Current Issues in Psychology: Problem Gambling (PDF)

Many people enjoy gambling, whether it is at the pokies, betting online, or purchasing a lottery ticket. However, for some people, gambling can stop being a source of occasional entertainment and become a serious problem. The term ‘problem gambling’ is most commonly used to describe an individual’s inability to control the amount of money and/or time spent gambling which results in negative consequences for their social, family, and work life. Some forms of gambling are more likely to lead to problem gambling. For example, electronic gaming machines (i.e., pokies) have been shown to be ten times more likely to lead to problem gambling than other lottery style games. Online sports betting and electronic casino gambling are also becoming increasingly concerning, particularly due to their availability, immersive environment, and ability to bet in private. Symptoms Although there are no consistent symptoms of problem gambling, instead there are a number of cognitive, emotional, behavioural, and financial signs that might indicate that a person is experiencing a gambling problem. These include: Cognitive and emotional frequent thoughts about gambling feeling irritable and restless when attempting to stop gambling gambling in order to escape problems/feel better gambling more and more money in order to achieve feelings of excitement. Behavioural arguments with family or friends as a result of issues relating to gambling relationship issues related to money or financial hardship hiding and/or lying about gambling behaviours experiencing difficulties at work or with study as a result of gambling behaviour repeated unsuccessful attempts to stop gambling difficulties resisting the urge to gamble. Financial relying on others to resolve financial troubles caused by gambling legal issues related to debt or financial troubles gambling in order to win back lost money. Causes There is no one cause for problem gambling. Rather, there are a range of factors that might increase the risk of a person developing gambling problems, including: Demographics: People aged 18-35 years are the most at-risk age group for developing gambling issues, with men more likely to experience problems with gambling than women (especially younger males). Personal differences: People who are more impulsive, have significant problems with mood and relationships, or have substance use problems are more at risk of developing problems with gambling. Stressful life events: In some individuals, negative life events such as the loss of a job, family problems, relationship breakdowns, or wider economic crises may also trigger gambling behaviour. This can create a cycle where in turn, gambling behaviour can then exacerbate stressful life events. Environmental factors: Living or working in areas with a large concentration of gambling venues (e.g., hotels/clubs) increases an individual’s risk of developing problem gambling. Pokie venue settings and online betting conditions, targeted advertising, increased access to gaming, and the design of the games themselves can all make it difficult for people to make informed choices about how much they spend and how long they gamble. Treatment Research has shown that a number of psychological strategies are helpful in the treatment and management of problem gambling, with the most effective being cognitive behavioural therapy (CBT), motivational interviewing (MI), and motivational enhancement therapy (MET). These programs can be administered face-to-face or virtually and included immersive and brief therapeutic options. These strategies are described below. Cognitive behavioural therapy CBT is a type of therapy that helps an individual to change unhelpful thoughts, feelings, and behaviours. In relation to problem gambling, CBT uses a range of cognitive and behavioural strategies to help identify and challenge unhelpful thoughts (e.g., superstitious beliefs), responses to stress and life difficulties, and how a person responds to triggers for gambling. CBT has been widely shown to be effective in reducing problem gambling behaviours, and includes both face-to-face or internet-based treatments. Motivational interviewing MI is a counselling approach which helps strengthen an individual’s motivation to change their gambling behaviour by exploring reasons for change and resolving any uncertainty they might be experiencing about the change. During MI, the psychologist uses a range of strategies to help bring about behavioural change, such as goal setting, developing a plan of action, and increasing the person's confidence to change their gambling habits. Motivational enhancement therapy MET is a brief psychological intervention based on the principles of MI. A core feature of MET is the delivery of personalised feedback following an initial assessment to bring about self-motivated behaviour change. MET typically consists of four sessions, with the first two sessions focusing on assessment, feedback, and the development of behaviour change plans, and the two follow-up sessions assessing the individual’s progress and reinforcing goals. Anger is a commonly experienced emotion which can range from mild annoyance to rage. Anger is triggered when a person believes they have been wronged by someone, that something unfair or unjust has happened, or that their wellbeing and social status are either not being respected or are under threat.¹⁻³ No person can make us angry, rather anger is influenced by people’s thoughts, their interpretations of events and their coping skills and available supports. Although anger is often seen as a harmful emotion, it can be a healthy emotional response when expressed assertively and respectfully. Sometimes anger can be helpful; it can motivate a person to take positive action to change a situation for the better⁵ or to achieve his or her goals. Frequent experiences of anger should not be ignored. Angry outbursts can cause fear, regret and/or work, relationship, and health problems for both oneself and others. When anger prompts someone to use violence, physical injury and even loss of life can occur. Angry people often report regretting their outbursts and wishing they could have expressed themselves in another way. Aspects of anger Problem anger is frequent, intense and long-lasting. The experience of anger involves a person’s thoughts, emotions, physical responses and behaviours. Thoughts Thoughts can be irrational or exaggerated. When angry, people are more likely to blame others, and not see themselves as playing a role in the situation. Thoughts might also focus on putting the other person down, or wanting to get revenge.⁴ Emotions Anger also involves an emotional response related to the person’s thoughts and beliefs about a situation. It can range from mild annoyance or irritation to more extreme feelings of rage or fury. Physical responses The sympathetic nervous system is activated during anger, raising the heart rate, increasing muscle tension and sometimes creating the sensation of feeling hot.⁴ Chemicals in the brain which help control mood, sleep, appetite, learning, and memory, are also thought to be involved in our expressions and experience of anger and, as a result, these aspects of our behaviour can be negatively affected.¹¹ Behaviours Problem anger is associated with a range of negative behaviours, particularly aggression and violence, which cause further difficulties for the person and their relationships, including family violence, workplace violence, bullying and harassment.4, 6, 12-14 Road rage, assault and substance-use issues have also been associated with problem anger. What causes problem of anger? Research is yet to find the cause of anger, however, the way anger is experienced and expressed can become a habit. Therefore, knowing the risk factors for anger can help when trying to choose an assertive and respectful expression. Some of the risk factors for anger are: Anger-related memories and images, such as those related to the experience of trauma, can trigger and add to the experience of anger.⁴ Family and cultural factors whereby families model what is acceptable behaviour and cultures can shape what is seen as a normal and appropriate response to stress.¹⁷ Fixed ways of thinking about the world and setting inflexible standards and expectations can increase the likelihood of anger when situations do not happen as expected.⁴ Anger can be a symptom of some mental health disorders, such as oppositional defiant disorder, post-traumatic stress disorder and some personality disorders.¹ Frequent outbursts of anger might therefore indicate broader mental health problems and should be evaluated. A tendency to respond to stress with anger, hostility or aggression may in part be influenced by a person’s genes. Treatment Problem anger can be addressed by psychological support and therapy by helping individuals change their way of thinking or behaving in response to situations which trigger their anger.1, 6, 19, 20 Increasing a person’s motivation to change is also an important part of treatment.21, 22 The most common therapies to treat problem anger are cognitive behavioural therapy, relaxation-skills training and life-skills training. Family- or relationship-based therapy can also improve communication and rebuild relationships affected by problem anger. Cognitive behavioural therapy (CBT) helps the person to change unhelpful thoughts and behaviours which can contribute to their anger, and aims to build skills to manage problem anger in an ongoing way. Cognitive reappraisal, where the person changes his or her interpretation of an event (e.g., seeing a driver who cuts them off as possibly rushing to an important appointment rather than purposefully holding them up) is particularly helpful in reducing or preventing angry responses.21, 23-26 Problem-solving, which helps the person identify problem situations that might trigger an angry response, and finding effective solutions can lead to lower levels of problem anger.19, 27 Relaxation-skills training helps to decrease tension in the body, which can be an important first step in addressing anger problems.21, 28 Communication-skills training helps the person to learn and practice calmer ways of handling situations which typically trigger an angry response by using real or role-played situations. 21, 29, 30 Such training may focus on skills such as compromise and negotiation, to improve conflict resolution and how to respectfully and calmly express their anger.³¹ Family- or relationship-based interventions can help families, couples or others in a relationship increase their understanding of a person’s anger and its negative consequences.