind of disclosure therapy requires.

Insurance often covers therapy provided by a licensed mental health professional. It does not cover life coaching.

What Life Coaches Are Designed to Do

Coaching, at its best, is oriented toward the future. The typical coaching model is action-focused and present-tense: you identify goals, develop strategies to pursue them, and are held accountable for taking steps forward. Coaching is generally not designed to explore the past, examine unconscious patterns, or treat psychological symptoms. Its frame is less clinical and more collaborative and directive.

For people who are psychologically healthy, have a clear sense of what they want to change, and primarily need structured support, accountability, and an outside perspective to move forward, coaching can be genuinely useful. Executive coaching has a reasonably strong evidence base for improving specific leadership outcomes. Career coaching can be valuable during professional transitions. Specific skill-focused coaching — communication, public speaking, productivity — can offer targeted help that therapy would not provide.

The issue arises when someone presents to a coach with needs that are actually clinical. A person whose relationship difficulties trace to insecure attachment developed in early childhood needs something different from accountability check-ins. A person whose self-sabotaging patterns are rooted in an internalized critical voice developed in response to early criticism needs something different from goal-setting frameworks. A person who is struggling with depression, anxiety, or trauma may feel temporarily helped by a coach's positivity and structure, but the underlying condition is not being addressed — and in some cases, the mismatch can delay them from getting the help that would actually work.

Where It Gets Complicated

The boundary between coaching and therapy has become increasingly blurry, in ways that are worth naming.

Some coaches explicitly position themselves as offering therapeutic-adjacent services — emotional support, processing past experiences, working through relationship patterns — without the clinical training or licensure that would be required to do so as a therapist. This is a meaningful concern. It is not that these conversations are harmful in all cases. It is that working with someone's psychological history, relational patterns, and emotional defenses requires clinical training because things can go wrong in ways that an untrained person is not equipped to recognize or manage.

Some therapists, on the other hand, offer coaching as a distinct service outside of the clinical frame — for clients who are psychologically well and simply want structured support around a professional or personal goal. This can be appropriate when the distinction is clearly maintained.

The coaching industry has also produced a large number of practitioners who describe themselves with clinical-sounding language — "trauma-informed," "somatic," "attachment-based" — while holding no clinical credentials. These terms describe real clinical approaches developed and validated within licensed mental health frameworks. They are not, by themselves, credentials.

How to Know Which One You Need

A few questions worth asking:

Are you dealing with a diagnosable mental health condition, or symptoms that might indicate one?

Persistent low mood, anxiety that interferes with daily functioning, panic attacks, sleep disruption, intrusive thoughts, or a history of trauma all suggest that a licensed mental health professional is the appropriate starting point. These conditions have established, effective treatments. They are not generally appropriate targets for coaching.

Do you want to understand why you do what you do, or primarily to change what you do?

Therapy and coaching are both interested in change, but they approach it differently. Therapy tends to work from the inside out — understanding patterns, processing what underlies them, and allowing behavior to shift as that understanding deepens. Coaching tends to work from the outside in — defining desired behaviors and building structures to support them. Neither approach is universally superior. The question is which matches what you are actually looking for.

Is the past relevant?

If what you are experiencing feels connected to earlier experiences — your family of origin, old relationships, formative failures or losses — that history is clinically relevant and belongs in a therapeutic rather than coaching frame.

Do you need the legal protection of confidentiality?

Coaches are generally not bound by the same legal confidentiality requirements as licensed therapists. If what you need to discuss is sensitive in ways that require legal protection, a licensed clinician is the appropriate choice.

What does the person's background actually include?

Before working with either a therapist or a coach, it is worth understanding their actual credentials. For a therapist: what is their license, what is their training, and what are their areas of clinical specialization? For a coach: what training do they have, through which organizations, and what does their work actually involve?

Can You Work With Both?

Yes, and for some people this makes sense. Therapy and coaching are not mutually exclusive, and they serve different functions that can complement each other when maintained as distinct relationships.

Someone might work with a therapist to address anxiety, process old relational patterns, or manage depression — and separately work with an executive coach to develop specific leadership skills or navigate a career transition. As long as both practitioners are clear about their respective roles and the client understands the difference, this kind of parallel support can be genuinely useful.

