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1. Joni Williams Splett, Associate Professor of School Psychology, University of Florida

Of all the challenges that threaten the well-being of America’s schoolchildren, one of the most serious and severe is the lack of school counselors and school psychologists. Despite the increased demand for their services, there’s simply not enough professionals in these fields to go around.

For instance, the American School Counselor Association recommends that there be one school counselor for every 250 students. However, in the 2021-22 school year – the most recent year for which data are available – the ratio of school counselors to students was one for every 408 students.

Similarly, the National Association of School Psychologists recommends one school psychologist for every 500 students. But the ratio of school psychologists to students stands at just one for every 1,127 students.

The Biden administration is well aware of the shortage and has taken action to close the gap.

For instance, in 2021, U.S. Surgeon General Vivek H. Murthy issued an advisory that calls for, among other things, expanding the mental health workforce in schools by using federal, state and local funds.

President Joe Biden released a Mental Health Strategy in 2022 that seeks to provide mental health care to more children. And in May 2023, the Biden administration announced US$286 million for 264 grantees to train and hire school mental health professionals – a move that grantees say will enable them to prepare more than 14,000 new mental health professionals for America’s schools. That’s a significant number, but schools would need to hire more than five times that amount to meet recommended ratios.

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As a professor of school psychology – and as a recipient of one of those grants – I also know that as important as it is to train more school counselors and school psychologists, increasing their numbers alone is not enough to change the course of the rising mental health needs among America’s children and youth. That is, doubling staffing of mental health professionals in schools doesn’t guarantee they will be used effectively or appropriately. Without accompanying changes to school systems and priorities, I fear the mental health needs among our youth will continue to accelerate, as it did during the pandemic.

To address this challenge, I see three areas where schools need to revamp the way they meet students’ mental health needs.

1. Free up school counselors and school psychologists

Research, including my own, shows that school-based mental health professionals are overwhelmed with job duties that are outside the scope of supporting students’ mental health. For instance, school counselors also serve as the testing coordinators in most schools.

School psychologists report being overloaded with evaluations to determine if students are eligible for special education services. About one-third of those responding to a recent membership survey of the National Association of School Psychologists indicated they don’t provide mental health interventions and services at all.

These school counselors and school psychologists report that about 25% to 50% of their day is consumed with paperwork and other miscellaneous duties. Constantly working outside their areas of expertise and desired practice is leading to burnout that leads many to leave the field.

To alleviate the situation, schools could search for ways to shift tasks that don’t require specialized knowledge, such as test coordination and certain types of paper work, to staff with less extensive and expensive training.

This would allow current school mental health practitioners – and the additional 14,000 the Biden administration hopes to bring into the field – to engage in the wider range of services their students need. This could be a way to better align their practice with the recommendations of their professional associations and potentially lead to more job satisfaction and less burnout.

2. Make time for mental health in schools

In my work with school districts across the Southeast, mental health professionals are being hired but then restricted to working with kids only during the student’s lunchtime or certain classes, such as art, music or physical education. Although I don’t advocate for children missing class, I also don’t think it’s a good idea for children to work on self-regulation strategies or investigate negative belief patterns while eating a hot dog or missing their favorite extracurricular. It also limits the number of students any one professional can support during a school day.

Some schools around the world have extended the school day. Some in the U.S. have moved to a year-round schedule with positive effects, such as improved achievement scores for students from low-income and minority backgrounds. Perhaps by rethinking the school day and the school year, more school time could be made for mental health professionals to take a holistic approach to all the areas a child may need instruction and support.

3. Prioritize prevention

Prioritizing prevention includes promoting a positive school climate and teaching healthy habits for maintaining one’s mental well-being to all youth. A positive school climate – including social, emotional and physical safety, respectful behavior, an emphasis on learning, and social connectedness with peers and teachers – is shown to reduce risky behaviors and aggression. It also increases positive mental health outcomes and academic success.

Teaching life skills, like being aware of one’s own and other people’s emotions, what’s causing the emotions, how to manage them in healthy ways and where to seek help, has also been shown to prevent the development and escalation of mental illness among children and youth.

There are evidence-based curricula that schools can use to teach and reinforce these skills. For example, Positive Action is designed to teach pre-K-to-12th grade students how their thoughts, feelings and behaviors are related. It is taught in classrooms by teachers for about 15 minutes, three to four days each week, for an entire school year.

There is evidence of large to moderate effects of Positive Action in elementary schools on student mental health, behavior and academic achievement. If these prevention strategies were prioritized in policy and funding, I believe America’s schools and school mental health professionals would be better positioned to more systematically address the unrelenting rise of children’s mental health needs.