²¹ Family-based interventions can help improve communication, conflict resolution and problem-solving skills, break cycles of anger and aggression, and increase the sharing of positive emotions, rather than anger.³¹ Some of these messages encourage the sexualisation of girls from a very early age, before they are emotionally or physically ready. Exploitation of children, particularly girls, as sexual objects has a detrimental effect on adolescent development, increasing the risk of depression, eating disorders and low self-esteem. Boys and men can be the target of sexualised messages and images, but research shows that girls and women are portrayed in a sexual manner more often. What parents and carers can do? Educate Teach girls to value themselves for who they are, rather than how they look. If you have boys, teach them to value girls as friends, sisters and girlfriends, rather than as sexual objects. And you can advocate for change with manufacturers and media producers. Ask questions such as "Why do you think there is so much pressure on girls to look a certain way?” "What do you like most about the girls you want to spend time with?" "Do these qualities matter more than how they look?" “What do you think of the different roles that are usually given to boys and girls?” Teach boys that girls should not be judged by how they look or what they are wearing. Find out what your school teaches so that you can follow up on what children are learning at school. Let the school know if you think there are gaps in what they are teaching. Always tell the child you are glad that they asked questions, whatever you really feel, but give yourself time to answer if you need it, and tell children what they need to know even if they don’t ask. Tune in and talk Tune in and talk with your children. Be aware of how your children are using the internet and social media, reading magazines and watching TV or movies. Talk about body safety, sex and sexuality with your children from an early age and often. Effective sex education programs discuss media, peer, and cultural influences on sexual behaviours and decisions, how to make safe choices, and what makes healthy relationships. Girls who are overly concerned about their appearance may have difficulty focusing on other things. Try to encourage girls to choose clothing that is comfortable, practical and expresses who they are. Speak up, and try to see it from their perspective If you don't like the choice your children make such as a TV show or outfit, explain why you have this opinion. A conversation with children about the issue will be more effective than simply banning the product. Support campaigns, companies, and products that promote positive images of girls. Complain to manufacturers, advertisers, television and movie producers, and retail stores when products sexualise girls. Keep in mind that dress can be an important social code for girls. Understand that looking different and reacting against their parents’ generation may be part of growing up. Encourage Encourage extracurricular activities such as sport, music, art that emphasise talents, skills, and abilities over physical appearance. Find ways to celebrate being female. This might be a special lunch, a girls’ day out, or flowers to mark when a girl gets her first period. Provide healthy role models Provide healthy models for your children. What you watch, look at online or buy influences your sons and daughters too. Take care about how much you talk about diets, or pass comments on your own body image. It can be more helpful to talk about healthy eating, and to show children that heath is about many more things than just weight. Mothers and fathers should be careful not to criticise their daughters or sons about how they look. This can create an unhealthy attitude towards appearances. Fathers can be particularly important in the development of their daughter’s self image and their son’s attitudes towards women. The way men treat and talk about the women in the family and women in general is a powerful example of how to behave for their children. Encouraging your children to find healthy heroes is important. Talk about people who really display the characteristics you want your child to copy. This helps your child understand how people demonstrate real worth in the world. Be real and maintain a balance Help your kids focus on what’s really important: what they think, feel, and value. Help them build strengths that will allow them to achieve their goals and develop into healthy adults. Remind your children that everyone is unique, and that it’s unhelpful to judge people solely by their appearance. Try to take advantage of opportunities that arise in conversations, but do not become too pre-occupied with all the experimentation your daughter tries in her dress or mannerisms. Remember that it is your example and values that your children will often copy. Remember, too, that despite differences, maintaining a good relationship with your daughter is paramount. Loneliness is a negative feeling that a person can experience when their social relations are not the way they would like. It is a personal feeling of social isolation. Prior to the COVID-19 pandemic, many Australians were struggling with loneliness. Recent research conducted by Swinburne University reveals that 1 in 2 Australians report feeling more lonely since COVID-19. About loneliness Loneliness is a feeling of distress people experience when their social relations are not the way they would like. It is a personal feeling of social isolation. It is different to feeling alone: we can be surrounded by others but still lonely, or we can be alone but not feel lonely. Loneliness may be a sign that a person’s relationships are inadequate or don’t meet their expectations or needs About loneliness As humans are essentially social animals, loneliness is thought to arise because an innate need to belong to a group is unmet. Loneliness signals a need to form a meaningful connection with others. Research has found that loneliness is related more to the quality than the quantity of relationships. A lonely person feels that their relationships are not meaningful and that he or she is not understood by others. Australians who are married are the least lonely, compared to those who are single, separated or divorced. Australians in a de facto relationship are also less lonely than those who are single or divorced. Lonely Australians have significantly worse health status (both physical and mental) than connected Australians. Lonely Australians are 15.2% more likely to be depressed and 13.1% more likely to be anxious about social interactions than those not lonely. Australians over 65 years are least lonely; other age groups experience similar levels of loneliness. Australians over 65 years also report better physical and mental health, lower levels of social interaction anxiety, fewer depression symptoms and greater social interaction than younger Australians. Younger adults report significantly more social interaction anxiety than older Australians. Higher levels of loneliness are associated with higher levels of social interaction anxiety, less social interaction, poorer psychological wellbeing and poorer quality of life. LONELINESSANDHEALTH Lonely Australians not only report poorer mental and physical health and quality of life, but their higher level of anxiety about social interaction, less frequent social interaction, and more frequent experience of negative emotions and depression symptoms can make it difficult to overcome loneliness. A U S T R A L I A N S ’ L E V E L S O F A N X I E T Y A B O U T S SO C IAL INTERACTIONS Anxiety about social interactions is common among Australian adults. The most challenging social situations include meeting people at parties, talking to unfamiliar people and speaking with someone in authority. Bullying is when a person deliberately and repeatedly hurts someone else. The hurt can be physical or emotional. Bullying can occur in a range of different contexts, but it is most commonly discussed in relation to children at school, cyber-bullying or people at work. Psychologists can help people affected by bullying, but more importantly, they can also help to create safe and healthy schools and workplaces that promote physical and psychological wellbeing. Key Point Bullying includes hitting, pushing, name calling, leaving people out and teasing. If someone often feels scared or hurt when they are with a particular person or group, they may be being bullied. Bullying is a form of aggression that can escalate into violence. Cyber-bullying is a particular form of bullying through the internet and mobile phones. Cyber-bullying can include spreading malicious rumours about a person, sending threatening messages, sharing embarrassing images, and excluding people from social networking groups. Children who are being bullied need adults to intervene and provide support. Workplace bullying is repeated, unreasonable behaviour directed toward an employee, or group of employees, that creates a risk to health and safety (definition used by WorkSafe Victoria). Four key elements of workplace bullying are: a workplace conflict that: is enduring and repeated in nature is inappropriate and possibly aggressive results in a level of (physical and/or psychological) distress. *“Power” can include such things as being older, being physically bigger or stronger, having more social status, or when a group of kids “gang up” on someone. ▪ A lot of teens describe bullying as, “When someone tries to make you feel less about who you are as a person, and you aren’t able to make it stop.” Bullying can begin as early as preschool. It increases in elementary school, peaks in middle school, and then decreases in high school. Globally, one in three children experiences bullying and a similar proportion are affected by physical violence Overall, many countries have seen a decline in the prevalence of bullying, but fewer have seen a decrease in physical fights or physical attacks Signs to indicate a child may be being bullied can include: gets hurt or bruised is scared or has nightmares loses or has damaged possessions puts him/herself down; doesn’t want to go to school has no friends or party invitations often feels sick acts aggressively. Signs and symptoms indicative of workplace bullying may include: experiences ranging from mild annoyance through to severe psychological, social and economic trauma. depression, anxiety, low self-esteem, decreased self-confidence, panic attacks, fatigue, eating disorders, post traumatic stress disorder, and/or suicidal ideation. Strategies for helping children affected by school bullying include: increasing supervision of children when with other