TRAUMA-
Women and PTSD: Using a Trauma-Informed Approach to Heal.
How to build a safe and soothing environment to recover from past traumas.
Reviewed by Ekua Hagan

KEY POINTS-
Untreated trauma can lead to PTSD, which females experience at nearly twice the rate as their male counterparts.
A recent CDC study reveals a sharp rise in sexual violence and attempted suicide rates among teen girls.
While EMDR is not a one-size-fits-all treatment, it has been found to be helpful in treating a variety of traumatic experiences.
A recent CDC study revealed that from 2017 to 2021, the number of teen girls in the United States who experienced sexual violence increased by 20 percent. On top of that, the study also shows in 2021, nearly 1 in 3 teen girls seriously considered attempting suicide.

Experiencing something traumatic, such as sexual abuse or violence, increases your risk of developing post-traumatic stress disorder (PTSD) in the future. The concerning and disheartening results of the CDC study serve as an alarm for healthcare providers everywhere to be equipped to handle an influx of young females who may be desperately trying to heal from serious mental health struggles. To start, we should look at how we define trauma and how it may lead to PTSD.

What Is Trauma?
When you hear the word “trauma,” what comes to mind? Perhaps a natural disaster, poverty, prolonged neglect, violence, or abuse? Trauma, by definition, is a lasting emotional response to intensely distressing events or situations that occur when we fall outside of our ability to cope. Everyone's experience of trauma can be subjective and unique, which is why a divorce, for instance, can be experienced as traumatic for one person but not another.

At the time of a traumatic event, the strong emotions you experience can interfere with your ability to completely process the event, and this one unpleasant moment becomes “frozen in time.” Eventually, if not addressed, you may develop post-traumatic stress disorder, a mental health condition that is triggered by an overwhelming event—either experiencing it or witnessing it. Some of the most common PTSD symptoms include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event, avoidance, and substance misuse. While this condition is certainly a possibility, it is important to note that not all people who experience a traumatic event will go on to develop PTSD.

When receiving a diagnosis, it is easy to feel as though there is something wrong with us, but keep in mind that our bodies and brains are engaging in completely normal survival responses to abnormal circumstances. Therefore, many practitioners will refer to this experience as post-traumatic stress injury, rather than a disorder.

Are Women at Risk of Experiencing More Trauma?
Research suggests that people of all gender identifications can experience trauma, so it is important for healthcare professionals to approach the topic without gender bias. However, statistics show that women may be more likely to experience certain types of traumatic events, such as physical and sexual violence by intimate partners. For transgender and non-conforming individuals, the rates tend to be even higher.

The National Center for Victims of Crime reports that 1 in 5 women in the United States has experienced rape or attempted rape in her lifetime. Sexual assault is often underreported, and even within relationships, forced intimacy without consent or consent while under the influence can be considered assault.

When it comes to the effects of trauma, studies have shown that women's brains may respond differently than men's. Women can have higher rates of reexperiencing events, negative alterations in cognition or mood, and dissociative responses, among other post-traumatic reactions. Something else worth noting is that women typically have different ways of expressing their emotions compared to men, with women more likely to use words such as "anxiety.” Therapeutic providers must take these gender-specific differences into account when providing care for their clients.

Over time, some individuals learn how to cope with their trauma in healthy ways, however, there are many female survivors who cannot fully process the event and/or are afraid to reach out for help. As mentioned earlier, untreated trauma can lead to PTSD, which females experience at nearly twice the rate as their male counterparts. Aside from mental health consequences, those living with unresolved trauma may also struggle with physical side effects like gastrointestinal issues and sexual dysfunction.

Emotional Distress and Trauma in Young Women
Uncovering why women tend to experience more trauma than men is a complex issue with many layers. In looking at the previous CDC study, we can see in 2021, 3 in 5 young women in their early teens were feeling persistently sad and hopeless, common precursors to depression. These are the highest levels of sadness and hopelessness seen in a decade and nearly twice the rate among teenage boys. This trend is also reflected in members of the LGBTQ+ community with 55 percent of young teens experiencing poor mental health.

While emotional distress does not necessarily correlate with trauma in young girls, we, as healthcare providers, need to stay attuned to what this trend can potentially manifest into. Teen girls struggling with these strong feelings may pull away from their loved ones and lose interest in their favorite hobbies and activities. To distract from feelings of low self-esteem, teens may experiment with substances, make impulsive decisions and, at times, engage in higher-risk sexual activity.

The CDC study also shared that since 2019, young females being forced to have sex has increased by 27 percent. Traumatic experiences such as this can be very harmful to a teenager's emotional development, therefore, it is important for survivors to fully process the memory and move forward in a meaningful way. Teens struggling with a traumatic incident might have trouble forming healthy relationships due to a lack of trust and poor boundary observance as well as increased behavioral issues and emotional dysregulation.

Rather than seeing these statistics as an indication of something "wrong" with those who identify as female and non-conforming individuals, we must focus on how to support them and create a more resilient and uplifting environment. This can involve providing resources and tools for managing difficult emotions and experiences, like support groups and systematic trauma screening. Recognizing the strengths of women who have experienced trauma, such as their courage and resourcefulness in coping with difficult situations, can help them build upon their existing strengths and develop new ones. If we focus on recovery, rather than pathology, we can create a more positive and empowering narrative around mental health and trauma.

What Does a Trauma-Informed Treatment Approach Look Like?
Although we have a considerable amount of knowledge about how trauma and PTSD impact an individual, how we respond as care providers is crucial to the healing process for those with whom we work.