What is not a good idea is treating coaching as a lower-stakes version of therapy, or choosing a coach specifically because they feel more accessible or less clinical. If what you need is therapy, coaching is not a substitute — and the reverse is also true.

Why You Can't Put Down Your Phone — And What It's Doing to Your Mind

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You pick up your phone to check one thing. Twenty minutes later, you are still there. Nothing of particular value has happened. You are not happier or more informed in any meaningful way. And yet something kept you.

That feeling — that your phone has a kind of superglue on it — is not a failure of willpower. It is the intended outcome of a design process that has been refined over decades specifically to produce it. Understanding how it works is the first step toward having a different relationship with your device. And for a significant number of people, it is also the first step toward understanding something more personal: why a habit that feels compulsive does not yield easily to ordinary self-discipline.

The Gambling Industry Did This First

The features that make social media apps difficult to put down did not originate in Silicon Valley. They were developed, iteratively and methodically, in the casinos of Las Vegas — beginning in the 1980s, when the casino industry replaced mechanical slot machines and physical card tables with digital versions.

The motivation was initially economic: digital machines were cheaper to maintain. But they also allowed casinos to add features — lights, sounds, animations — and more importantly, to run continuous large-scale experiments on millions of gamblers each year. Tweak the machine, measure how long people stay on it, keep the changes that increase engagement, repeat for decades.

The result, according to anthropologist Natasha Dow Schull, who spent 15 years researching machine gambling, was the most addictive form of gambling ever created. Some users stayed at machines for 24 or 48 hours without stopping. Schull documented casino workers reporting that machines had to be cleaned nightly after users — in the grip of what she called the "machine zone" — refused to leave even to use a bathroom.

This is not a metaphor. It is a description of what happens when a carefully engineered system successfully overrides the normal regulatory mechanisms of human attention and bodily awareness. And when tech companies built social media platforms, Schull found that they had, whether by design or by parallel discovery, replicated the same four features that produce this state.

The Four Features — and What They Do to Your Brain

Science journalist Michaeleen Doucleff, in her new book Dopamine Kids, breaks down what she calls the "superglue recipe": the four features that, combined, are most effective at producing what researchers call "dark flow" — a trance-like state of absorption that is distinct from healthy engagement and consistently leaves people feeling worse rather than better after.

1. Solitude. You use the app alone. There are no other people physically present to provide social cues — cues that, in ordinary life, help regulate behavior. When we are around other people, we pick up feedback about whether what we are doing seems normal, enjoyable, or excessive. That feedback is absent when we scroll alone in a bedroom or on a couch. Research has found that children who use screens alone are more likely to remain on an app even when it interferes with sleep or homework. The same principle applies to adults: physical solitude removes one of the most natural brakes on behavior.

2. Bottomlessness. There is no end to the content. No final page, no closing credits, no natural stopping point. Infinite scroll, autoplay, and algorithmically generated feeds ensure that something new always appears the moment the previous thing ends. As Schull describes it, there is no natural stopping point — and in the absence of one, the ordinary thought "maybe I should stop now" is immediately preempted by the next item appearing before the thought can complete itself. When social media companies introduced infinite scroll in the 2010s, time-on-app increased dramatically.

3. Speed. The faster the interaction, the longer people stay engaged. The gambling industry discovered this with slot machines — at peak speed, a player can run through more than a thousand games per hour, one every three seconds. The same principle operates in scrolling: the smoother and faster the content flows, the harder it becomes to locate a natural moment of pause. Speed, Schull suggests, contributes to a blurring of the boundary between self and screen — a sense of merger that is a hallmark of the machine zone state.

4. Personalized teasing. This is perhaps the most psychologically sophisticated feature, and the one that AI has dramatically amplified. The algorithm does not give you what you want. It gives you something close to what you want — and then, a few interactions later, something a little closer. Full satisfaction would end the session. The goal is not to satisfy but to sustain the feeling of being on the verge of satisfaction.

Neuroscientist Mateusz Gola at UC San Diego explains the mechanism: when people feel they are making progress toward a goal, dopamine release intensifies their motivation to continue. The feeling of getting closer — even when the goal is receding — activates the same neurochemical drive as actual progress. The app generates the sensation of approaching satisfaction without ever delivering it. That gap is where the hours disappear.