children letting children know what bullying is, why it is unacceptable, and how to spot it making clear rules and consistent consequences for all children praising children when they play cooperatively with others teaching them that telling a trusted person about bullying is okay teaching children how to stand up for themselves helping children to improve their social skills. Strategies for children affected by cyber-bullying include: talking with children about how cyber-bullying can happen, why it is not ok, and how it can affect the receiver encouraging them to talk if they feel uncomfortable, bullied or intimidated teaching them strategies for blocking, deleting, reporting bullies trying not to rely on blocking access to online environments as the only way to protect children. Strategies for dealing with children who are bullying others can include: increasing supervision when the child is with other children explaining what bullying is and why it is not acceptable talking with the child about the impact of bullying on others. Try to get them to understand what it is like for the person being bullied, for example by asking how they would feel if they were being bullied talking with the child about what they think might help them to stop bullying showing them how to join in with other children in a friendly way (for example: first observe a game and the other children, look for a natural break in the game for joining in, choose a person with a friendly face and ask them if you can join) making clear rules and consequences, and being consistent in dealing with inappropriate behaviour; praising children when they play cooperatively with others enrolling the child in a group program that helps children learn to manage their behaviour. Strategies for dealing with workplace bullying include: creating channels for employees to voice their concerns around bullying in the workplace breaking the collusion of silence amongst colleagues about the bully's behaviour and its effects on victim(s) offering the bully every assistance possible (in good faith) to improve and change his or her behaviour dealing with bullying through supervisory support and disciplinary processes modelling respectful behaviour from the top down and setting clear expectations at all levels of the organisation Grief is the natural reaction to loss, and can influence the physical, emotional, cognitive, behavioural and spiritual aspects of our lives. Grief can be experienced in response to a variety of loss-related events, such as the death of a loved one, separation or divorce, the loss of a sense of safety or predictability, physical incapacity through disability, or the loss of one’s home or community due to disaster.1 People cope with grief and loss in a variety of ways. While some might find it helpful to talk openly about the experience, others might prefer time alone. The intensity and duration of the grieving process can also differ between individuals. For most people, the experience of grief will dominate their emotions, thoughts, and behaviours for a number of weeks or months. Grief is the acute pain that accompanies loss. Because it is a reflection of what we love, it can feel all-encompassing. Grief is not limited to the loss of people, but when it follows the loss of a loved one, it may be compounded by feelings of guilt and confusion, especially if the relationship was a difficult one. As time passes, most individuals learn to cope with their grief and go about their daily lives, although for many the loss will remain a part of them.2 Most people who experience loss will not need professional help, however some (approximately 10 to 20%) seek and require professional support. Grief is an individual experience and people can respond to loss in a variety of ways. Responses include emotional, cognitive, physical and behavioural changes. ⁴ Emotional responses include: sadness anger guilt and remorse anxiety loneliness helplessness shock and disbelief a sense of yearning relief. Cognitive changes can include: confusion difficulty concentrating preoccupation with the loss a loss of interest in enjoyable activities vivid dreams or nightmares. Physical and behavioural responses can include: muscle tightness tiredness/reduced energy sleep disturbances social withdrawal changes in appetite crying restlessness avoiding places or people who remind the individual of the loss treasuring objects that are associated with the loss. In addition, there can be significant changes to a person’s spiritual or philosophical views and beliefs, for example, people may question their faith or the meaning of life. The Process of Grief Because grief obeys its own trajectory, there is no timetable for feelings of pain after loss; nor is it possible to avoid suffering altogether. In fact, attempts to suppress or deny grief are just as likely to prolong the process, while also demanding additional emotional effort. Similarly, the misperception that “more” grief is better or that there is a proper way to grieve can make the process more difficult. For some people, grief is a short-term phenomenon, also known as acute grief, although the pain may return unexpectedly at a later time. But other individuals may experience prolonged grief, also known as complicated grief, lasting months or years. Without help and support, such grief can lead to isolation and chronic loneliness. Does everyone follow five stages of grief? Many people expect to experience denial, anger, bargaining, depression, and acceptance, in that order, due to the continuing influence of On Death and Dying, the 1969 book by psychiatrist Elisabeth Kubler-Ross. However, it has been demonstrated that many, if not most, people will not progress through these stages. While some people do experience the stages, and eventually reach acceptance after a loss, grief is now understood to be highly individualized and unpredictable. What’s the difference between grief and depression? Many of the symptoms of grief overlap with those of depression. There is sadness, and often the loss of capacity for pleasure; insomnia; and loss of interest in eating or taking care of oneself. But symptoms of grief tend to lessen over time, although they may be temporarily reactivated on anniversaries or when other reminders of a loss arise. While negative thoughts such as “life is unfair” and “I’ll never get over this” are part of the normal grieving process, it is important to prevent them from guiding your actions. What We Mourn It is expected that someone will grieve after the loss of a parent, sibling, partner, child, or best friend. But those are not the only losses that lead to grief. People may grieve the loss of a treasured pet, a job or other important role in life, or a home or other emotionally significant possessions. And it often occurs after a divorce. Treatment Grieving is a difficult and challenging process. Its nature depends on a number of factors, such as the person’s coping style and personality, as well as the type of loss.⁵ However, regardless of the circumstances, losing a loved one can cause great pain and suffering. Most people learn to manage their grief and adjust to their loss in their own time. Maintaining self-care activities and routines,6 and having adequate social support available⁷, can be helpful during this time of adjustment. However, for people who experience prolonged or complicated grief reactions, a number of more targeted psychological treatments and strategies can be of great benefit, including Challenging unhelpful thoughts and behaviours Cognitive-behavioural therapy for complicated grief helps identify and modify a person’s unhelpful thoughts and behaviours in order to improve their mood and increase their quality of life. Complicated grief treatment Complicated grief treatment addresses the symptoms of loss by helping people re-establish relationships and focus on personal life goals. Improving family relationships Some psychological treatments focus on strengthening family bonds and developing good communication patterns as this can help prevent people from experiencing significant psychological distress as a result of the loss. Psychologists sometimes refer to this as focused family grief therapy Finding meaning Finding meaning and significance in the loss that a person has experienced can also be helpful. Psychologists may use a range of meaning reconstruction approaches to help achieve this. Helping yourself Remember to ask for help if you need it; don’t be afraid to speak up and admit that you are struggling to cope with your loss. Be honest with family and friends about how you are feeling and be open to accepting their help. Allow yourself time to grieve your loss. Talk with others who share a similar experience; joining a bereavement support group (in person or online) can be helpful. Take care of your physical health; participate in regular exercise, eat healthy meals, limit alcohol use, attend medical check-ups etc. Participate in enjoyable activities, hobbies and interests regularly. Maintain normal sleep patterns. Practice relaxation or mindfulness activities to help calm the mind and body. Reflect on your religious or spiritual beliefs. Helping someone else Provide practical support, such as helping with funeral arrangements, assisting with housework and meal preparation, buying groceries etc. Support the person emotionally; providing comfort and reassurance, talking about the person’s loss, listening with compassion, or sharing memories are important to the healing process. Be a source of information support, such as financial advice, or helping the person understand how and/or why the loss occurred. Do not just focus on the person’s loss; talk about everyday life, current affairs etc. Check in with the person weeks, and even months, after the loss to show you still care. Suggest that they speak to a professional if their grief does not seem to be lessening over time or they are struggling to function What Not to Say to Your Grieving Friend Death and grief make us uncomfortable. It's hard to know what to say to a griever, and it can be even harder to know what not to say. Being present and bearing witness to your friend's pain is just as important as having the right words. Anything that starts with “at least.” Starting a statement with “at least” is akin to saying, “look on the bright side,” and any bright side a griever might feel is theirs alone to identify. “At least she wasn’t in pain.” “At least she lived a long life.” “At least she didn’t have kids.” “At least she had a baby to carry on her legacy.” Nope. None of these is okay. It’s not your place to try to cheer up the griever or to point out that it could be worse. Did she smoke? When I tell