A trauma-informed treatment approach looks at an individual's experiences and past traumas to better understand and address their current physical and emotional challenges. This approach prioritizes creating a safe and supportive therapeutic environment where the client feels comfortable to share openly. Clinicians might use somatic therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), which recognize that trauma can be stored in the body and can manifest in behavioral disorders and compulsions like eating disorders and substance use disorders. EMDR is an evidence-based psychotherapy that helps individuals reprocess traumatic memories to heal from PTSD.

One meta-analysis of 23 studies found that EMDR was effective in reducing symptoms of PTSD, depression, and anxiety. While EMDR is not a one-size-fits-all treatment and may not be effective for everyone, it has been found to be helpful in treating a variety of traumatic experiences, from combat and sexual assault to natural disasters, accidents, and childhood abuse.

By acknowledging the connection between the body and trauma, EMDR allows the individual to utilize their body's natural healing processes in the therapeutic journey. EMDR's client-centered approach puts the client in the driver's seat, empowering them to take an active role in their healing. Overall, EMDR provides a unique and effective pathway for women to address past traumas and move towards a more fulfilling future.

Although many women may deal with trauma and PTSD throughout their lifetimes, healing is possible. To help survivors navigate their struggles, we must provide more resources such as peer support groups, education on consent and healthy relationships, and accessible treatment options.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 contact the National Suicide Prevention Lifeline, 1-800-273-TALK, or the Crisis Text Line by texting TALK to 741741.

ANXIETY-
Health Anxiety and Beliefs About Being Weak and Vulnerable.
When every symptom is a crisis.
Reviewed by Tyler Woods

KEY POINTS-
People with health anxiety often hold the dysfunctional belief that they are weak and vulnerable to disease.
Dysfunctional beliefs can be reshaped into adaptive beliefs through a process called cognitive restructuring.
By developing a more adaptive belief about being strong and capable of overcoming many illnesses, one can improve their health anxiety.
One day during your typical morning routine you notice what looks like a scab on the top of your hand. What is this? Well, there goes your morning. You suddenly aren’t that concerned about getting to work on time and you begin your careful inspection. You knew for certain you hadn’t scraped your hand at any point. Why else would you have a scab? Suddenly, the new diagnosis hits you. Skin cancer.

You can’t believe it’s finally happening. You had known for years you were doomed to eventually develop some type of melanoma. After all, as a youth, you spent most summers slathered in baby oil and frying yourself to a crisp.

Over time, the scab faded. But you notice a new symptom: upper back pain. Uh oh. So and so’s cousin’s first symptom of lung cancer was back pain. So, naturally, you throw yourself down yet another rabbit hole. And round and round it goes. You have barely moved on from skin cancer, and are already embracing a new imminent tragedy.

Of course, you didn’t end up having skin cancer. Nor did you end up having lung cancer. As usual, those seemingly catastrophic symptoms just sort of went away. But until they do, you are convinced that this is “it.”

What’s happening behind the curtain
This cycle isn’t anything new to you. If you have health anxiety, I am sure you are well aware of this pattern and your tendency to overreact to symptoms and bodily sensations. But you may not be aware that there is something profound happening underneath all of this.

Many people with health anxiety hold the core belief that they are weak and vulnerable to disease. It is as if you assume that any illness that comes your way, big or small, would be the thing that puts you straight into the grave. Core beliefs are the lens through which we see ourselves and the world around us. They influence how we interpret everything. If you believe you are weak and vulnerable to disease then, naturally, you are going to be terrified of all symptoms or bodily sensations because, if it is due to a serious disease, then you assume you are finished. It’s "game over."

Reshaping this core belief into a new, more adaptive belief
Let’s consider a new way of seeing your health. It is possible that you are underestimating your ability to overcome, manage or cope with an illness. Even if you were to get diagnosed (or have been diagnosed) with an illness, there are many reasons to assume that, in most cases, the illness would be treatable. For example, let’s say you are diagnosed with high blood pressure. This does not automatically mean you are going to die of a stroke or heart attack. Yes, of course, high blood pressure can increase one’s risk for a heart attack or stroke. But with changes in lifestyle and access to medical resources, this condition is manageable. In fact, thanks to science and the progression of modern medicine, there are a wide variety of options for treating the majority of health conditions.

I have seen many of my clients’ health anxiety improve drastically when they learn how to use cognitive restructuring to reshape their unhelpful beliefs (i.e., "I am weak and vulnerable to disease"). They learn how to identify what they once thought was "evidence" for this belief. They then begin to collect evidence for a healthier belief (i.e., "My body is strong and capable of overcoming most illnesses"). Through this process, they begin to slowly shed the old belief and form a new one.

Strengthening your new belief
What’s more, once the new, healthier belief is formed, it only becomes stronger over time. This is because our core beliefs, whether adaptive or maladaptive, continue to be strengthened through a process of reinforcement. Even though we often don’t realize it, we are selectively paying attention to the data in our environment that confirms the beliefs we already have.

This way of processing information can work for us or against us. Up until now, this process has been working against you when it comes to your beliefs about health. You have been searching for ‘evidence’ in your environment that you are weak and vulnerable to disease. It is time to retrain your brain to search for evidence for you being strong and capable of overcoming most illnesses.

The more you practice training your brain to notice this information in your environment on a daily basis, the easier it will become for you to begin processing information in this new way. You will begin to naturally notice evidence of you being strong and capable of managing or overcoming disease. Retraining your brain requires a lot of effort upfront but becomes much easier over time. It is well worth the effort.