Joni Williams Splett, Associate Professor of School Psychology, University of Florida

Should you happen to have visited a major city in the past 10 or 20 years, you might have noticed a health trend: yoga. The thousands-year-old Indian spiritual practice made its way into gyms, universities and even religious centres worldwide. New yoga centres seem to pop up weekly, advertising new yoga styles and making new health claims. Interestingly enough, yoga is not just perceived as a recreational activity but mainly as a way to increase and maintain health: national surveys show that about 31 million U.S. adults (more than 13% of the population) have used yoga for health reasons.

Yoga has been shown in clinical trials to improve pain by stretching muscles and aligning posture, to lower blood pressure by rebalancing the autonomous nervous system and to reduce inflammation by regulating chronic stress. In recent times, yoga is more and more perceived not only as a way to reduce stress and increase physical fitness but also to overcome mental suffering. This should not really come as a surprise: already about 2000 years ago the Indian sage Patanjali, the “grandfather” of modern yoga, defined yoga as the “control of the fluctuations of the mind”. And “fluctuations of the mind”, rumination or uncontrollable thoughts are cardinal symptoms of several mental disorders.

This potential of yoga to control unwanted mind wandering has hit the big time when Hillary Clinton reported how “alternate nostril breathing”, a classical yogic breathing technique, helped her to heal from her election loss – and from giving up her lifelong dream of becoming president of the USA. However, beyond gossip and anecdotal evidence, there are hard scientific facts and clear mechanisms by which yoga might help with mental symptoms:

Trauma-related symptoms

Post-traumatic stress disorder (PTSD) is a major public health problem affecting up to 6% of the world population. PTSD results from substantial traumatic experiences and is thus far more common among veterans, survivors of wars or natural disasters, and victims of violence. The syndrome is characterized by re-experiencing, avoidance and arousal. PTSD is associated with a brain structure called the amygdala which connects the memory of certain experiences with emotions – in the case of PTSD the amygdala is overactivated and thereby constantly produces the aforementioned symptoms.

By reducing stress, yoga can increase parasympathic activity, this is the relaxation response, and could thereby directly reduce amygdala activity. This seems to be mainly driven by yogic breathing such as alternate nostril breathing. From a psychological viewpoint, PTSD is characterized by the paradox that patients feel anxious about the future although the traumatic event lies in the past. This is mainly driven by an overgeneralization of past experiences and negative appraisal of own actions, negative reactions by other people and life prospects.

Yoga involves aspects of mindfulness, this is a non-judgmental open attention to and acknowledgment of even unpleasant emotions or memories. This can increase emotion regulation rather than avoidance. The mindful awareness of the transitory nature of one’s momentary physical, sensory, and emotional experience during yoga practice is thought to lead to a change in self-appraisal, thereby reducing PTSD symptoms.

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In line with these thoughts and theories, clinical trials have shown that yoga actually can reduce symptoms of PTSD: studies from North and South America and Australia have recruited veterans and other people with traumatic experiences and randomly allocated them to yoga interventions lasting weeks to months or to control groups which were not treated at all or received rather unspecific health counseling. In a meta-analysis of these studies, my colleagues and I demonstrate that those participants who practiced yoga experienced a much stronger and clinically relevant reduction in their symptoms – even if the yoga style was not specifically designed for participants with PTSD.

Fear and anxiety

Other studies have targeted anxiety disorders. Anxiety is a normal response to specific situations or events. Without anxiety, mankind would surely not have survived. However, excessive fear or anxiety may be indicative of an anxiety disorder. In generalized anxiety disorder (GAD) for example, elevated levels of anxiety, which are associated with concerns about health, relationships, work, and financial issues, lead to a wide variety of physical symptoms and behavioral changes. In the U.S., more than 4% of the population have been estimated to suffer from GAD alone.

Excessive anxiety also has implications for long-term health, with somatic symptoms of anxiety, such as palpitations and irregular heartbeat, being associated with an increased risk of cardiovascular disease. Interestingly, treating anxiety is one of the main reasons people give for practicing yoga. Again, mindfulness seems to play a key role here: patients with GAD have been shown to be less “mindful” than the general population, indicating that mindful body work, breathing and meditation can help here – perhaps by “controlling the fluctuations of the mind”? Interestingly, anxiety disorders are more prevalent among patients with breathing disorders such as asthma or chronic obstructive pulmonary disease and breathing retraining has been an essential part of many cognitive behavior therapy approaches for anxiety disorders.