people my sister died of lung cancer, nine times out of ten, they ask me whether she smoked. I imagine they’re looking for reassurance that if they don’t smoke, they can cross lung cancer off their list of horrible things that might happen to them. They want to know there’s some order to the chaos. It’s the same as asking whether someone who died in a car crash was wearing a seatbelt. Neither is okay because these questions blame the victim and are irrelevant to the griever, whose person is gone whether or not she smoked, even if he was wearing his seatbelt. I Can’t Imagine Yes, you can. You just don’t want to. The problem with this one, even though it seems respectful, is there’s no adequate response. Saying “I can’t imagine” erects a wall between you and the person you’re trying to comfort, shutting down the possibility of any meaningful conversation. You can only empathize with the griever when you allow yourself to imagine, which in turn creates a safe space for the mourner to share how she feels. You’re So Strong Telling someone they’re strong when they feel broken might make the person feel like there’s something wrong with them for falling apart, or even for feeling sad. While you’re trying to pay a compliment, you’re actually telling the person how they are doing instead of waiting for them to tell you. Let Me Know if There’s Anything I Can Do Your grieving friend has enough on her plate without trying to figure out what you can do for her. If you want to do something useful, bring a meal or give her a restaurant gift card. Take her children out for ice cream. Mow her lawn. Sit with her in her grief. But don’t ask her to come up with something you can do. In the end, the best thing to say when you don’t know what to say is just that. “I don’t know what to say, but I’m here for you.” What my high-school friend got right was acknowledging how hard death and grief are, even for those trying to provide comfort. You don't need to fill the silence. Being present for your friend by recognizing and bearing witness to her pain is at least as important as the words you have to offer. How Partners Commit Relationship Sabotage Defensiveness, difficulty with trust, and more. A new study in the Journal of Couple and Relationship Therapy explains how the instinct to destroy our own relationships is rooted in the urge to protect ourselves against the possibility of actually being vulnerable with our partners. “It is instinctual to want to belong with others and connect with others in a meaningful and intimate way,” explains psychologist Raquel Peel, the lead author of the research. “But, if as part of that process, we experience pain, the instinct to self-protect can take over. This means that avoiding pain becomes the main goal, as opposed to seeking intimacy.” Put simply, relationship sabotage happens when we choose our instinct to protect ourselves over our instinct to connect with others so we can avoid vulnerability and, therefore, trauma. It can also come from not wanting to repeat what has happened in a previous relationship or what we have seen happen in another relationship. According to Peel, relationship sabotage (a form of self-sabotage) is inherently rewarding to us. We assume our relationships won’t last and so we break them preemptively – strengthening our belief that our relationships don’t last. The negative feedback loop is reinforced and it gets harder to sustain a long-term relationship. Peel’s study conducted extensive interviews with a diverse sample of 696 individuals to understand why and how people self-sabotage in relationships. It identified three key ways the phenomenon typically plays out: Defensiveness is often enacted as a counter-attack when one is feeling victimized. Someone might feel attacked themselves through their partners’ constant criticism or feel vulnerable in their relationship and afraid of getting hurt. Therefore, to combat these feelings, they try to take control by putting on defenses in advance. Trust difficulty is a learned attitude and behavior. For instance, individuals expect their trust will be broken because it has happened in the past or that is what they understand to be true in relationships, and their expectations can often trigger behaviors that fulfill that prophecy. Lacking relationship skills refers to the fact that some individuals do not know how to be in a relationship or how to work toward healthy engagements. They probably did not have positive role models in their early lives. Practicing relationship skills, such as honest and open communication, and managing expectations can help get a relationship back on track. Peel’s study also offers five insights useful to counteract your own or your partner’s patterns of self-sabotage in relationships. If you are on a self- sabotaging streak in your own love life, Peel recommends working on the following: Trust. People with a fear of, or a tendency toward, infidelity struggle with trusting their partners. If you do not trust your partner to not hurt you, a relationship can turn into a power struggle. Commitment. People often fear commitment because it can mean different things to different people. Defining how deep your commitment is to your partner and asking your partner to meet a certain threshold of commitment can help you avoid the problems of over-commitment or tolerating unacceptable behavior. Communication. Relationships develop cracks when things, especially concerns, are left unsaid. A lack of communication could lead to pretending that everything is fine and defaulting to ‘auto-pilot’ mode when active piloting is needed. Safety. Feeling unsafe is usually a result of unresolved trauma. For the emotionally insecure, being vulnerable with someone else is one of the hardest things to achieve — but it is necessary. Acceptance. Stepping into a relationship is a risk you take. Yes, one has to be careful and thoughtful when making such a decision. But, accepting that the possibility of getting hurt (or not) is beyond your control can make your relationship more satisfying. “Although we do not have much control over what others will do and how they might behave when in a relationship with us, we can work on ourselves,” Peel concludes. “Learning about your fears and reasons for self-protection can teach you ways to navigate the experience of feeling vulnerable and be open to the possibility of connecting with others in a genuine way.” Narcissists have a prominent place in the popular imagination, and the label "narcissist" is widely deployed to refer to people who appear too full of themselves. There's also a growing sense that narcissism is on the rise around the world, especially among young people, although most psychological research does not support that notion. Narcissism is properly viewed on a spectrum. The trait is normally distributed in the population, with most people scoring near the middle, and a few at either extreme. The Narcissistic Personality Inventory (NPI), developed by Robert Raskin and Calvin S. Hall in 1979, is the most commonly used measure of the trait. Scores range from 0 to 40, with the average tending to fall in the low to mid-teens. Healthy individuals who score somewhat higher may be perceived as exceedingly charming, especially on the first encounter, but eventually come across as vain. Such individuals may have awkward or stressful personal encounters but still have a fundamentally healthy personality. The Traits of Narcissism It’s easy to describe someone who spends a bit too much time talking about her career or who never seems to doubt himself as a narcissist, but the trait is more complicated than that. Narcissism does not necessarily represent a surplus of self-esteem or of insecurity; more accurately, it encompasses a hunger for appreciation or admiration, a desire to be the center of attention, and an expectation of special treatment reflecting perceived higher status. Interestingly, research finds, many highly narcissistic people often readily admit to an awareness that they are more self-centered. A high level of narcissism, not surprisingly, can be damaging in romantic, familial, or professional relationships. How do I spot a narcissist? Narcissism is characterized by a grandiose sense of self-importance, a lack of empathy for others, a need for excessive admiration, and the belief that one is unique and deserving of special treatment. If you encounter someone who consistently exhibits these behaviors, you may be dealing with a highly narcissistic individual. What’s the difference between narcissism and pathological narcissism? Pathological narcissism, or narcissistic personality disorder, is rare: It affects an estimated 1 percent of the population, a prevalence that hasn't changed since clinicians started measuring it. The disorder is suspected when narcissistic traits impair a person’s daily functioning. That dysfunction typically causes friction in relationships due to the pathological narcissist's lack of empathy. It may also manifest as antagonism, fueled by grandiosity and attention-seeking. In seeing themselves as superior, the pathological narcissist naturally views everyone else as inferior and may be intolerant of disagreement or questioning. Do narcissists know that they are narcissists? If you wonder whether someone is a narcissist, it might be best just to ask them. It’s generally assumed that people either don’t realize that they are narcissists, or deny it to avoid a challenge to their identity. But in research using the so-called Single-Item Narcissism Scale, people who answered affirmatively to the single question, “Are you a narcissist?” were far more likely than others to score highly on narcissism on the 40-question Narcissistic Personality Inventory. Are there any benefits to being narcissistic? Research has discovered some benefits in relatively high but subclinical narcissism, such as increased mental toughness (performing well in high-pressure situations) and higher achievement in school and on the job. A heightened sense of self-worth may also make a person more motivated and assertive than others. Other research has linked narcissism to a lower incidence of depression. Is my boss a narcissist? A narcissistic boss places getting ahead over getting along, which means they’re often uncollaborative, arrogant, and argumentative, and myopically focused on becoming “the winner.” Narcissistic bosses take all the credit for successes and lash out at those who do not demonstrate loyalty. These tendencies and others indicate that you may be dealing with a narcissistic boss. How to Handle a Narcissist Navigating a relationship with a narcissist can be deeply frustrating and distressing. In their quest for control and admiration, narcissistic