MINDFULNESS-
How to Talk to Be (Really!) Heard.
Trade in your armor for mindfulness.
Reviewed by Tyler Woods

KEY POINTS-
Life in relationships is a continuous balancing act of longing for contact and wanting safety.
Paradoxically, the things we do to feel safe actually make it less likely we’ll be heard and more likely we’ll be hurt.
Mindful awareness is the skill we need—both to be heard and to be safe.
All of us have stories to tell. The story of how much I like you and hope you’ll go out with me, the story of needing a night off from doing dishes, the story of why I’m so mad at you.

We want to tell our stories; but we don’t just want to tell, we want to be heard. As difficult as it is, at times, to tell the story, it’s even harder to be heard. And, then we discover, to our surprise and dismay, it can be hardest with the most important people in our lives.

If there’s something more important for relationships than learning to talk so that you will be heard, I’m not sure what it is.

We Want To Be Heard—Not Hurt
Most of the things we do to protect ourselves, not surprisingly, actually make it less likely we will be heard and more likely we will be hurt, things like talking too much, or too fast, or too loud, or sounding as if we have all the answers. Imagine putting on a suit of armor and going in for a hug.

Meanwhile, we are often unaware of these defenses and of their effects on ourselves and our partner. When we are anxious and armored our perceptual abilities and cognitive processing are compromised. We literally hear less well, see less well and think less well. We’re inside a shell, cut off from important information and our ability to make use of it. We can end up feeling mystified with no idea of how we’re behaving or why we’re not being heard.

The Alternative To Armor: Mindful Awareness
What's the alternative to armoring, both for connection and safety? Tuning in. Fully aware of what’s going on, with yourself and your partner, you regain the ability to talk in ways that help your partner to hear you. This ability to be aware in each unfolding moment is something we call mindfulness. So how does this help us to be heard and to feel safer?

We are most at risk when the other person feels unsafe. The dance goes something like this. You’re feeling nervous about telling your story. Without mindfulness, you fail to notice that your voice is becoming louder and you’re speaking faster. The effect of this on your partner is to make them feel nervous, on edge, unsafe. So, they start to shut down, armor up, have more trouble hearing and processing. Without mindful awareness, you fail to hear your own voice and you fail to notice the effect it’s having. You then fail to notice that, as they shut down, you actually feel less safe than ever, so you continue to talk loud and long—the firehose effect. Pretty soon, you find yourself in exactly the pickle you hoped to avoid: feeling unheard, shut out, and misunderstood. Sound familiar?

Let’s replay this with less armor and more awareness. You want to tell your partner something important that may be hard for them to hear. You’re feeling nervous about telling your story. With mindfulness, you notice that you’re nervous. You pause a minute to take a few breaths. Maybe you say something like, “I’m nervous about this, but I really need to talk to you.” You start off slow, but, at some point, your voice becomes louder and you’re speaking faster. With mindfulness you notice your own voice, you observe your partner starting to get tense, closing down. You stop talking for a minute to collect yourself. You ask how they’re doing with the conversation. Maybe they say they’re trying to listen, but it would be easier if you’d slow down and maybe not talk so loud. You start again, this time slower and softer. You’ve course-corrected and are headed more in the direction of being heard—and understood, cared about, connected.

The next time you want to tell your story, lose the armor and use mindful awareness to guide you. Speak in ways that help your partner to feel safe and open, so that they can hear you. One story at a time, you can build a relationship of trust, intimacy, and the pleasure of being really heard.

PERSONALITY DISORDERS-
Can Pathological Liars Be Cured?
Even the most dishonest people can change.
Reviewed by Tyler Woods

KEY POINTS-
There is a distinction between normal lying and pathological lying.
Several psychotherapy interventions can help pathological liars.
Psychopharmacological interventions do not seem to be helpful.
With evidence-based treatments, pathological liars can become more honest.
Imagine that you are at a party and you meet someone who tells you, “Once, I saved a friend of mine… I had to jump a mile down from a helicopter into a pool of alligators and sharks in Florida. I was able to fend off the shark attack and outmuscle the alligators with my strength. My friend treated me like I was a hero. And I had to use a harpoon to kill the many sharks and gators. The harpoon went into the alligator’s eyeball.”

Most people would quickly realize that the person was lying. In fact, this heroic account is a real one, from a pathological liar that my co-author, Drew Curtis, and I discussed in our book, Pathological Lying: Theory, Research, & Practice. When people lie pathologically, their chronic deceit often causes considerable problems in their lives. So, can we treat them and reduce their habitual dishonesty? Can pathological liars be cured?

Pathological Versus Normal Lying
First, I will distinguish pathological lying from "normal" lying. Most people lie occasionally, whether to avoid embarrassment, protect someone's feelings, or make themselves look good. Pathological liars, on the other hand, lie habitually, often for no obvious reason. The lies can range from small exaggerations to elaborate fabrications. This pattern of deception can have significant negative consequences on the individual's personal and professional relationships, as well as their overall well-being. Many of them want to stop lying, as it causes them considerable distress. About 90 percent of people report that they have interacted with a pathological liar, and they note that lying is often a central feature of the person.

Pathological lying is not an official psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, the primary reference guide used by mental health professionals. That is, it is not recognized as a standalone mental disorder, although we make the case that it should be. However, pathological lying is listed as a symptom or characteristic of other psychiatric conditions, such as personality disorders (such as narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder) and factitious disorder.

Treatments for Pathological Lying
So, is there a cure for pathological liars? Treatment can be a challenge because it is often intertwined with other mental health issues, the individual is often not motivated to change, and the lies may have become a deeply ingrained part of their identity. However mental health professionals can offer various treatment options that are empirically supported.

Cognitive-behavioral therapy (CBT) has proven to be an effective approach. CBT helps people identify and change dysfunctional thinking patterns such as a yearning for attention that trigger the urge to lie and identify alternative more honest patterns of responding.