Dark Flow Is Not the Same as Healthy Absorption

It is worth pausing on a distinction that NPR's coverage of this research highlights, because it matters for how we evaluate our own relationship with screens.

Psychologist Mihaly Csikszentmihalyi described "flow" as a highly positive state of complete absorption in a challenging, meaningful task — playing an instrument, writing, solving a difficult problem, physical exertion at the edge of one's capacity. This kind of flow is associated with a sense of aliveness and competence, and it leaves people feeling satisfied and energized afterward.

Dark flow is structurally similar but experientially and neurologically different. It is produced by easy, repetitive, low-stakes interaction with an optimized system — not by genuine engagement with something demanding. And where healthy flow tends to leave people feeling good, dark flow consistently leaves people feeling flat, lethargic, and sometimes genuinely worse than before they began.

This distinction is clinically important, because people often experience both states as a kind of absorption and may not clearly distinguish between them in the moment. The question worth asking is not "was I engaged" but "how did I feel when I stopped, and did I stop because I chose to?"

What This Has to Do With Anxiety and Mental Health

The connection between heavy phone use and mental health struggles — particularly anxiety and depression — is well-documented, though the mechanisms are still being studied and the relationship is almost certainly bidirectional.

What the four-feature framework clarifies is one important pathway: the phone is not simply a distraction from anxiety. For many people, it has become a primary avoidance mechanism. Unpleasant emotions — boredom, loneliness, low-grade stress, the approach of a difficult task — reliably trigger phone use in a way that is functionally similar to other avoidance behaviors. The phone offers immediate relief from the discomfort of unstructured attention. And like other avoidance strategies, it works in the short term while maintaining and often deepening the underlying discomfort over time.

In clinical work, I often find that the question is not just how much someone is using their phone, but what they are using it instead of. What feelings are being interrupted? What gets picked up as soon as there is a pause — a moment in an elevator, a minute between tasks, the first quiet moment before sleep? The pattern of when phone use occurs is often more clinically revealing than the raw quantity.

The solitude feature is particularly worth noting in this context. The most psychologically costly phone use — the kind most strongly associated with worse mental health outcomes — tends to happen in the absence of other people, often late at night. This is the same time when, as I have written elsewhere on this blog, the brain's capacity for rational self-regulation is at its lowest and the default mode network has the most room to amplify worry. The phone, in this context, is not just distracting — it is feeding a system that is already primed toward rumination.

What You Can Actually Do

Knowing the mechanism does not automatically change behavior, but it changes the frame — and that matters. Struggling to put down your phone is not a character flaw. It is a reasonable response to a system that has been deliberately optimized to prevent you from putting it down. Naming it as such reduces the self-criticism that tends to accompany failed attempts at self-regulation and makes it easier to approach the problem practically.

A few things that research and clinical experience suggest are genuinely useful:

Add friction. The superglue recipe works by removing every obstacle between you and the next piece of content. Reversing this means deliberately adding obstacles back in. Paying per video rather than subscribing to unlimited streaming is one version of this. Keeping your phone in a drawer when you are home, and requiring yourself to go to the drawer to use it, is another. These feel cumbersome precisely because they are working against a design that has removed all friction. That friction is the point.

Use the phone around other people. The solitude feature is real. Physical presence of other people disrupts the conditions for dark flow. This does not mean you need to socialize every time you use your phone — it means that phone use in a coffee shop or a shared room is meaningfully different, neurologically, from phone use alone at 11pm.

Identify your trigger moments. Most compulsive phone use is not random. It is reliably preceded by specific emotional states — boredom, low-grade stress, the approach of something difficult, loneliness. Noticing your own pattern is the beginning of having a choice. Therapy is well-suited for this kind of pattern-mapping, particularly when the underlying feelings that are being avoided are worth examining in their own right.

Treat this as a systemic problem, not a willpower problem. If someone consistently struggles to disengage from a system that has been engineered to resist disengagement, the solution is to change the system — the physical availability of the phone, the subscription structures, the app configuration — rather than to rely on willpower to override it.

A Note on Children

Doucleff's book, and the research it draws on, is primarily oriented toward children and adolescents. This is appropriate: the developmental implications of early, heavy exposure to dark-flow-optimized systems are significant and warrant serious attention from parents and clinicians alike.