Not surprisingly, yogic breathing is often seen as the main part of yoga when it comes to treating mental disorders, not the well-known yoga postures. The effects of yoga have been researched for a number of anxiety disorders, including GAD or phobia. We have analyzed these studies in a further meta-analysis. While the results are positive, most studies are quite old and do not fulfil the requirements of modern science, so replications are urgently needed. What yoga clearly does is relieving symptoms of anxiety in healthy individuals – be it diffuse everyday fear, examination anxiety or performance anxiety in musicians.

It remains unclear whether alternate nostril breathing alone can really ameliorate mental suffering. What is clear is that yoga can help with trauma-related symptoms and anxiety, and that breathing exercises are a main mechanism by which it does so. Needless to say that patients with mental disorders should not try yoga on their own but only after consulting their psychiatrist and psychotherapist. For minor everyday anxiety, simple yogic breathing techniques might be worth a try as a self-care strategy.

Holger Cramer, PhD, is professor (full) for research in complementary medicine at the University Hospital Tübingen, Germany, and scientific director of the Robert Bosch Center for Integrative Medicine and Health at Bosch Health Campus, Stuttgart.

Taking care of your mind is just as important as taking care of your body. Unfortunately, you may sometimes forget about your mental health.

After all, it’s evident if you visit the gym instead of watching TV or eat salmon for dinner rather than fried chicken. How you treat your mind is usually less visible and more difficult to track.

To stay on top of things, it helps to develop easy habits that fit into your usual routines. That way, smart choices become more automatic. Use these tips to help you get started.

Taking Care of Yourself

Slow down

Multitasking increases your stress levels and can actually damage your brain. When you find yourself rushing around, take a deep breath. Figure out your priorities and eliminate unnecessary commitments.

Shift your attention

Do you dwell on disappointment
ts and overlook the positive events that happen each day? Start a gratitude journal to remind you of the things that you’re thankful for.

Listen to music

Your favorite songs can lift your spirits and give you more energy. Put together playlists for working out and doing household chores.

Spend time outdoors

Bask in the sunshine. If you’re working at home, bring your laptop out on the patio. Go camping or take a picnic to the beach on weekends.

Monitor media consumption

Disturbing news can weigh you down, and comparing yourself to others.

Reading that book can make you feel like you’re missing out. Search for inspirational content and set limits on screen time.

Continue learning

Stimulate your brain. Read books and take online courses. Talk with others about their careers and hobbies. Ask lots of questions.

Stay active

Physical exercise benefits your mind and body. Any routine you enjoy will help.

Rest and relax

Sleep deprivation and chronic stress can interfere with your mood and cognitive abilities.

Aim for 8 hours of sleep each night and take refreshing breaks throughout the day. Take time to reflect in solitude or enjoy soothing hobbies.

Value yourself

Love and accept yourself for who you are. Treat yourself with kindness and compassion.

Build your confidence by setting goals and working towards them.

For a quick assessment of your mental well-being, check out the TheraConnect Mental Health Quiz.

Connecting with Others:

Show appreciation

Strengthen your relationships by letting others know that they’re important to you.

Pay attention to what your friends and loved ones have to say.

Remember their birthdays and send gifts and cards for no special occasion.

Gather together

Online communications work well as a supplement rather than a substitute for face-to-face interactions.

Socialize offline with family dinners and standing dates with friends.

Practice forgiveness

Let go of grudges and resentments. Encourage reconciliation and healing.

Share a laugh

Humor relieves anxiety and depression and can even serve as a natural painkiller. Tell funny stories about your personal life and pass along your favorite video clips starring pets and babies.

Set boundaries

Make a conscious decision about how you want others to treat you and what kind of behavior you find acceptable.

This might include your expectations about privacy, communication, physical boundaries, and so on.

Then clearly let others know your wishes.

Give generously

You’ll feel a warm glow when you help someone in need.

Some research suggests that the mental health benefits are most substantial when you know the recipient. Donate to charities and remember your loved ones, too.

Develop your own mental health routines based on your personal needs and preferences. Nurturing your mind will help you enjoy a happier, more meaningful life.

Stress is an unavoidable aspect of existence, a natural reaction of our bodies and minds when encountering challenges or threats. It represents how we respond to stressors, ranging from daily tasks such as a demanding job and family pressures to significant life events like the loss of a loved one or receiving a new diagnosis.

Experiencing stress triggers the “fight or flight” response, a sophisticated physiological process led by the hypothalamic-pituitary-adrenal (HPA) axis. This response releases stress hormones like cortisol, adrenaline, and noradrenaline, preparing your body to act swiftly by elevating your heart rate, accelerating your breathing, and tensing your muscles.