Another potential treatment option is dialectical behavior therapy (DBT). Originally developed to treat borderline personality disorder, DBT combines elements of CBT with mindfulness techniques and teaches patients how to regulate their emotions, tolerate distress, and improve interpersonal relationships. This approach may be particularly helpful for pathological liars who struggle with emotional instability and impulsivity.

Pharmacological interventions may also be considered, particularly if the pathological lying is accompanied by other mental health disorders, such as anxiety or depression. However, while researchers have examined treatments such as fluoxetine and lithium, there is not yet compelling evidence that pharmacological interventions can successfully decrease problematic lying.

Group therapy and family therapy are also helpful. Lying is a social phenomenon, so addressing it from a social perspective can help pathological liars gain insight into the problematic ways they relate with others. Group members and family members can help the pathological liar understand how their dishonesty is harming their social connections. These confrontations can also help the liar develop new tactics for relating in honest ways.

Pathological Liars Can Change
Instead of dismissing pathological liars as nefarious manipulators, we should recognize that they are often struggling with very real psychological problems. While there is no "one-size-fits-all" solution to treating pathological lying, there is strong evidence that some treatments lead to significant improvements. The journey toward "curing" pathological lying is typically a complex and challenging one, but with the right combination of treatments and a motivation to change, pathological liars can become more honest.

STRESS-
Feeling Stressed? It Might Be Your Liver Calling.
The liver-mental health connection is probably more important than you think.
Reviewed by Tyler Woods

KEY POINTS-
Liver disease is a common but rarely recognized contributor to mental health symptoms.
Non-alcoholic fatty liver disease is now the most prevalent liver condition, affecting one-third or more adults in the U.S.
A diseased liver cannot protect the body and brain from accumulating toxins that cause symptoms of physical and mental illness.
Improvements in health and lifestyle habits are the best way to reverse early to moderate liver disease.
Julia thought she must be losing her mind. Ostensibly in her prime, at age 35, and working at a successful law firm, she began having panic attacks out of the blue at work. Her sleep deteriorated. She suffered from spells of brain fog and began making embarrassing mistakes at work. Finally, after finding herself on the side of the road after missing a turnoff she'd made 10,000 times before, she decided to speak with her physician.

Thankfully for Julia, the doctor didn't refer her to mental health. Instead, results from her metabolic tests revealed a more likely cause of her symptoms: advanced liver disease. In Julia's case, identifying and treating her liver disease not only reversed her mental health symptoms, it may have saved her life.

Right now, unfortunately, millions of Americans are experiencing some of the same symptoms as Julia, suffering from the same invisible process of liver pathology, but not understanding the connection or getting the right treatment.

The liver and mental health.
Anxiety, depression, mood swings, memory loss, sleep impairment, personality changes.

If the above symptoms make you think "mental illness," then you may be overlooking a potential cause now affecting nearly half of American adults: fatty liver disease. This once-rare condition results primarily from factors such as excess body fat, poor dietary practices, and alcohol and substance abuse.

Although most people know about obesity and diabetes, far fewer have heard about fatty liver disease, their close metabolic cousin. And almost no one realizes how closely their liver health is connected to their mental health1. The aim of this post is to change that.

The liver is a remarkable organ, both for its staggering contributions to our overall health and for its vast underappreciation by the general public (see above figure). Outside of specialized liver doctors—such as hepatologists and gastroenterologists—even most healthcare providers do not realize the hundreds of life-enabling functions the liver performs each day.

The liver is the ultimate domestic engineer, working 24-7 to chemically neuter toxins in our blood before they infect our bodies. The organ functions as a nutritional warehouse for many essential vitamins and minerals and metabolizes medicines, alcohol, and other substances that would otherwise quickly jeopardize our existence.

The liver labors in these and many more roles in almost total obscurity, taking a relentless beating in the process of protecting us. Thankfully, the liver also just happens to be the organ equivalent of Wolverine—the fast-healing superhero mutant from the Marvel movies—in its ability to regenerate.

But even the marvelous liver has limits. Too much insulin, too much alcohol, or too much fructose, for example, and even the normally indomitable liver can no longer keep pace and begins to develop invasive fat within the liver tissue itself (the liver, under normal conditions, contains only trace amounts of fat).

The first signs of liver disease are sometimes recognized by physicians in the form of chronically elevated triglycerides, results on liver function tests such as alanine aminotransferase (ALT), or even by certain medical imaging procedures such as MRI and ultrasound. Caught early, fatty liver disease is treatable, frequently even reversible.

When these signs are missed, however, liver fat levels slowly progress, spiraling from the initial stages of inflammation to fibrosis and even cirrhosis. The latter cirrhosis stage is when the life-threatening process of liver failure ensues. As liver disease progresses across these stages, not only do many forms of physical illness become more likely, symptoms of mental illness also increase2.

As shown in Figure 2 above, liver disease can be a direct cause of mental health symptoms because a compromised liver cannot prevent toxins in the blood from reaching the brain. These unwelcome invaders then proceed to wreak havoc on a range of critical brain functions. Concentration, memory, mood stability, and the ability to tolerate and respond to stress are just a few of the potential mental capacities that can be impaired when toxins begin accumulating in the brain. Sadly, fatty liver disease remains a silent epidemic in the U.S., with most people unaware of the signs, symptoms, or causes3.

Healthy liver, healthy mind. What to do?
Treating fatty liver disease is a good news/bad news situation. The bad news is that there are no medicines approved by the FDA for the treatment of fatty liver disease. Unlike high blood pressure, cholesterol, or glucose, there is no simple prescription drug for fatty liver disease.