people may manipulate and exploit others, damaging their self- esteem and even aiming to alter their sense of reality. Arguing with a narcissist about their action often proves fruitless. A more successful solution is to establish boundaries and emotionally distance yourself. Recognize that you may not be able to control your feelings about a person, but you can control how you respond to them. Cutting ties with a narcissistic partner, family member, or boss may eventually be the best if not the only solution. In that process, it's helpful to reflect on the characteristics of the individual to avoid finding oneself in similar scenarios in the future. What are the strategies to handle a narcissist? Acknowledging your frustration, appreciating where the behavior comes from, and refusing to lose your own sense of purpose when a narcissist takes center stage are key strategies, among others. Researchers who classify narcissists as either vulnerable or grandiose argue that specific approaches are warranted for each type. How do I deal with a narcissistic boss? Manage your expectations, align your successes with your boss’s, draw boundaries, and don’t try to argue, justify, or explain yourself. These and other tactics can help you navigate a narcissist in the workplace. Are narcissists successful leaders? Narcissists tend to have an intense drive for power, attention, and affirmation, which may benefit them in campaigns for corporate management or political leadership. Once in charge, though, they may focus more on self- promotion and the suppression of opposition than advancing an organization’s goals and their lack of empathy fosters little loyalty. Narcissism in Relationships A narcissist's desire to elicit admiration and praise, especially from potential romantic partners, often makes them charming and charismatic, traits that can rapidly ignite a romance. But their inherent deficit of empathy may prevent them from understanding a partner's inner world and establishing a fulfilling long-term relationship. It's nearly impossible for people with narcissistic personality disorder to truly fall in love and build a trusting, equal partnership. Such an individual may seek to establish strict rules in a relationship and attempt to isolate a new partner from friends and family, among other disturbing behaviors. Why do narcissists make such a good first impression? Research suggests that people may initially be drawn to narcissists because they seem to possess stronger self-esteem than they really do, a trait that people often appreciate. Can narcissists fall in love? Narcissists may show passion and charm in the early stages of dating. But for most narcissists, relationships are transactional. They provide positive attention and sexual satisfaction to bolster a narcissist’s ego and self- esteem. The objective is to enjoy uncommitted pleasure, and most narcissists lose interest in the relationship as the expectation for intimacy increases or they feel that they’ve conquered the challenge of securing a relationship. Do narcissists have more hookups than other people? From an evolutionary perspective, it has been theorized that, at least in the realm of mating, narcissism may serve an adaptive function: increased success in short-term mating. Cross-cultural research has found that narcissists tend to have higher levels of sociosexuality: They are more interested in short-term relationships or hookups, and more likely to pursue partners who are already in committed relationships. What’s the difference between selfishness and narcissism in a relationship? Narcissistic personality disorder is relatively rare— there are many more people who are simply selfish. The difference lies in whether the person is periodically mean and self-centered or whether they consistently lack empathy. Trauma Very frightening or distressing events may result in psychological harm. This harm is called trauma, and can affect a person’s ability to cope or function normally. Everyone's reaction to potentially traumatic experiences is different. Most people recover well with the help of family and friends and do not experience long-term problems. Some people experience problems directly after the traumatic event or much later. Potentially traumatic events are powerful and upsetting incidents that intrude into daily life. They are usually experiences which are life threatening or pose a significant threat to a person’s physical or psychological wellbeing. Situations and events that can lead to psychological trauma include: acts of violence such as an armed robbery, war, or terrorism natural disasters such as bushfires, earthquakes, or floods interpersonal trauma such as rape, domestic violence, or child abuse traumatic loss of a loved one, including the suicide of a family member or friend experience of a life-threatening illness or injury involvement in a serious motor vehicle or workplace accident finding out that a close family member or close friend was involved in a traumatic event An event may have little impact on one person but cause severe distress in another. Other stressful situations which appear less severe may still trigger traumatic reactions in some people. It is important to focus on how a person experiences an event and the impact it has on them. symptoms Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks. For others, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources. Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional (how we feel). Physical symptoms can include excessive alertness (always on the look-out for signs of danger), being easily startled, fatigue/exhaustion, disturbed sleep and general aches and pains. Cognitive (thinking) symptoms can include intrusive thoughts and memories of the event, visual images of the event, nightmares, poor concentration and memory, disorientation and confusion. Behavioural symptoms can include avoidance of places or activities that are reminders of the event, social withdrawal and isolation and loss of interest in normal activities. Emotional symptoms can include fear, numbness and detachment, depression, guilt, anger and irritability, anxiety and panic. As long as they are not too severe or don't last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends, and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, posttraumatic stress disorder, anxiety disorders, or alcohol and drug problems. Most people who experience a traumatic event will not require treatment. For others, treatment from a mental health professional will be required to help them process the experience safely. Seek psychological assistance if the symptoms of the trauma are too distressing, or if they are impairing everyday activities such as work, study, family, and relationships. Signs that psychological treatment may be helpful include: being unable to handle the intense feelings or physical sensations feeling numb and empty experiencing strong distressing emotions that persist being physically tense, agitated or feeling on edge disturbed sleep or nightmares lacking support from someone with whom you can share your emotions having relationship problems with friends, family, and colleagues increasing your use of alcohol or drugs. Treatments include trauma-focused psychological interventions such as cognitive behavioural therapy (CBT), exposure therapy, and eye movement desensitisation and reprocessing (EMDR). These focus on education, stress management techniques, and helping the person to confront feared situations and distressing memories. In some cases, medication such as antidepressants can be useful, alongside trauma-focused psychological approaches. Post-traumatic stress disorder Most people are likely to experience traumatic events in their lifetime, and most individuals recover well, given time and adequate social support. For some individuals, however, the experience of a traumatic event or ongoing exposure to trauma can result in post-traumatic stress disorder (PTSD). PTSD refers to a set of symptoms that can emerge some time after exposure to a potentially traumatic event involving actual or threatened death, serious injury, or sexual violence. Exposure to such events can be through: direct experience of the traumatic event witnessing the event happening to someone else in person learning that the event has happened to a close family member or close friend or repeated or extreme exposure to the aftermath of trauma (e.g. first responders to emergency situations). With good psychological intervention, however, the chances of recovery are strong. Without treatment, individuals are at increased risk for developing chronic PTSD and other mental health conditions, such as depression, anxiety and/or problems with alcohol or drug use. symptoms A diagnosis of PTSD is made when symptoms are present for more than one month and cause significant distress, or interfere with important areas of functioning, such as work, study, or family life. These symptoms can include: A sense of reliving the traumatic event experiencing unwanted and distressing thoughts or images, flashbacks, or nightmares related to the traumatic event. feeling as though the event is recurring, even when it is not. Avoidance and numbing avoidance of people, places, thoughts, and activities associated with the traumatic event. feeling emotionally flat, losing interest in enjoyable activities, or feeling disconnected from friends and family. Negative thoughts and mood persistent negative thoughts about self, others, and the world. distorted views about the causes and consequences of the event. Feeling wound-up feeling irritable, angry, over-alert, or edgy. experiencing difficulties concentrating. experiencing difficulties getting to sleep or staying asleep. CAUSES Not everyone who experiences a traumatic event develops PTSD. Research looking at factors related to the causes of PTSD has identified several mechanisms that could contribute to the development of ongoing symptoms including changes to brain and body activity in response to a traumatic event. These models help guide choice of effective interventions. Risk factors Known risk factors include: the type and severity of the trauma – for example, sexual assault and abuse, military combat and terrorist acts are linked to a higher rate of PTSD than motor vehicle accidents and natural disasters lack of social support and subsequent life stress treatment There are several effective psychological treatments for PTSD. These treatments have been shown through research to help reduce the symptoms of PTSD and to help people recover. They include cognitive therapy for PTSD (CT-PTSD), prolonged exposure (PE), eye movement desensitisation and reprocessing (EMDR), cognitive