In the short term, this stress response can be advantageous, aiding you in handling immediate threats and challenges.

However, when stress becomes chronic, it can severely affect your mental and physical health. Chronic stress may cause issues such as anxiety, depression, headaches, sleep disturbances, and cardiovascular diseases, including high blood pressure and heart disease. It can also weaken your immune system, affect digestive health, and compromise your overall well-being, highlighting the importance of effective stress management.

Feeling overwhelmed by stress is more common than many believe. The American Psychological Association notes that a significant portion of individuals report experiencing at least one symptom of stress monthly. In our fast-moving world, filled with continuous and overwhelming stressors, it’s vital to develop techniques for managing stress.

This article aims to help you identify the sources and symptoms of stress, offer practical strategies for stress management, and suggest ways to build a resilient mindset, empowering you to take control of your life and health.

Identifying Sources and Symptoms of Stress

Common Causes of Stress

Stress can arise from a wide array of sources, and understanding these can be essential in managing and mitigating its effects. One of the most prevalent causes of stress is related to employment. This includes being unhappy in your job, having a heavy workload or too much responsibility, working long hours, and dealing with poor management or unclear expectations.

Financial stress is another significant factor, with concerns about money, retirement savings, college tuition, and housing costs being common stressors for many people. According to the American Psychological Association, 72% of adults reported being stressed about money.

Personal and family-related issues also play a substantial role. These can include relationship problems, whether romantic or platonic, bereavement, illness or injury, and even significant life changes such as moving home, getting married, or becoming a parent. Events like divorce, job loss, and health scares can also be major stressors.

Social and environmental factors should not be overlooked. Living through stressful community-wide, national, or global events, experiencing discrimination or abuse, and dealing with everyday tasks like household chores or commuting in heavy traffic can all contribute to stress levels.

Physical and Emotional Symptoms

The symptoms of stress can manifest in both physical and emotional ways. Physically, chronic stress can lead to headaches, trouble sleeping or oversleeping, muscle pain or tension, digestive issues, and changes in sex drive. It can also result in high blood pressure, which is a significant risk factor for cardiovascular diseases like coronary heart disease.

Emotionally, stress can cause a range of symptoms including moodiness, anxiety, restlessness, lack of motivation, irritability, and feelings of sadness or depression. People under chronic stress may experience panic attacks, constant worrying, and a general feeling of being under constant pressure. These emotional symptoms can often lead to behaviors such as overeating, smoking, or substance abuse as coping mechanisms.

Additionally, stress can affect your daily functioning, leading to withdrawal from family and friends, and impacting your ability to perform tasks effectively. Recognizing these symptoms is important because if left unchecked, they can escalate into more severe mental health issues such as post-traumatic stress disorder (PTSD) or other anxiety disorders.

Practical Strategies for Stress Management

Time Management Techniques

Effective time management is an important strategy for reducing stress. When you feel overwhelmed by multiple tasks and deadlines, it can exacerbate your stress levels. To manage your time better, start by prioritizing your tasks.

Create to-do lists and set clear goals for what needs to be accomplished. Focus on the most important tasks first and break them down into manageable chunks.

This approach helps you regain control over your schedule and reduces the feeling of being overwhelmed. Another key aspect of time management is learning to say “no” to requests that would create excessive stress in your life. Set limits appropriately and delegate tasks when possible.

Using time management tools and apps can also help you organize your calendar, to-do lists, and tasks more efficiently. Additionally, adopting a “work smarter, not harder” approach can be beneficial. This involves prioritizing your work, concentrating on the tasks that will make a real difference, and leaving less important tasks to last.

Accept that you cannot do everything, and it’s okay to focus on what is truly essential.

Mindfulness and Relaxation Practices

Mindfulness and relaxation practices are powerful tools for managing stress. Guided meditation, for example, can help you find centered relaxation and distract you from the stresses of daily life. There are numerous guided meditations available online that can guide you through even just a few minutes of relaxation.

Deep breathing techniques are also highly effective. Deep breathing can reduce the activation of your sympathetic nervous system, which is responsible for the “fight or flight” response. Techniques such as inhaling for a count of five seconds, holding for two seconds, and exhaling for a count of five seconds can help activate your parasympathetic nervous system, promoting rest and relaxation.

Other relaxation techniques include progressive muscle relaxation, yoga, and engaging in hobbies like painting, reading, or listening to music. These activities can provide a sense of calm and rejuvenation, even if practiced for just a few minutes a day.