But the same mechanisms operate in adults. Two landmark legal cases in California in 2026 found that tech companies including Meta and Google had deliberately designed their apps to be addictive for younger users. The appeal process is ongoing, but the underlying science — the four features, the dark flow state, the gambling industry origins — is not in dispute. These systems were designed for maximum engagement without reference to user wellbeing. Adults are not immune to that design.

If you are an adult who recognizes your own phone use in this description — and most people reading this will — the same principles apply. The phone has superglue on it. That is not an accident. And acknowledging that is not surrender to it. It is the beginning of a more honest, and more effective, relationship with it.

Citations

Doucleff, M. (2026). Dopamine kids. [Publisher TK].

Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., Makeig, S., Potenza, M. N., & Marchewka, A. (2017). Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42(10), 2021–2031. https://doi.org/10.1038/npp.2017.78

Schull, N. D. (2012). Addiction by design: Machine gambling in Las Vegas. Princeton University Press.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3–17. https://doi.org/10.1177/2167702617723376

Doucleff, M. (2026, June 1). How your phone keeps you scrolling — even when you want to stop. NPR Short Wave. https://www.npr.org/2026/06/01/nx-s1-5823736/phone-social-media-addiction-tech

Remote Work Is Quietly Making Us Lonelier — Here's What the Research Says About Why Community Matters

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Most people will tell you they love working from home. No commute, no small talk with a coworker they cannot stand, no one looking over their shoulder. Surveys consistently find that the large majority of remote-capable workers say they would be happiest working from home, and many say they would take a real pay cut to keep it that way.

And yet a major new study, published this month in Science, found something that complicates that preference considerably: remote work has significantly deepened isolation and psychological distress in this country, and it accounts for roughly a third of the overall decline in American mental health between 2011 and 2024.

This is worth sitting with, because it runs counter to what most people believe about their own choices. The thing that feels most personally liberating may also be one of the most significant drivers of a worsening mental health landscape. That contradiction is not really about remote work specifically. It is about something more fundamental: how much human beings depend on incidental, unplanned, in-person contact with other people, and how easily that dependency goes unnoticed until it is gone.

What the Research Found

The study compared workers in jobs that could plausibly be done remotely, such as finance and software engineering, with workers in jobs that require in-person presence. People in remote-capable roles worked from home roughly three times as often in 2024 as they did in 2019, and as they did, something measurable happened to the texture of their days.

The majority of remote workers spend their entire workday completely alone. Over half report feeling less connected to their colleagues. Even in digital communication, remote workers receive less feedback from coworkers and have meaningfully less contact with people outside their immediate team.

What is particularly striking is that people did not compensate for this lost workplace contact by socializing more elsewhere. More days passed with no social contact of any kind — no greeting from an office mate, no small exchange with a barista, no nod to a fellow commuter. These are the kinds of interactions that are easy to dismiss as trivial. The research suggests they are not.

Workers in remote-capable jobs saw steeper increases in psychological distress, mental health visits, and antidepressant prescriptions than workers whose jobs required them to be physically present. And the pattern began in 2020 and has not let up since — pointing toward remote work itself, rather than more recent anxieties like AI displacement, as the driving factor.

The effect was not distributed evenly. People who lived with a spouse and children saw their mental health hold relatively steady. People who lived alone experienced a roughly 20 percent decline in psychological wellbeing. Isolation, in other words, compounds. The less embedded a person already is in other forms of daily human contact, the more remote work appears to cost them.

Why the Cost Is So Easy to Miss

If remote work is doing this much damage, why does it not feel that way to most people experiencing it?

Part of the answer is the pace at which the cost accumulates. Loneliness that builds gradually does not announce itself as loneliness. It gets attributed to other things — a hard year, a breakup, a friendship that drifted, the ordinary tiredness of getting older. The texture of an isolating life is rarely dramatic. It is just quieter than it used to be, in ways that are easy to rationalize as unrelated to where you happen to be sitting during the workday.

This is consistent with something I see often in clinical work. People rarely arrive in therapy saying "I think my life lacks adequate community." They arrive describing low mood, flatness, a vague sense that something is missing, irritability, or difficulty finding motivation. The absence of community does not present as a clearly labeled deficiency. It presents as depression, anxiety, or a diffuse dissatisfaction that does not trace easily to any single cause — which is exactly what makes it so important to ask about directly.