Instead, the most effective treatments for improving fatty liver disease and liver-induced mental health symptoms are behavioral. Losing body fat—particularly abdominal area body fat—, reducing sugar and fructose intake, lowering insulin resistance through exercise, sleep, and stress management, and limiting or eliminating alcohol and certain medicines that can harm the liver in high quantities such as acetaminophen (Tylenol), are some of the best ways to improve liver function (particularly at early stages).

Summary.
Because fatty liver disease is becoming more common each year in the U.S. population, a growing number of people will experience the physical and mental side effects of the condition. Talk to your doctor about liver function tests during healthcare visits, and remember how this much this vital organ contributes to your health and well-being.

COGNITION:
The Difference Between Preferences and Demands.
We tend to escalate our preferences into demands.
Reviewed by Vanessa Lancaster

KEY POINTS-
Preferences tend to be healthy and adaptive, while demands are maladaptive and lead to emotional problems.
Preferences reflect an individual's unique personality and can contribute to a sense of well-being.
Psychopathological demands reflect distorted or dysfunctional thinking patterns that impair an individual's emotional and mental health.
It's essential for a practitioner of REBT (rational emotive behavior therapy) and cognitive behavioral therapy (CBT) to distinguish between strong preferences and absolute demands. Preferences and psychopathological demands are two distinct types of beliefs affecting a person's emotional well-being. I prefer I want, I wish, and I desire express preferences and are motivating, whereas I must, I should, or I have to are demands and cause emotional disturbance. For example, if you want to be employed, you strongly prefer to do well at the job interview. If you have a demand, this means you tell yourself you absolutely must do well at the interview.

Where do demands come from? A demand starts as a wish, preference, or desire, such as, "I prefer to do well in life and get approval." Yet, as humans, we tend to escalate our preferences into demands. We tell ourselves, "Because I prefer to do well and get approval, therefore I must. It's a dire necessity." A demand involves thinking in terms of absolutes. It's like having a preference for the nth degree.

Preferences refer to your likes and dislikes and your personal choices and have the potential to give you joy and satisfaction. For example, you may prefer spending time outdoors, listening to music, or reading a good book. These preferences positively influence your emotions when outdoors and negatively when you're stuck indoors.

Psychopathological demands consist of those beliefs or thought patterns that create an emotional disturbance. These include ideas such as "I must do perfectly well and get approval, and if I fail, this means I'm not good enough and unworthy of love" or "I must be perfect." They create anxiety, depression, guilt, anger, and addictions.

A key difference between preferences and psychopathological demands is preferences tend to be healthy and adaptive, while demands are maladaptive and lead to emotional problems. Preferences reflect an individual's unique personality and can contribute to a sense of well-being. In contrast, psychopathological demands reflect distorted or dysfunctional thinking patterns that impair an individual's emotional and mental health.

Another difference is preferences tend to be flexible and subject to change as circumstances change, while psychopathological demands are rigid and resistant to change. Preferences can evolve over time as individuals gain new experiences and new perspectives, while demands are likely to persist even when irrational or harmful. Strong preferences, as opposed to demands, lead to constructive problem-solving. Creative experimentation with possible solutions. Assertiveness and determination. Intense appropriate emotions, including sorrow, regret, disappointment, frustration, dislike, annoyance, determination, passion, hopefulness, flexible thinking and acting, unconditional self-, other-, and life-acceptance, enjoying life somewhat in the face of failure, criticism, and loss.

A must results in global evaluations such as I'm no good, you're no good, my life is no good and also disturbed emotions including anxiety, depression, and anger.

You probably have a demand if you're experiencing any of these symptoms: fixed, rigid behavior; compulsive striving or withdrawing and giving up; emotional disturbance including anxiety, guilt, hurt, anger, dwelling, ruminating, and obsessing; depression, hopelessness, resentment, anger, or hostility; procrastination; addictions; perfectionism; and demanding guarantees.

The Difference Between Preferences and Demands
Demands are created when you turn preferences into absolutes.
Preferring and demanding have important consequences for your emotions.
Overall, preferences have evidence to support them, but demands do not.

BURNOUT-
Burnout: A Silent Stalker.
How to avoid becoming its next victim
Reviewed by Tyler Woods

KEY POINTS-
High-achieving women naturally gravitate toward extreme jobs, making them more vulnerable to burnout.
High-achieving women often don't recognize the signs and symptoms of burnout until they're in its grasp.
The three keys to avoiding burnout are acceptance, knowledge, and taking protective measures to avoid it.

High-achieving women tend to be highly adept at handling challenges, in part because they excel at anticipating problems. By doing so, they can either prevent problems from escalating or develop an action plan to handle problems when they arise. Unfortunately, burnout seems to be an exception for high-achievers, often sneaking up on them unexpectedly and significantly interfering with their productivity and overall quality of life.

There are two main reasons for this. The first has to do with the inherent nature of high-achieving women. They tend to gravitate toward jobs that are extreme, which makes their work hours exceedingly long and their workloads exceptionally heavy. Adding insult to injury, they also put enormous internal pressure on themselves to excel. Naturally, this kind of intensity can take a heavy toll on the body and mind, yet high-achievers are so confident in their ability to overcome challenges and so passionate about what they take on that they have trouble anticipating that burnout (for them) is even a possibility. The second has to do with the nature of burnout itself. No one wakes up one morning and is struck with a bad case of burnout. It's much more insidious, creeping up on its victims over time, which makes it much harder to see coming.