Seeking Professional Help

Sometimes, despite your best efforts, stress can become too much to handle alone. Seeking professional help is a sign of strength, not weakness. Talking to a therapist or counselor can provide invaluable emotional relief and help you develop healthier coping mechanisms.

Cognitive behavioral therapy (CBT), for instance, can help you change negative thought patterns and manage stress more effectively. In addition to individual therapy, group therapy and support groups can offer a sense of community and shared understanding. Many universities and workplaces also provide mental health resources, such as counseling services, that can be extremely beneficial.

For those who prefer more structured approaches, biofeedback therapy can be an option. Biofeedback involves using sensors to monitor your body’s response to stress and teaching you how to control these responses through relaxation techniques.

Cultivating a Resilient Mindset

Building Emotional Strength

Building emotional strength is a cornerstone of cultivating a resilient mindset. This involves several key strategies that help you navigate life’s challenges more effectively. One of the most important aspects is acknowledging and accepting your emotions. Rather than suppressing or hiding your feelings, it is essential to recognize and understand them.

This process, often referred to as “feel, don’t hide,” allows you to confront your emotions head-on and release them in a healthy manner, preventing the buildup of chronic stress, anxiety, or depression.

Practicing mindfulness is another powerful tool for building emotional strength. Mindfulness techniques such as deep breathing and meditation help you remain grounded and focused on the present moment, reducing the impact of external stressors. These practices soothe the amygdala, leading to a decrease in cortisol levels and a subsequent reduction in stress.

By centering yourself in the moment, you enhance your ability to manage negative emotions and think more clearly, thereby building your resilience against future adversities.

Cognitive Behavioral Therapy (CBT) is also highly effective in building emotional strength. CBT involves identifying negative thought patterns and actively working to replace them with more constructive beliefs. For example, reframing a thought from “I can’t handle this” to “I can cope with this challenge by breaking it down into smaller tasks” can significantly improve your ability to navigate life’s ups and downs more effectively.

Additionally, maintaining a positive outlook is vital. Practicing gratitude and identifying the silver lining in difficult situations can shift your focus from what’s wrong to what’s right in your life. This optimism helps foster an environment where resilience thrives, making it easier to navigate through adversity.

Maintaining Healthy Relationships

Maintaining healthy relationships is another critical component of cultivating a resilient mindset. Having a supportive network of family, friends, work colleagues, and community members can provide a sense of belonging and self-worth.

These relationships act as a buffer against stress, making you more resistant to its negative effects. Research has shown that strong social connections can help you cope better with life’s challenges and reduce the risk of mental health conditions such as anxiety and depression.

Community support is essential for building resilience. Being part of a community or support group can provide emotional support, practical help, and a sense of connection.

This support system can help you feel less isolated and more empowered to face challenges. Moreover, having people who believe in you and your abilities can boost your self-confidence and motivation to overcome obstacles.

Finally, self-compassion plays a significant role in maintaining healthy relationships and building resilience. Treating yourself with kindness, especially during setbacks, helps create a stronger emotional buffer. Self-compassion involves acknowledging your suffering, flaws, and mistakes, and choosing to love yourself regardless.

This practice enhances your ability to return to a state of balance and well-being after facing adversity.

Conclusion: Taking Control of Your Stress

In conclusion, managing stress is a multifaceted process that requires a combination of understanding, strategy, and action. By identifying the sources and symptoms of stress, you can take the first steps towards mitigating its effects.

Implementing time management techniques, practicing mindfulness and relaxation, and seeking professional help when needed are all essential strategies for maintaining your mental and physical health. Building emotional strength and maintaining healthy relationships further enhances your resilience against stress. Remember, taking control of your stress is not a one-time achievement but an ongoing process.

By integrating these strategies into your daily life, you can reduce the negative impacts of stress and improve your overall well-being. Take the first step today, and commit to a healthier, more balanced life.

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Stress is a factor in high blood pressure.

High blood pressure (BP) is a common, chronic condition where the force of the blood against your artery walls is consistently too high. Over time, this extra force damages the artery walls, leading to severe health complications.

I. What the Numbers Mean

Blood pressure is measured by two numbers:

1. Systolic Pressure (Top Number): Measures the pressure in your arteries when your heart beats.
2. Diastolic Pressure (Bottom Number): Measures the pressure in your arteries when your heart rests between beats.