processing therapy (CPT), and psycho-social interventions. Cognitive Therapy for PTSD (CT-PTSD) Trauma can be involuntarily re-experienced when an individual is left feeling a sense of serious, current stress and danger from persistent PTSD due to the way the trauma has been processed. CT-PTSD aims to reduce this by addressing unhelpful thoughts and beliefs resulting from the trauma. CT-PTSD aims to adjust excessively negative judgements and address unhelpful thoughts and problematic behaviours, as well as any subsequent unfavourable beliefs individuals may develop about themselves, others and the world. Prolonged Exposure (PE) In PE, the individual is supported to gradually confront the memories of their traumatic experience and situational reminders of that experience that are otherwise avoided. This involves assisting them to change the way they think and feel about the traumatic experience and develop more helpful ways of coping, through: education about common reactions to trauma, breathing retraining, behavioural exposure (to feared situations that individuals avoided due to trauma- related fear), and cognitive processing (discussion of thoughts and feelings related to the exposure exercises). Eye Movement Desensitisation and Reprocessing (EMDR) In EMDR, the individual is guided by the therapist to focus on particular images, thoughts, and bodily sensations related to the traumatic experience while being sensorily stimulated. Most commonly this is done by having the client move their eyes back and forth across their field of vision (e.g., by tracking the movement of the therapist’s finger). The theory and research behind EMDR is that doing this helps the person to process the trauma and integrate the memory with existing memory networks. Cognitive Processing Therapy (CPT) In CPT, the individual is assisted to identify unhelpful thoughts and beliefs (“stuck points”) and subsequently challenge and replace them with more helpful and realistic alternatives. This is done via an adaptation of standard cognitive therapy approaches. CPT has a smaller exposure component than PE (see above) that is typically restricted to writing an account of the traumatic experience. CPT also helps to address associated problems such as depression, guilt, and anger. Psycho-social interventions Support from family, friends, and others after the experience of a trauma has been found to be a highly significant predictor of recovery. As a result, treatment for PTSD is likely to involve building or strengthening the individual’s social support network. Lifestyle changes that address unhelpful habits which have emerged after the traumatic event - such as reducing or eliminating the use of alcohol or drugs or re-establishing normal activities - will also be helpful. Relaxation exercises can help reduce feelings of agitation and “edginess”, while maintaining a balanced diet and engaging in routine exercise supports overall emotional and physical wellbeing and can also aid recovery. 2 Reasons Overthinking May Be in Overdrive When emotional intelligence collides with a vulnerable identity. KEY POINTS Overthinking is common but can be difficult and exhausting. Emotionally intelligent people are self-aware. They reflect and engage in self- analysis regularly. Situations that ding an emotionally intelligent person's sense of self may kick overthinking into hyperdrive. Overthinking is often defined as thinking about something too much and for too long. Often overthinking can pivot around a massive self-analysis — for example, “Did I do the right thing? Am I a worthwhile person? Why can’t I turn off my negative thoughts? Am I selfish?” A person can ruminate on these thoughts for days. In addition, fixating on one worry can lure a person down a rabbit hole of spiraling worries that are somehow connected to the original anxiety. Either way, overthinking can create a wave of anxiety and depression that is difficult to shake. Often a person finds relief in the busyness of the day because overthinking seems to occur at night. Although this is a tough situation, it may help to consider the precipitant for overthinking. Two factors may be at play. Before articulating the two possible contributors to overthinking, it is important to acknowledge a common experience of the emotionally intelligent. It involves a critical aspect of emotional intelligence: self-awareness. This includes the capacity to look inward and introspect to assess personal accountability, gain insight, and understand that uncomfortable feelings help a person grow and evolve. It is a sophisticated gift, yet when a person’s identity is under duress, it can induce overthinking. For example, an individual may spin after receiving negative feedback about who she is. She wishes to trust the person who provides the criticism, but she may not be entirely convinced the assessment is correct. This deep confusion can elicit shame and live inside her brain for days. The predicament may trigger an intense self-inventory because the person wants to figure it out. The confusion about her identity creates a surge of overthinking. In combination with the emotionally intelligent tendency to self-reflect, two situations involving a person’s identity may create a susceptibility to overthink. One is developmental and the other is situational. The years between 12 and the early 20s are often referred to as the identity formation stage in human psychosocial development. In adolescence, a person is inundated with new independence. She begins to make decisions for herself that do not involve attachment figures — for instance, what to wear, what music to listen to, what activities to join, etc. This autonomy forces her to think about who she is in the world, which can be a daunting and overwhelming task. Often a helpful analogy to better understand this stage is to imagine a log cabin that represents the young adult’s identity. Because it is under construction, it may have a great foundation and two amazing walls; however, the young person still needs to construct two additional sides of the cabin and nail down a roof. So, if a strong wind blows on the young person’s cabin, she feels as if it may crash to the ground. She feels insecure and unstable. Conversely, a gust of wind blows against an adult’s cottage, which is fully formed, and the older person recognizes the structure is sound. Despite its difficulties, the identity formation plight is necessary and, if all goes well, results in a well- adjusted adult. However, when it is combined with the self-reflective component of emotional intelligence, the process may be distressing, intense, and trigger a temporary overdrive in overthinking. Second, a major life change forces a person to shed trusted aspects of their identity and, eventually, integrate new things. During this reconsolidation period, components of a person’s self-esteem are unguarded and exposed, resulting in him or her feeling raw, easily ashamed, and sensitive to feedback that is critical of whom he or she is. For example, substantial life changes may include divorce, the birth of a child, a move to a new city, etc. Aspects of a person’s sense of self are discarded and new elements are incorporated. For example, a man who is going through a divorce may logically recognize it is a healthy decision, but his “title” as husband is gone and his family unit, as he knew it, is different. Although he has new credentials — single dad — it still takes time for him to mourn the loss of the old in order to fully embrace the new. This process creates momentary vulnerability in his identity. So, during this time, he may feel both relieved but also confused. He may feel sad but also excited for the future. Nonetheless, the period of loss and growth may elicit a surge in overthinking until he reaches consolidation. When the emotionally intelligent characteristic of self- reflection collides with a vulnerable identity, it can create an intensification of overthinking. The developmental plight of identity formation and a massive life change may create temporary dings in a person’s sense of self, which may magnify overthinking. When this occurs, a person should remember that she is not “crazy.” Talking through this process with an empathic listener, engaging in mindful activities, journaling, spending time in nature, and seeking assistance from a counselor may help. There are three things to know about overthinking. First, overthinking isn’t always negative. Authentic self-analysis is often an emotionally intelligent tendency, preferable to self-serving and impulsive decision making. Second, overthinking may become dysfunctional when it morphs into fixation and prevents a person from focusing on his or her responsibilities. Understanding why thinking spirals out of control and knowing how to reign it in may be useful. Third, a certain type of partner may unwittingly exploit a person’s natural tendency to look at himself or herself. This may elicit self-doubt in a person, which may lead to intense indecision. Identifying this dynamic and responding accordingly may help. A person who is emotionally intelligent often consistently notices how his or her actions and words impact others, an ability which is frequently referred to as social awareness. Thinking about an issue from different perspectives and reflecting on how a decision may affect others, especially loved ones, allows a person to be empathic. Looking inward and taking stock of hurtful patterns of relating helps a person gain self-awareness and insight. Instead of making a selfish decision, an emotionally intelligent person typically attempts to be considerate of others while balancing his or her own needs. Yet, when an issue causes a person to spin in a state of panic and eclipses his or her ability to focus on responsibilities, it may be due to intensely conflicting emotions. Often it is helpful to locate an empathic person and ask him or her to be a sounding board. A good listener is usually able to reflect and honor a person’s competing emotions which may help him or her sort things out. Unpacking, identifying, and understanding each of the contrasting feeling states may assist a person in gaining clarity. For example, Suzie is upset because her aunt expects a visit on Suzie’s only free weekend. She dreads the long drive and is allergic to her aunt’s cat. She recognizes she will be miserable. Suzie’s aunt calls continually and relays excitement, stating, “Your visit is the only thing I have to look forward to. I am counting down the days!” Following her aunt’s messages, Suzie spins. She does not want to go but would feel guilty about canceling. When the urge to reschedule bubbles up, she shames herself and asks, “Am I