But this doesn’t mean that you have to fall prey to burnout. There are readily identifiable warning signs, and if you know what to look for, you can anticipate and defend against it.

Defense #1: Acceptance
As a high-achiever, you’re likely very passionate about what you do, so it might be hard to imagine that you could ever burn out. But that’s exactly how it gets you. If you don’t recognize or accept that burnout is a possibility, you’ll never see it coming.

Defense #2: Knowledge
Once you accept that burnout is a possibility, you have to understand what it is and how it develops in order to anticipate and protect yourself against it.

Burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment. Once you’re in its grasp, it’s difficult to function effectively on a personal and professional level. Yet, knowledge is power. By knowing the signs and symptoms, all of which exist on a continuum, you can recognize them earlier and take important steps to protect yourself from becoming a victim of burnout.

In a previous post, I provide a detailed discussion about burnout's signs and symptoms. But for the purposes of this article, here's a quick breakdown:
Signs/symptoms of physical and emotional exhaustion:
Chronic fatigue
Insomnia
Impaired concentration/attention
Physical symptoms such as chest pain, heart palpitations, shortness of breath, gastrointestinal problems, dizziness, fainting, and/or headaches (all of which should be medically assessed)
Increased vulnerability to infections, colds, flu, and other immune-related medical problems
Loss of appetite
Anxiety
Depression
Anger

Signs/symptoms of cynicism and detachment:
Loss of enjoyment
Pessimism
Isolation
Detachment (a general sense of feeling disconnected from others or from your environment)
Signs/symptoms of ineffectiveness and lack of accomplishment:
Apathy/hopelessness
Irritability
Lack of productivity/poor performance

Defense #3: Protective Action
Once you identify the areas in which you’re experiencing some vulnerability, you need to take action to prevent a worsening of these signs and symptoms. This is typically the hardest part for high-achieving women because it requires making changes to what, by all accounts, appears to be an enormously successful and accomplished life. It takes courage and strength to honestly assess the amount of stress in your life and find ways to reduce it before it's too late. It’s easy to convince yourself that if you just keep plugging away, everything will eventually even out and all will be well.

However, the danger of ignoring burnout is the same as ignoring a stalker. It's not going to just go away on its own. In order to protect yourself, you’re going to have to make some modifications. The more signs and symptoms you have, the more changes you’ll have to make to see an effect. And yes, that's hard, especially for high-achievers who pride themselves on successfully tackling even the most challenging problems. But the alternative is unsustainable in the long run. Without protective action, burnout will always win out.

DOPAMINE-
The Pursuit of Pleasure.
How can we maximize pleasure?
Reviewed by Vanessa Lancaster

KEY POINTS-
Short-term pleasures such as eating and sexual activity promote our survival as a species.
Pursuing long-term pleasures, including those derived from supportive social interactions, may help strengthen society.
A “pleasure dividend” can result from a long-term investment in a meaningful activity.

Humans likely are geared to seek pleasure to guide our behavior. Short-term pleasures such as eating and sexual activity ensure that we engage in activities that promote our survival as a species. I believe that long-term pleasure derived from activities such as creative expression, industrious work, participation in athletics, and long-term social interactions help strengthen the social fabric of society, which can promote our longevity and success.

Philosophers have discussed the reasons for pleasure for more than two millennia. The Greek philosopher Epicurus (341-270 BCE) suggested that pleasure was the highest good and represented the ultimate goal in life. Aristotle (384-322 BCE) believed that pleasure is the byproduct of virtuous behavior, and both he and Confucius (551-479 BCE) emphasized that we should pursue it in moderation. Christian theologian Thomas Aquinas (1225-1274 CE) viewed pleasure as a gift from God that should be used according to God’s will.

On the other hand, Christian theologian St. Augustine (354-430 CE) believed pleasure represented a temptation that led people away from God, and Buddha (563-483 BCE) suggested the desire for pleasure was the source of suffering.

Dopamine is one of the brain neurotransmitters that strengthens pleasurable experiences triggered by our brain’s reward system. Thus, dopamine release as a result of activities that we find pleasurable reinforces the continuation of such activities. Unfortunately, humans have discovered ways of triggering dopamine release, such as drug use, that leads to harmful behaviors.

If we ask ourselves how we might maximize pleasure in our lives, the answer likely lies in balancing activities that lead to short-term and long-term pleasures. Personal preferences, lifestyle, previous experiences, and cultural considerations affect our choice of activities that we find pleasurable. Further, we should avoid pleasure traps that can derail our lives. Finally, we should also consider the concept of a “pleasure dividend” that arises from contemplating past long-term pleasures.

Short-Term Pleasures
Eating, drinking, and satiety of hunger lead to short-term pleasures that we begin to experience immediately after birth.

Endorphins released during exercise help promote physical activity, which is essential for maintaining good health.

Sexual expression brings pleasure that motivates us to reproduce.
Relaxation, including meditation, hypnosis, prayer, and yoga, can lead to pleasure by releasing stress or tension.

Playing video games, checking our social media, gambling, watching movies, listening to music, going to amusement parks, shopping, applying makeup, or other self-grooming activities are different sources of short-term pleasure.

Long-Term Pleasures
Research has shown that people who engage in meaningful social interactions live longer and healthier. Perhaps this is why we derive pleasure from the development of good family relationships, friendships, and teams, and belonging to groups, such as fans of music, sports, and theater, being members of organizations such as fraternities, sororities, or those devoted to volunteer activities to help others or worship. Intraspecies' social interactions with pets can bring pleasure from companionship and love.

Pursuing hobbies can bring pleasure from being part of a group of hobbyists or developing expertise in a field, such as collecting stamps or coins or being involved with cars or motorcycles, including driving, racing, or customizing.