II. The Dangers of Uncontrolled Hypertension

Because hypertension often causes no symptoms, it can quietly damage your body for years. Uncontrolled high blood pressure is a major risk factor for:

• Heart Attack and Stroke: Damage to the arteries causes them to narrow, harden (atherosclerosis), and become more likely to clot.
• Kidney Disease: High pressure damages the small blood vessels in the kidneys, making it harder for them to filter waste from the blood.
• Heart Failure: High pressure forces the heart to work harder to pump blood, causing the heart muscle to thicken and weaken over time.
• Vision Loss: Damaged blood vessels in the eyes can cause retinopathy.

III. Key Lifestyle Management Strategies

While medication may be necessary, lifestyle changes are the cornerstone of hypertension management and prevention.

1. Dietary Modifications (The DASH Diet)

The DASH (Dietary Approaches to Stop Hypertension) diet is specifically designed to lower blood pressure.

2. Regular Physical Activity

Regular exercise strengthens your heart, allowing it to pump more blood with less effort, which lowers the pressure on your arteries.

• Aerobic Exercise: Aim for 150 minutes of moderate-intensity activity per week (e.g., brisk walking, jogging, cycling, swimming).
• Strength Training: Incorporate resistance exercise at least two days a week, as it improves overall cardiovascular health and helps manage weight.

3. Weight Management

Losing even a small amount of weight (5–10 pounds) can significantly reduce blood pressure. Excess weight increases blood volume and forces the heart to work harder.

4. Stress and Sleep

Chronic stress triggers the release of hormones (like cortisol and adrenaline) that temporarily increase heart rate and narrow blood vessels.

• Stress Reduction: Practice relaxation techniques like deep breathing, meditation, or yoga.
• Sleep: Aim for 7–9 hours of quality sleep per night. Poor sleep quality is directly linked to higher blood pressure.

IV. The Importance of Monitoring

If you have been diagnosed with hypertension, regular home monitoring is vital.

1. Get a reliable cuff: Use an automatic cuff that goes around your upper arm (these are generally more accurate than wrist cuffs).
2. Measure correctly: Sit quietly for five minutes before measuring. Rest your arm on a table so the cuff is at heart level. Take two or three readings a few minutes apart.
3. Track results: Keep a log of your readings and bring it to all your doctor appointments.

Disclaimer: This information is for educational purposes only. Always consult a qualified healthcare professional regarding any medical conditions or before making significant changes to your diet, exercise, or medication regimen.

Dealing with a narcissistic or toxic family member can be one of the most emotionally draining experiences a person faces. Unlike a coworker or acquaintance, you can’t simply cut ties easily when the individual is your parent, sibling, or close relative. Narcissistic family dynamics are often marked by manipulation, gaslighting, boundary violations, and cycles of love and rejection. Learning how to recognize these behaviors and protect your mental health is essential. Research shows that narcissistic traits are strongly linked to self-centeredness, lack of empathy, and control-seeking behaviors (Campbell & Foster, 2007).

Recognizing Narcissistic Family Dynamics

1. Constant Criticism or Control
   A narcissistic family member often undermines your confidence, offering harsh criticism under the guise of “helping.” They may also attempt to control your choices, from career to relationships.
2. Gaslighting and Denial
   Gaslighting—making you question your memory, perceptions, or feelings—is a hallmark of narcissistic behavior (Stern, 2018). A toxic relative might deny things they said or twist events to make you feel unstable.
3. Favoritism and Triangulation
   Narcissists may create competition among siblings or relatives, using favoritism and comparison to stir jealousy and maintain control (Brown, 2016).
4. Emotional Rollercoasters
   You may feel loved and appreciated one moment, then rejected or ignored the next. This inconsistency keeps you emotionally hooked, always seeking approval.

Why It’s Harder With Family?

Family ties make boundaries more complicated. Many people feel guilt or an obligation to maintain relationships, even when they are unhealthy. Research on family systems shows that toxic dynamics can shape self-esteem and identity well into adulthood (Bowen, 1978). Breaking free from these patterns requires both mindfulness and intentional boundary setting.

Strategies for Protecting Your Mental Health

1. Set and Enforce Boundaries

Boundaries are not punishments—they’re protections. Communicate clearly:

• “I’m not comfortable discussing that.”
• “If you raise your voice, I’m leaving the conversation.”

Even if the narcissist ignores or pushes back against your limits, consistently holding your ground reinforces your self-respect.

2. Use the Grey Rock Technique

This strategy involves becoming emotionally unreactive. Instead of defending yourself or arguing, keep responses brief and neutral. By refusing to feed into their manipulation, you minimize their control (Stosny, 2013).