There is also a structural reason the cost is hard to see: a half-empty office is not an appealing alternative to working from home. When most of your colleagues are also remote, going into an office does not restore the social environment that used to exist there. The choice many people are actually weighing is not "office community versus home isolation." It is "isolation at home versus isolation in a quiet office." Neither option, as currently structured, delivers what used to happen by default.

The Office Was Doing More Than We Realized

One of the more striking findings referenced in this research is that the workplace has historically been the single most common place where American adults form friendships — ahead of religious communities, neighborhoods, children's schools, and sports teams.

This is worth pausing on, because it reframes what was lost when offices emptied out. It was not just a commute and a desk. For a very large number of adults, it was the primary infrastructure through which adult friendship actually happened. Adult friendship, unlike childhood and adolescent friendship, rarely has a built-in structure that produces it automatically. Work was that structure for millions of people, largely without anyone noticing it was serving that function until it stopped.

This matters clinically because friendship and social connection are not peripheral to mental health. They are among the most well-established protective factors we have. Strong social ties are associated with lower rates of depression and anxiety, better physical health outcomes, longer life expectancy, and greater resilience in the face of life stressors. Loneliness, conversely, has been associated with health risks comparable to those of smoking and obesity. This is not a soft or sentimental claim. It is one of the more robust findings in health psychology.

When the primary structure that produced incidental adult connection disappears, and nothing replaces it, the consequences are not abstract. They show up, as this research demonstrates, in mental health visit rates and prescription data.

This Is Not an Argument for Returning to 2019

It would be easy to read this research as an argument for mandatory full-time office return, and that is not the right conclusion to draw from it.

The prepandemic norm, in which work occupied every hour of the workday and frequently crowded out time with friends and family, was its own kind of problem. Many people who value remote work do so for genuinely good reasons: more time with their children, more flexibility during illness, freedom from long commutes, escape from difficult office dynamics. None of that should be dismissed.

The point is not that offices are good and remote work is bad. The point is that human connection requires structure, and that structure does not happen automatically. Whatever the working arrangement, something has to actually produce the in-person contact that our nervous systems and our psychological wellbeing depend on. For decades, the office provided that structure as an incidental byproduct of simply showing up. Remote work removed the structure without anyone deciding to remove the connection it produced, and most people have not yet found something to replace it.

What This Means in Practice

The research points toward a conclusion that is genuinely useful, even if it requires intention that used to be unnecessary: connection has to be built deliberately now, because it is no longer happening by accident.

This looks different depending on your circumstances, but a few things are worth naming directly.

If you work remotely, audit your week for incidental human contact. Not scheduled, purposeful socializing — actual incidental contact. A coffee shop where someone knows your order. A walk where you might run into a neighbor. A coworking space, even occasionally. These small, low-stakes interactions are not filler. The research suggests they matter more than most people assume.

If you live alone, take the finding about compounding isolation seriously. The mental health cost of remote work fell hardest on people without a spouse or family at home to provide a baseline of daily contact. If that describes you, building deliberate structures for connection is not optional self-care. It is a meaningful protective factor for your mental health.

Consider what structures actually produce connection, rather than just opportunities for it. A standing weekly lunch with a friend produces connection more reliably than a general intention to "see people more." Structure that requires no ongoing willpower to maintain tends to outperform good intentions.

If you manage other people, recognize that this is a workplace mental health issue, not just an individual one. Organizations that have taken this seriously have restructured physical spaces to centralize rather than isolate, rethought how they recognize the often-invisible work of connecting teams, and built deliberate touchpoints like regular one-on-ones into how teams function. These are not perks. They are interventions with measurable mental health value.

A Closing Thought

Robert Putnam wrote, more than two decades ago, that Americans were increasingly "bowling alone" — disengaging from the associational life that had once structured American communities. What this new research suggests is a continuation of that trajectory into the texture of an ordinary workday: many of us are now, in a real sense, typing alone.

The remedy is not nostalgia for a five-day office week that had its own real costs. It is a recognition that community does not assemble itself. It has to be built, and in the absence of the structures that used to build it without anyone trying, building it now requires intention that can feel unfamiliar, even effortful.