that selfish? Am I a bad person? I am the only family she has.” Yet, thinking about spending the weekend in the car and sick from allergies depresses Suzie. After losing sleep due to the issue, Suzie calls her friend, Jen. Jen listens to Suzie’s conundrum and reflects Suzie’s strong and conflicting emotions: “You are exhausted and need to take care of yourself, but you also feel tremendous guilt about disappointing your aunt. I get it. I would too. It’s confusing. Taking care of yourself is important, though. You matter.” After processing the rivaling emotions with Jen, Suzie feels better. She gains clarity and is able to honor how she feels. Quickly, she is able to identify a compromise. She decides to ask her aunt to meet her halfway at a well-known Thai restaurant (her aunt’s favorite cuisine). That way, she isn’t spending her weekend in the car or subjecting herself to the cat. Regardless of her aunt’s potential response, Suzie feels better. Instead of doing what is best for her aunt, she is proposing a plan that is good for both of them. Overthinking may also be exasperated by a certain type of partner. This sort of partner often externalizes blame instead of owning his or her actions and words. Often, he or she points the finger at a person who tends to be introspective because it works. The person who looks at himself or herself sometimes believes a partner who projects blame because he or she trusts the partner. For example, say Suzie approaches her partner about the predicament with her aunt. Her partner is annoyed with Suzie’s perseveration and attacks her: “You overthink everything. Just don’t go. Or if you want to be selfish, go ahead and cancel.” Now, Suzie is extremely confused. On the one hand, she feels like an idiot for being indecisive because it annoys her partner. On the other hand, he is indirectly insinuating she is selfish if she cancels. Her anxiety and confusion escalate. Finally, she decides to follow through with the visit because she is fearful that her partner believes she is selfish. Ironically, the week prior, her partner failed to visit his father in the hospital because he was playing tennis with his friends. In place of taking responsibility for his egocentric behavior, he projects it onto Suzie. Although it may be painful to self-reflect and introspect, thinking deeply about issues may allow a person to act with empathy in relationships. However, pervasive rumination may indicate a person is grappling with deep conflict, often about himself or herself. Processing the differing feelings with an understanding person may allow intense emotions to breathe. This may provide relief and clarity. Additionally, it may be useful for a person to gain awareness of a narcissistic partner’s tendency to unfairly attribute his or her own selfish tendencies onto him or her. If overthinking eventually leads to an authentically constructive outcome, the discomfort may be worthwhile. Can Someone With BPD or NPD Change? The most common cause of both BPD and NPD is basically the same—severe neglect, abuse, or abandonment in childhood. But as we have discussed, not everyone with these experiences develops a personality disorder. The difference is that those who develop BPD or NPD experienced such extreme shame that they needed to build up a wall in order to protect themselves from being further shamed. When most survivors of abuse and neglect reach adulthood and are around other people outside the home, they notice that their behavior is not acceptable to others. Or they experience a great deal of pain whenever they are in an intimate relationship. Once this occurs, many seek out counseling, self-help books, or seminars in order to change what they now realize is harmful behavior. But unfortunately, those who have developed a personality disorder due to the defensive wall they have built up are usually blind to the fact that their behavior is unacceptable or even damaging to others, even when it is brought to their attention. Instead, they are convinced that there is nothing wrong with them. Even when they are forced to acknowledge that their behavior is unacceptable, they refuse to actually believe it. They developed such powerful defenses that they are convinced that they are always right and that other people just don’t understand them. Even though they may not consciously become abusive in their relationships, those with BPD or NPD frequently behave in abusive ways in their relationships. And unfortunately, they cannot readily change and are usually not motivated to do so. Even those who are willing to make changes typically need years of specialized psychotherapy in order to do so. Basically, three things are generally required in order for someone with BPD or NPD to change: 1. The person needs to become aware that they have a serious problem and that this problem is negatively affecting those around them (their partner, their children, their employees, or co-workers). 2. The person needs to be highly motivated to change, either because their partner is threatening to leave them, their children are becoming alienated from them, or there is the threat of losing their job. 3. They are willing to engage in appropriate therapy and willing to work hard to change. Sadly, even when such a person does go into therapy, they seldom continue for long. And any so- called “changes” they make are usually short-lived. One of the main reasons for this is that they cannot or will not be self-reflective and therefore risk exposing their true self—even to themselves. It is always someone else’s fault. It is always the other person who needs fixing. Even with good therapy, in which they are encouraged to become aware of how the walls they have built up keep them from true intimacy and how much better their life could be without those walls, most are not willing to do the work required to let down those walls. It is just too difficult for them to become vulnerable and to let down their defensive walls—even with a compassionate therapist. Can Someone With BPD Change? Until fairly recently, the diagnosis of BPD became associated with treatment resistance and poor prognosis. One important source of resistance in treating patients with BPD is their notion that change may entail betraying their family, as well as giving up habits they may feel work well for them in avoiding feelings. Another issue is that patients with BPD often feel entitled to special treatment and often seek only approving forms of attention from those who treat them. Such appeals for special treatment may prompt clinicians to worry that gratifying them can reinforce unrealistic interpersonal expectations, but that withholding may elicit reactive worsening of symptoms or dropping out of therapy. Currently, thanks to the public being educated about this personality disorder, more and more people who suffer from BPD are getting the kind of help they need and are not as resistant to. Research has shown that therapies need to be specifically tailored to this population in order to achieve successful treatment. The most effective short-term treatment for BPD is called cognitive behavioral therapy or dialectical behavior therapy (DBT). DBT was developed only after it was realized that patients with BPD resisted a traditional behavioral approach. DBT incorporates techniques of validation and the concept of acceptance to a cognitive-behavioral framework. Can a Narcissist Change? Unfortunately, once a narcissistic individual loses respect for you, it may be nearly impossible to regain it. If he or she shows no signs of respect for you whatsoever—he sighs and rolls his eyes when you talk, she laughs at you when you try to stand up to her, he challenges you to try to live without him—then there is little chance of ever regaining his respect, and the relationship will continue to be an abusive one. Your best bet is to work on gaining enough strength to end the relationship. If you choose to stay, all you can do is cut off his aggressiveness and abusiveness by confronting it at the moment and work on building a strong enough sense of self that your partner cannot erode your identity. On the other hand, there are some people with NPD or narcissistic tendencies who are willing to recognize how their behavior is damaging to their loved ones. But even those who are highly motivated to change will constantly be tempted to blame others for all the problems in the relationship or talk themselves out of taking a deep, serious look at themselves. The most effective treatment for those suffering from NPD is psychodynamic psychotherapy. Due to the fact that their primary problems involve their relationships with others—namely: their lack of empathy, their sense of entitlement, their inability to trust others, and their rage—one-on-one therapy can teach them how to have an open, honest relationship that is not manipulative or exploitative. Be Realistic About Your Partner Changing While I strongly believe that any abuser who seeks professional help has a chance of stopping his or her behavior, unfortunately many refuse to get help, and even those who do often end therapy prematurely. One-on-one individual therapy offers an abuser the opportunity to show their true self to someone else in a safe environment. But this can be very threatening to someone who is abusive because in order to change, they must let down their defensive wall and allow the therapist to really see them. This act of vulnerability can be almost impossible for some. There are definitely emotionally abusive partners who are not going to change, certainly not without professional help. Some are so shut down emotionally and so defended that they refuse to admit they have been abusive. Others are too afraid to look at their own history of being abused or neglected. Others lack the empathy to comprehend the pain they have caused. They can only focus on how their partner has hurt them. KEY POINTS Fantasies can misguide you in relationships. It is important to be aware of how past relationships may impact present ones. Good relationship choices lead to greater happiness. A real relationship is often different from how you imagined, but that can make it more satisfying. Frequently, patients want to form new relationships unburdened by patterns, memories, and fears imported from earlier (usually failed) connections. They want to be fully present in a relationship and resist versions of themselves warped by characters from (what they hope is) a discarded past. But Debbie could only wish to be emotionally independent. “There’ve been a lot of men in my life,” she said. “And none are really gone.” What she meant was that every time she met someone new, she’d react as if they were some warmed-over