3. Detach Emotionally

Recognize that their behavior says more about them than about you. Adopting an observer mindset—where you notice patterns without internalizing blame—helps protect your emotional energy (Ronningstam, 2016).

4. Limit Contact (If Possible)

If interactions are consistently damaging, consider reducing the time you spend with them. In extreme cases, “low contact” or “no contact” may be necessary for healing.

5. Prioritize Self-Care

Counterbalance the negativity by investing in self-care practices: meditation, journaling, therapy, or time with supportive friends. Research shows that mindfulness improves resilience and emotional regulation in stressful relationships (Keng, Smoski, & Robins, 2011).

6. Seek Support

Talking with a therapist or joining a support group can help you validate your experiences and develop coping strategies. A neutral, professional perspective can also reduce feelings of guilt or obligation.

When Guilt Gets in the Way?

One of the hardest aspects of dealing with a toxic family member is guilt. Narcissistic relatives often weaponize family loyalty to keep you tied to unhealthy dynamics. Remember: protecting your mental health is not selfish—it’s necessary.

A useful affirmation is: “I can love my family while also loving myself enough to create boundaries.”

Conclusion

Dealing with a narcissist or toxic family member is challenging, but not impossible. By recognizing the signs of manipulation, setting firm boundaries, and practicing self-care, you can protect your well-being. Family ties do not require you to sacrifice your mental health. As Dr. Ramani Durvasula, a psychologist who specializes in narcissism, often reminds her clients: “Radical acceptance of who they are sets you free to live your life.”

Protecting yourself does not mean you don’t care about your family—it means you also care about your own peace, healing, and future.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bowen, M. (1978). Family Therapy in Clinical Practice.
• Brown, N. W. (2016). Children of the Self-Absorbed: A Grown-Up’s Guide to Getting Over Narcissistic Parents.
• Campbell, W. K., & Foster, J. D. (2007). The narcissistic self: Background, an extended agency model, and ongoing controversies. The Self, 115–138.
• Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056.
• Ronningstam, E. (2016). Pathological narcissism and narcissistic personality disorder in DSM-5. Personality Disorders, 7(3), 203–210.
• Stern, R. (2018). The Gaslight Effect: How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life.
• Stosny, S. (2013). Living and Loving After Betrayal.

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– a clinical psychologist explains why it’s worth the effort

The percentage of Americans seeking mental health treatment nearly doubled between 2004 and 2022, with almost a quarter of the population reporting that they saw a mental health care professional in 2022.

This surge in help-seeking has many potential explanations. The pandemic, along with other external stressors, led to unprecedentedly high rates of anxiety and depression across all age groups.

Yet the majority of Americans with a mental health condition are not receiving adequate treatment or any treatment at all.

People who are pondering getting help face a lot of decisions with little information about how to navigate the system available to them.

As a licensed clinical psychologist and director of clinical training for a clinical psychology program at the University of Montana in Missoula, I spend a lot of time thinking about how to increase folks’ access to treatment. I also field a lot of practical questions that people have about the process.

It’s a difficult landscape to navigate, particularly when there is a nationwide shortage of mental health care providers.

Recognizing when to seek help

Mental health conditions – technically diagnoses or disorders – are defined by either feeling distress or experiencing impairment in one or more areas of your life.

If you seek out mental health treatment, a diagnosis is often required for you to receive services. You should seek out professional advice as a first step. Clinicians make diagnostic determinations based on the Diagnostic and Statistical Manual of Mental Disorders, currently in a revised, fifth edition. Finding adequate mental health care amid a nationwide shortage of mental health professionals is tricky, but not impossible.

Getting a diagnosis

Mental health practitioners include, but are not limited to, psychologists, social workers, counselors, psychiatric nurse practitioners, and psychiatrists. Many people start with a referral to one of these providers through their primary care provider.

There are clear differences between these professions in terms of training and scope of practice, but all require licensure. The best way to check if a practitioner’s license is valid or if they have had misconduct actions is to do a search for your jurisdiction, the profession (such as psychiatrist), plus “license lookup” or “license verification” to be directed to your state’s official licensure site.

The training of mental health professionals is vastly different within this broad category. Psychiatrists, psychiatric nurse practitioners, and some psychologists (in states that allow it) are trained in prescribing medications for mental health conditions. Counselors and social workers typically hold a master’s degree that is focused on understanding human well-being, methods of psychotherapy, and providing treatment. Psychologists typically hold a doctorate degree and have additional, specialized training in psychological assessment, research, and supervision.

The right specialist for you might be determined by your specific needs, such as an assessment or medication, but pragmatic issues are often key factors.