Traveling and spending time in nature (including hiking, fishing, and bird watching) to explore new cultures and places can lead to multisensory pleasures, including exposure to novel sights, sounds, and tastes.

The creative arts, including writing, painting, sculpting, woodworking, photography, and music, lead to the pleasure associated with self-expression and sometimes with sharing creative works. Cooking, gardening, and home improvement projects can also be elevated to pleasurable creative activities.

Whether competitive or not, participation in athletic activities can help develop long-term pleasure. Team sports can augment sports-related exhilaration because of players’ support of one another. Adventure sports, such as bungee jumping, sky diving, or rock climbing, can be associated with even more pleasure because of the adrenaline rush that occurs with the perception of increased risk.

Life-long learning through attending classes, reading, watching videos, or apprenticeships can bring pleasure through personal growth and self-discovery.

Pleasure Traps
Pleasure traps typically involve short-term pleasures that are pursued excessively and can impact our lives adversely.

Examples of such traps include drug use (including excessive use of alcohol, nicotine, cannabis, stimulants, depressants, hallucinogens, and narcotics.) Obviously, drug addiction can completely consume lives and lead to early death. People also are harmed by developing a dependence on drugs to avoid dealing with life challenges. Drugs can also damage physical and mental health.

The use of pornography is yet another pleasure trap that has become ubiquitous because of easy access to the internet. Adverse effects of pornography can range from developing an addiction to porn, development of anxiety and depression due to an inability to cease the use of porn, to causing an inability to function well in real-life sexual encounters.

Other pleasure traps include the excessive pursuit of short-term pleasures such as eating, which can lead to obesity, and engagement in frequent novel sexual encounters, with the associated risks affecting physical health (e.g., venereal disease), and mental health (e.g., inability to develop long-term, meaningful relationships). Gambling addiction has been a long-standing pleasure trap. Social media and video game addictions are modern traps that can lead to poor academic performance and inadequate development of social skills.

During puberty, adolescents appear to have a lower level of dopamine in their brains, which may fuel their desire to engage in riskier, more dangerous behavior to achieve pleasure (Arain, 2013).

Another form of a pleasure trap involves deriving pleasure from viewing or participating in negative events, including violent behavior or infliction of pain.

Pleasure Dividends
A form of pleasure that has not been widely described is the pleasure achieved from recalling an activity that led to long-term pleasure. I refer to this pleasure as a dividend as it results from a long-term investment in a meaningful activity.

For example, thinking back about the feelings experienced during a championship sports competition, during a get-together of a close family or friends, or after completing a long-term goal such as writing a book can bring great pleasure.

Takeaway
Maximizing pleasure in our lives involves balancing short-term and long-term pleasures while being mindful of the additional benefit from achieving pleasure dividends and the need to avoid harm caused by pleasure traps.

The Joys of Sexual Mistakes.
What many of us fear can be the very thing that creates amazing sex.
Reviewed by Tyler Woods

KEY POINTS-
Believing there is a "right" way to do sex is associated with sexual dysfunction, lower desire, and lower sexual satisfaction.
Agreeing to laugh when sex goes askew can be the first step to making sex fun again.
Mishaps can allow us to re-evaluate our tired old patterns and add some spicy readjustments.
Flimsy erections, unusual sounds, oozings, too much moisture, too little moisture, elusive orgasms: These are the embarrassments, the “failures,” the cringe-worthy moments that can shut down a sexual moment. But are these really mistakes? Or can they be opportunities to have amazing sex?

The perception of a “sexual failure” is directly linked to performance. Those who believe there is a ‘right’ way to do sex will also believe there to be a ‘wrong’ way to do sex. And believing there is a ‘wrong’ way to do it can remove all of the joy, pleasure, and connection from a sexual encounter. The belief that sex should be done in a particular way is also associated with higher rates of sexual dysfunction, lower desire, and lower sexual satisfaction. And it can rob the pleasure from our lover as well.

So, what makes for higher sexual desire and satisfaction? Sexual expression. And sexual expression is linked to? You got it, being able to do things ‘wrong’ and not getting too twisted up about it.

Sexual mishaps happen all of the time, and the people who are having the best sex are the ones who don’t believe in sexual ‘wrongs’. They can recover by either shrugging off, laughing, or talking about them with honesty.

These beautiful mishaps can be exactly what many of us fear about sex but they can also be the very things that make for a rich and intimate experience.

Sexual mishaps are important for a few key reasons:
1. The opportunity to laugh and be human together
First of all, sexual mishaps can lighten the mood. One piece of research I find myself quoting over and over again is the wonderful work by Peggy Kleinplatz, who looked at “optimal sex” in long-term relationships (2013). In it, she found that levity and laughter are a component of optimal sex. Sexual mishaps can add to that levity, reminding us that sex is imperfect and meant to be playful and fun.

Since sexual mishaps are such a common part of sex, agreeing to laugh when something goes askew can be the first step to turning sex into play rather than a performance, or "work."

2. The opportunity to change our tired pattern
Most couples get stuck in a loop of what they do sexually. They find what will lead to orgasm and stay with it. Sounds logical. But this routine was usually developed at the beginning stages of the relationship, and continuing with this type of "efficient sex" does not allow either person to grow and change. Sexual passion and satisfaction require an openness to variety and newness to thrive (Frederik, 2017). Mishaps can allow us to re-evaluate our tired old patterns and add some spicy readjustments.