That effort is worth making. Community is not a nice-to-have layered on top of mental health. For many people, it is one of the load-bearing structures of it.

APA CITATIONS

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352

Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. Simon & Schuster.

Yang, E., & Pallais, A. (2026). The mental health costs of remote work. Science. [As referenced in The New York Times, June 2026]

The New York Times. (2026). Why remote work has made America lonelier — and what to do about it. The New York Times.

What the New Alcohol Research Means for Your Mental Health

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A major study on alcohol and health made headlines this week — not only for what it found, but for how it got published.

The Alcohol Intake and Health Study was commissioned by the federal government but unreleased under President Trump, who decided not to feature its findings in new dietary guidelines after pushback from the alcohol industry and a congressional committee. The study, published June 9 in the Journal of Studies on Alcohol and Drugs, found that health risks increase with even low levels of drinking, and that no level of alcohol offers a protective effect on mortality. Grow Therapy

The scientific content is worth examining on its own terms, separate from the politics. And from a psychological standpoint, there is a dimension of this conversation that rarely gets the attention it deserves: not just what alcohol does to the body, but what it does to the mind.

What the Study Actually Found

Researchers reported there was no protective net effect of any level of alcohol consumption on health. Low levels of alcohol use may be associated with elevated health risks, with higher consumption associated with progressively increased risks of cancer, cardiovascular disease, and death and disability.

"We did not observe a significant protective effect of alcohol on health at any level of consumption," said Dr. Shield. "At low levels, alcohol may be associated with a reduced risk of ischemic heart disease and stroke. But when you look across the full range of health outcomes, including cancer and other chronic diseases, those potential benefits are outweighed by the risks, even at seven drinks per week."

The study concludes that even "moderate" drinking raises the risk of early death and more than 200 diseases, including cancer and heart disease, and that no amount of alcohol can protect against premature death. The researchers noted that individual risk varies based on genetics, lifestyle, and other factors — population-level statistics do not translate directly to any one person. But the headline finding is clear: the belief that moderate alcohol consumption is harmless or beneficial is not supported by the best available evidence.

The Politics Are Worth Noting — and Then Setting Aside

The study was commissioned by the Biden administration as one of two government reviews meant to inform new dietary guidelines. One official involved accused the Trump administration of "sidelining" the research — an allegation the administration denies. The guidelines that were released advised consuming "less alcohol for better overall health" without providing the detailed risk thresholds the study authors had developed.

Whatever the policy outcome, the science is published, peer-reviewed, and consistent with years of accumulating evidence. It is available.

The Mental Health Dimension

This is where I want to spend most of this post, because it is the part of the alcohol conversation that tends to get least attention.

Alcohol is not primarily a physical health issue for the people I work with. It is primarily a psychological one.

Most people who come to therapy with complicated relationships to alcohol are not people whose drinking looks like textbook addiction. They are people who have a glass or two of wine most evenings to decompress. People who drink more during difficult periods and less during easier ones. People who tried to cut back and found it harder than expected. People who use alcohol the way they use other things — scrolling, overworking, overeating — to manage feelings that have nowhere else to go.

Alcohol and the Anxiety-Depression Loop

Alcohol is a central nervous system depressant. In the short term, it reduces anxiety by dampening the brain's stress-response systems. This is why it feels like it works. The problem is what happens next.

As alcohol is metabolized, the nervous system rebounds — producing heightened anxiety, disrupted sleep, and emotional dysregulation that can last well into the following day. A 2026 systematic review found a significant association between hangovers and increased negative affect, including anxiety, stress, and depression, with people who have higher baseline anxiety experiencing the most severe effects.

This creates a cycle that is clinically recognizable and extremely common: anxiety leads to drinking, drinking temporarily reduces anxiety, the rebound effect increases anxiety, increased anxiety motivates more drinking.

Research found that drinking to cope was significantly associated with greater stress, anxiety, depression, and loneliness — and was a meaningful predictor of increases in depression over time. The motivation to manage distress appears to be driving the negative effects of alcohol use on mental health. Drinking while stressed is not the same, clinically, as drinking because the alternative is feeling something you do not have the tools to tolerate.