version of a former guy. She never felt “free,” to use her word, to learn about them on their own terms. She’d make assumptions as if they were someone she had known; she’d act on those assumptions; the guy would become bewildered, annoyed, and decide that the whole thing just wasn’t worth it. By the time she came to see me, she knew what was going on—that she was in thrall to her old relationships—but she couldn’t help herself. Debbie was attractive, around 35, and divorced. She’d come to the city three years earlier, assuming that she’d make a new start. As a commercial artist with an established client base, it shouldn’t have been hard, at least on its face. But like most people who assume that a change in geography somehow changes them, her relationships remained rocky. As we spoke, she acknowledged that she felt out of control, destined to make choices that would continue to destabilize her. An affair that had sent her into retreat occurred just when Debbie thought that New York might change the course of her career. She had always been successful as a commercial artist, but, since making the rounds, she’d fantasized that—someday, of course—her work might be shown at MoMA. A few people suggested that she try serious art. It was a heady time. “No one ever before said I was that good.” In her spare time, she took painting classes. She approached galleries. Unfortunately, a gallery owner approached her, although not as she might have wished. Everard was a former Londoner who had come to New York ten years earlier, intending to work for a big auction house. But then he started an art advisory business on the side. Ultimately, he opened a gallery. When he met Debbie, he clearly had an eye for talent. Nor was he shy about letting her know. Their affair was fueled, in part, by his encouraging her ambitions as a budding, serious artist. He introduced her around. He sold a couple of her pictures. Mostly, though, he allowed her to imagine an alternative, glamorous existence of openings, international buyers, and commissions from MoMA trustees. “I got hooked, I guess, on my fantasies.” When the affair inevitably ended (Everard found someone else to “encourage”), Debbie couldn’t shake how she’d felt around him. “I still have a hard time living in the real world,” she told me. “I want every guy to make me feel like Everard did—really going somewhere with my art.” What interested me, however, was why. even when she understood the motivations that inevitably led her to a fall, she still allowed them to take hold of her. Why would she give in to stirrings that she knew, from past relationships, did her no good? Perhaps, I think, because she always had. It had become a pattern. She couldn’t tell whether a relationship was based on real, growing affection or just on some high that she got, before it all crashed and burned. The pattern emerged quickly, as soon as she started college. Before she graduated, she'd met a local painter whom, she thought, was the handsomest man she had ever painted. “I married him because he inspired me. Even though we competed.” The problem was that she met someone new. He was a professor of statistics at a local university, and they’d been introduced by a mutual friend. When Debbie started dating him, he seemed nice enough, but (at least from her perspective) there was no spark. “He doesn’t know much about art,” she told me. “He says that if I want to go in the direction of serious painting, then I should try, but he has no basis for encouraging me.” In other words, here was a guy who didn’t fit Debbie’s pattern. In fact, he was the opposite: he didn’t flatter her or push her towards serious art, and he wasn’t likely to hurt her or leave her. The challenge with Debbie was to help her distinguish between short-term excitement—the pattern that we’d discovered—and what might lead to happiness in the long run. Okay, Larry had not been exposed to art. But, as it turned out, he was really nice to Debbie. He wasn’t selfish, and wasn’t preying on her ego. I suggested that Debbie give him a chance. “You could teach him about art. Bring him to some galleries.” The point was not to allow old patterns, deeply rooted in her past and in her fragile ambitions, to derail a promising relationship. “Even if Larry is not, finally, The One,” I said, “at least you’ll have the experience of being with someone who doesn’t recycle your self-defeating tendencies.” I hoped she’d notice the difference, and get to like it. When we seek romantic happiness, we are frequently our own worst enemies. We prefer to live out temporary fantasies rather than pursuing real- life, long-term goals. We tell ourselves, “Don’t settle,” but what we’re really saying is that we don’t want to compromise with our fantasies. At some point, however, we have to learn how to navigate our fantasies, and the best way is to actually see how it feels. If we learn anything from Debbie, therefore, it’s that trying to get past the pull of our fantasies —especially when they are tied up with our greatest ambitions—is far from easy. We can even be aware that we’re falling into our old ways and do it anyway. But if we ever want to be happy for the longer term, without all the usual awful blowback, then we have to try. How Many Problems Does It Take to Kill a Relationship? The rule may be: No more than four. Early in a relationship, everyone is on their best behavior. Both partners emphasize their best traits, while carefully concealing their flaws. It can’t last forever. Eventually, imperfections emerge. Problems arise. Doubt creeps in. Should we stay, or go? That’s what makes dating so difficult. Though we form impressions of a partner’s physical features immediately, their personality, qualities, quirks, and characteristics get revealed much more gradually. As we learn more, we have decisions to make. No one is perfect, so flaws are inevitable. But, how much is too much? Studying Decision Points in a Relationship To study this, researchers used what they called a “Choose Your Own Adventure” design. Across two studies, 1,585 participants immersed themselves in a story where they were in a relationship that became increasingly serious. As the relationship progressed, participants encountered 17 decision points. At each, participants learned some new information about their partner. Next, they chose their relationship adventure by deciding whether to stay or go. These weren’t just any decision points though. Rather, each potentially included a “dealbreaker,” which are qualities people are unwilling to tolerate in their relationship partners. Dealbreakers include qualities like being dirty, clingy, lazy, needy, and having a bad sense of humor. In other words, qualities no one wants in a partner. For example, the first decision point focused on attractiveness with the dealbreaker description explaining the person you're dating is, “… around your height, less attractive than you were expecting, and a touch disheveled, but seems friendly.” Not attractive AND disheveled. Definite dealbreakers. The non-dealbreaker described the potential partner as, “… attractive, dressed nicely, and seems friendly.” A much better partner. What They Found Remember, that dealbreakers theoretically represent strict criteria that a potential partner must avoid. Exhibiting a dealbreaker should automatically make that person undatable. But participants didn’t treat alleged dealbreakers as absolute triggers for ending the relationship. An unattractive disheveled appearance should, in theory, make a person want to discontinue the relationship. But it didn’t. Participants generally gave the relationship a chance, and chose to learn more about the potential partner. Instead of treating problems as make or break, participants were more flexible and tended to bend their alleged dealbreakers. Though the first dealbreaker didn’t automatically kill the relationship, the negative information had a cumulative effect. As participants received more negative information, they grew increasingly likely to discontinue the relationship. Generally, the tipping point was between three and four pieces of bad information. Rather than it taking a single dealbreaker to end a relationship, it seems the real rule daters generally follow is “no more than four.” Participants who came into the study with a longer list of dealbreakers were quicker to end the relationship. Participants also ended the relationship when they learned about a particular dealbreaker that was important to them (e.g., they cared a lot about political affiliation and learned the partner held opposing views). We may have a plan for how we want to approach new relationships, but we have a difficult time sticking to it. Despite learning about dealbreaker information that should rule out a potential relationship partner, people continued the relationship. In other words, we don’t run at the first sign of trouble. That may be a good thing because it gives us a chance to learn more and revise our impression. Then again, we may be opening ourselves up to forming a stronger emotional connection that makes it more difficult to discontinue an undesirable relationship. We become more likely to settle. The good news was that most people eventually reached a breaking point where the number of dealbreakers accumulated to a point where they were too much to handle. The important thing is that we recognize red flags and make informed decisions about our relationship’s future. The One Crucial Ingredient of Any Happy Relationship When it's present, partners feel safe. John Gottman is a researcher who looks more like a kindly grandfather than a rock star, but scholars swoon and doctoral students ask him to sign their dissertations when he wanders by. For over 50 years he has observed and coded couple interactions. Much of this has been done in his “love lab,” which is an apartment at the University of Washington where couples live while being observed, measured, and monitored He has described the most minute interactions of couples, learning what helps them succeed or fail. After decades of poring through data and squinting at statistics, what has he found? That most of the crucial accomplishments in a successful relationship “have to do with establishing trust.” Trust is at the heart of a healthy partnership, and nurturing it and repairing it when it gets damaged is a must. Stephen Covey agrees: “Trust is the glue of life. It's the most essential ingredient in effective communication. It's the foundational principle that holds all relationships.” Many studies back this up. Trust is one of the most sought-after traits in a partner, and most relationships will not progress without it.

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