3. The opportunity to recognize where we hold sexual shame
Shame is one of the biggest deterrents to sexual pleasure. It's the reason many people seek out therapy (of all kinds). Sexual shame is automatic, having developed earlier in life, from messages that sex is something we should fear or be ashamed of. This shame is deeply personal. What for one person is a die-of-embarrassment moment can be easily laughed off, or go unnoticed, by another person.

Seeing which sexual mishaps make us feel like curling up into a ball can give us insight into our own patterns of shame. This awareness can then allow us to address these shame points directly—learning where those messages came from, and seeing if the facts match up with those original beliefs. Often, this added insight and knowledge allow us to realize that shame is unnecessary.

4. The chance to open conversations up to the realities of sex (and be human)
Let's take a common embarrassment for women: unusual bodily sounds. Even though these are a natural and common occurrence, a sexual episode can be hijacked with anxiety and shame by a simple “poof” of air. Many women can get into their heads wondering if her lover heard it, and what they might think. Should she say something? If so, what (without ruining the mood)?

A droopy erection can cause similar concerns for men. Maybe he is in the mood for sex but his penis isn’t cooperating. This is one of the most common sexual distractions for men, with accompanying thoughts like, “Will she think I don’t find her sexy? Will she think I'm not manly enough? Should I apologize if she seems disappointed?”

Once our head is dominated by these non-erotic, self-judgey thoughts, our arousal, intimacy and our pleasure quotient are all guaranteed to go down. Many people suffer silently with their sexual shame, and without enough information, a lover could be left confused. Without some form of understanding or communication, both lovers are forced to make up stories in their heads about what is happening.

There is a tremendous opportunity in this moment, not only to break the tension, but also to gain a greater connection and understanding of yourself and your partner, by talking about it. But because we are conditioned to avoid the topic of sex, most people don’t have much practice, and a conversation about "real" sexual matters can feel awkward.

Where to start?
I suggest a simple agreement with your lover: to allow/encourage each other to be human during sex. The best time to create this simple agreement is outside of the bedroom, so no one’s arousal is being interrupted.

Follow up by welcoming the parts that make you cringe. Find out more about the actual realities of sex (the facts) and talk about them. And above all, find some humor in these sexual moments. After all, so much about sex is messy, unexpected and, well, funny.

So, let’s make some mistakes in bed! Having a mishaps-welcome attitude can go a long way to fun-proofing your sex life.

Where in the World Do People Hug and Kiss the Most?
A new study investigated affectionate touch between partners in 37 countries.
Reviewed by Vanessa Lancaster

KEY POINTS-
Scientists assessed the association between the frequency of hugging, kissing, and other forms of affectionate touch and love in 37 countries.
People in Austria showed the most affectionate touch towards their partners.
There was a universal association across countries that more loving partners also touched more often.
When did you last hug or kiss someone?

Hugging, kissing, and other affectionate touch are important parts of romantic relationships, but people differ quite a bit in how much they hug and kiss their partners. A new study, now published in the peer-reviewed journal Scientific Reports, focused on understanding the relationship between touch and love across different countries (Sorokowska et al., 2023). While we may assume that people who love their partners more also touch them more, cultural factors may strongly influence this association, making this kind of psychological research highly important.

A New Large-Scale Study on Love and Touch
In the study, the research team led by scientist Agnieszka Sorokowska conducted two different experiments. In the first experiment, data from 7,681 volunteers from 37 different countries were analyzed. Each volunteer was in a relationship. They filled out a questionnaire about how much they loved their partner and a second questionnaire about the role of affectionate touch in their relationship. The volunteers were shown pictures of embracing, stroking, kissing, and hugging in this questionnaire.

The participants were asked to indicate whether or not they performed each of these behaviors with their partner the week before participating in the experiment. This way, each volunteer got a percentage between 0 percent (none of the four behaviors), 25 percent (one of the four behaviors), 50 percent (two of the four behaviors), 75 percent (three of the four behaviors), and 100 percent (all four behaviors). By calculating the average value for all participants from one country, the scientists could determine the countries in which people showed the most and least affectionate touch to their partners.

In which countries did people show the most affectionate touch towards their partners?
The number one country was Austria (97.3), followed by Germany (96.8) and Cuba (95.8). The United States was at 91.3 points. The least affectionate touch toward their partners was shown by volunteers from China (52.8), The Netherlands (57.5), and Ukraine (58.6). The scientists also investigated whether the amount of affectionate touch someone shows towards their partners was associated with how much they loved them. A clear association was found. Across all countries, people who loved their partners also showed more types of affectionate touch towards their partner.

In the second experiment of the study, the scientists explored this association between love and touch in greater detail. In this part of the study, 199 volunteers from Poland filled out a more detailed questionnaire on touching in their romantic relationships, the so-called Affective Touch Survey. Compared to the first experiment, the volunteers were not only asked whether they showed affectionate touch towards their partner during the week before the experiment took place but also how many times they touched their partners.

How often did the participants touch their partners?
On average, volunteers touched their partners 3.36 times per hour. For embracing the average was 0.61 per hour, for stroking 0.67, for kissing 1.08, and for hugging 0.89. Volunteers differed quite a bit in much they hugged and kissed. For hugging, the range was between zero to 10 hugs per hour, and for kissing it was between zero and 20 kisses per hour. If you assume that someone sleeps around eight hours per 24-hour day that are 160 hugs and 320 kisses per day for these very romantic individuals.

Comparable to the first experiment, touch and love had a strong statistical association. People who loved their partners more also touched them more.

Loving Couples Touch More
So, while the study found large differences in the frequency of hugging and kissing between countries, the association between love and touch was universal. People who loved their partners showed higher levels of hugging, kissing, and other affectionate touches. So when you doubt whether you should give your partner a heartfelt hug, do it!