What Alcohol Use Often Communicates

In a clinical context, alcohol use rarely presents in isolation. It almost always appears alongside something else: unprocessed grief, chronic anxiety, a relationship that is not working, loneliness, trauma that has not found another way to surface.

This is not a moral judgment. It is a clinical observation. The nervous system learns, through experience, that alcohol reliably alters its state. When the state it most wants to alter is distress, alcohol becomes a solution — one with real short-term efficacy and significant long-term costs.

One of the most important things therapy can offer is not a focus on the drinking itself, but on the function it serves. What is the drinking solving? What emotional experiences is it managing that have no other outlet? These questions often open into territory that is far richer than a conversation about units per week.

A Note on the Sober-Curious Conversation

The sober-curious movement has normalized a kind of low-pressure re-evaluation of drinking that was largely absent from public discourse a decade ago. This is clinically useful. It has made it easier for people to examine their relationship with alcohol without the threshold of "do I have a problem?" — which carries significant stigma and tends to prevent honest reflection.

You do not need to identify as an alcoholic, or be in crisis, to ask whether your drinking is serving you well. The new research supports that curiosity. It does not demand abstinence. What it does suggest is that the cultural default — that moderate drinking is benign, and that examining your relationship to it is only necessary if things have clearly gotten out of control — is not well-supported by the evidence.

If you are noticing something — recognition in the anxiety-depression loop, a discomfort with how much you are drinking, an awareness that it has become harder to stop than it used to be — that is worth paying attention to. Not as evidence of a disorder, but as information about what else is going on.

What AI Is Doing to How We Feel About Work — and Ourselves

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The conversation about AI and work tends to organize itself around a single, concrete question: will my job still exist?

It is a reasonable question. But in the therapy room, that question is rarely the whole story. What I hear more often is something less concrete and harder to name: a background unease that has been building for months, a sense that the ground beneath a professional identity has quietly shifted, a worry not just about whether a job will disappear but about what it would mean if the work that defines you became something a machine could do.

That is a different kind of question. And it is the one I want to address here.

The Numbers Tell Part of the Story

The economic data on AI and work is genuinely uncertain. A comprehensive analysis of three independent labor datasets found no detectable rise in aggregate unemployment for workers in AI-exposed occupations since late 2022. What the same data did show, however, was a closing door for younger workers — a nearly 20% drop in young developer employment from 2024 peaks, and roughly one in three organizations expecting AI-driven workforce reductions in the near term. Notably, the disruption is beginning at the top of the skill ladder, not the bottom — the workers most exposed to AI today are the highest-paid and most-educated. ScienceDirectScienceDirect

This is clinically significant. The people most likely to have organized their identity, self-worth, and life structure around professional achievement are now among those most directly in AI's first wave.

What the Research Says About AI and Meaning at Work

Beyond job displacement, there is a subtler but equally important story about what AI is doing to the experience of work itself.

A 2026 study in Scientific Reports found that passively relying on AI — copying AI-generated content rather than engaging with the task directly — reduced self-efficacy, sense of ownership, and the meaning workers perceived in their work. Workers who collaborated actively with AI, drafting first and then refining with AI assistance, showed less erosion of these psychological dimensions. KOSU

The distinction matters. What damages the psychological experience of work is not AI use per se, but AI use that removes the worker from genuine engagement with the task. Classic perspectives emphasize that work is not merely a means of production but a central source of human identity and meaning — and that meaningful work emerges when individuals experience a sense of agency and purpose. Strip those out — not by taking the job but by making the job no longer require what is distinctively human — and you have a mental health problem even in the absence of unemployment. KOSU

Work, Identity, and What Happens When the Ground Shifts

For most working adults, work is not simply a source of income. It is a primary source of identity. It structures time, provides social belonging, confers status, and supplies the daily evidence that one is competent, valued, and needed.

The APA's 2025 Work in America Survey found that 54% of U.S. workers reported that job insecurity had a significant impact on their stress levels. Research published in JAMA Network Open found that greater job security was associated with meaningfully better mental health outcomes. Connecticut Public

AI-related insecurity introduces something distinct from ordinary job insecurity. Ordinary insecurity says: I might lose this position. AI-related insecurity says something more fundamental: the things I am good at might not matter in the way I thought they did. The expertise I spent years developing might be replicable by a tool that costs a few dollars a month.

That is an identity challenge, not merely an economic one. And identity challenges tend to produce anxiety, depression, and an existential disorientation that does not respond well to reassurance about aggregate job numbers.

The Particular Burden on High Achievers

High-achieving professionals — people who have organized significant portions of their identity and self-worth around competence and accomplishment — are often among those hit hardest by this shift, not because their jobs are most threatened, but because their relationship to their work is most psychologically loaded.

When your sense of self is built substantially on being very good at something, and the thing you are very good at becomes something a machine can replicate, the threat is not just professional. It raises questions that go far beneath the employment contract: What am I for? What makes me valuable — not as a worker, but as a person? What remains that is distinctively mine?

These are reasonable responses to a genuinely disorienting shift. But they are also, without support and reflection, the questions most likely to produce sustained anxiety and loss of meaning that erode wellbeing over time.

What Uncertainty Does to the Mind and Body

Even for people whose jobs are not immediately at risk, the ambient uncertainty of this period carries its own weight. Decades of research have shown that job insecurity negatively impacts workers' mental and physical health as well as job satisfaction, commitment, and trust. The mind's threat-detection system is designed to respond to identifiable dangers. It is less well-equipped to handle prolonged, ambiguous threat — a landscape shifting in ways that are difficult to predict or prepare for. The result is a persistent background activation of the stress response: disrupted sleep, reduced cognitive flexibility, and the kind of sustained low-level hypervigilance that depletes the emotional resources needed to engage creatively with change. Connecticut Public

This is not catastrophizing. It is a nervous system responding, with the architecture it has, to a situation that is genuinely uncertain and genuinely consequential.

What Actually Helps

I want to be careful not to offer easy reassurance, because the situation does not warrant it. AI is changing work, the pace is accelerating, and the disruption is real. What I can offer is an honest account of what tends to support people through genuine identity disruption.

Separating who you are from what you do. The capacity to hold a stable sense of self that is not entirely contingent on professional achievement is one of the most robust protections against the psychological damage of career disruption. This is a capacity that can be developed — and one therapy is well-positioned to support.

Engaging actively rather than passively. The research suggests the psychological risk is not in using AI but in ceding agency to it. Workers who use AI as a collaborator — thinking first, then augmenting — preserve more of the psychological dimensions of meaningful work.

Naming the identity questions directly. The anxiety that surfaces around AI and work is often not primarily about the job. It is about the self. Bringing those questions into explicit awareness is more useful than managing them through distraction or reassurance-seeking.

Attending to what remains distinctively human. Judgment. Relationship. Context. Ethical reasoning. Creative synthesis. Embodied experience. These are not consolation prizes. They are the things that have always mattered most in the work that matters most to people.

A Note on When to Seek Support

If anxiety about AI and work is disrupting your sleep, your concentration, your relationships, or your sense of purpose — if the uncertainty is settling into something that feels less like concern and more like despair — that is worth taking seriously.

Navigating major identity disruption is a legitimate clinical concern. It does not require a formal diagnosis. It requires a space to think carefully about who you are, what you value, and what a meaningful life looks like when the structures that once organized it are shifting.

I work with adults in New York City navigating anxiety, career disruption, identity questions, and the intersection of professional life and psychological wellbeing. [Reach out here] if you would like to explore what support might look like.

APA Citations:

Brand, J. E. (2015). The far-reaching impact of job loss and unemployment. Annual Review of Sociology, 41, 359–375. https://doi.org/10.1146/annurev-soc-071913-043237

Nguyen, T., Weinhardt, J. M., & Campbell, E. (2026). Relying on AI at work reduces self-efficacy, ownership, and meaning while active collaboration mitigates the effects. Scientific Reports, 16, 13583. https://doi.org/10.1038/s41598-026-42312-6

The New York Times Magazine. (2026, June 9). Who will actually thrive in the hybrid A.I.-human work force. The New York Times Magazine. https://www.nytimes.com/2026/06/09/magazine/ai-jobs-workforce-labor.html

Weir, K. (2026). Workers are facing an age of uncertainty. Monitor on Psychology, 57(1), 76. https://www.apa.org/monitor/2026/01-02/trends-work-uncertainty