Paying for therapy

If you are one of the 92.1% of Americans who are fortunate to have health insurance, by law you should receive coverage for therapy that is comparable to what you would receive for medical or surgical procedures. However, mental health care is still difficult to access in many parts of the U.S.

Exact coverage may depend on your deductible, whether the therapist is in- or out-of-network, and the therapist’s rates. Ethical guidelines for all of these professions dictate that a therapist should let you know about their rates, expected course of treatment, and your rights as a client as soon as possible in the therapy process. Not all therapists accept Medicare or Medicaid, unfortunately; these plans often reimburse providers at lower rates than private insurance companies.

Often, the number of sessions that are covered by insurance is determined by your diagnosis. Your therapist should always be able to tell you the diagnosis that you have and what they have submitted to your insurance company. It’s important to know that many mental health care providers are limited in the types of insurance that they take, if they do so at all. Check with your health care plan to see your exact coverage for mental health services, including more complex situations such as inpatient hospitalization or long-term treatment.

Many communities have excellent school-based health centers for youth and certified community behavioral health centers for all ages. These useful resources often provide “one-stop shopping” for health care and can sometimes provide therapy services on a sliding fee scale. The first community health centers in the U.S. launched nearly 60 years ago and still provide crucial medical services, including mental health care.

What to expect in a session

The exact type of therapy you receive depends on several factors: your diagnosis, your therapist’s specialized training, your goals for treatment, and your preferences.

Research indicates that certain treatments are particularly effective for some specific diagnoses. Pay attention to what treatment specialty your therapist provides: Some offer specific approaches such as cognitive behavioral therapy, psychodynamic psychotherapy, or dialectical behavior therapy.

Regardless of the specific type of therapy you receive, you can expect to be asked a lot of questions about your thoughts, behaviors, and feelings. Information about your past challenges and successes can help to clarify the goals for treatment. Knowing when you started feeling distressed, how it’s affecting your life, and what you would like to be different are all important in helping your therapist to formulate a treatment plan.

Some of the things that you talk about in therapy are likely to be painful or difficult, and it’s not uncommon for you to sometimes feel worse in therapy than you felt before. This is because a lot of people have pushed away emotionally challenging aspects of their lives before coming to therapy. Coming to terms with these experiences by sharing them with your therapist is most often beneficial.

Using medication alongside conventional therapy

Medication and psychotherapy are often used in combination with one another. If the person prescribing your medication and your therapist are two different people, you’ll be asked to sign a release of information for each of them so that they can coordinate your treatment.

For example, you may meet with a psychiatrist just a few times each year, but a weekly therapy session may give your therapist insight into how you are responding to medication on a more timely basis.

Certain conditions may particularly benefit from the combination of therapy and medications. For instance, major depression, obsessive-compulsive disorder (OCD), and panic disorder often have better outcomes with combined treatment. Sometimes, the steps that people need to take in order for therapy to be effective, such as gradually confronting feared situations for those with OCD, are more approachable for people who are also taking effective medication.

Research has long established that having one mental health diagnosis increases the risk of having another one; for example, people who have attention-deficit/hyperactivity disorder, or ADHD, are frequently also diagnosed with other conditions such as anxiety, depression and substance use disorder. Situations where people have more than one diagnosis may also be best treated through a combination of psychotherapy and pharmacotherapy.

Finding the right fit

Several research studies have indicated that the quality of the therapy relationship based on the client’s feeling of connectedness is an important factor in treatment outcome.

If you don’t feel that there’s a great match between what you need and what your therapist is offering, you should keep looking for a better fit.

According to the World Health Organization (WHO), more women are affected by depression than men. This pattern is seen in countries around the world, including the United States.

Cross-national and cross-cultural studies have indicated that the prevalence of depression among women is higher at any given time than among men. This pattern does not seem to have many exceptions.

Why is that? Biological differences between men and women, like hormones, explain part of it. These are examples of sex differences. But social factors between men and women (gender differences) may play a bigger role. For instance, women, in general, experience more stress than men, and research has shown that social stress is a main cause of depression.

But new research that I’ve conducted with my colleague Maryam Moghani Lankarani suggests that men might be more vulnerable to depression caused by stressful events.

Why are More Women Depressed than Men?

Researchers have defined stress as any major change to the status quo (existing balance) that may potentially cause mental or emotional strain or tension. These stressful life events can include marriage, divorce, separation, marital reconciliation, personal injury or illness, dismissal from work, or retirement.

Men are more likely to have depressive episodes following work difficulties, divorce, and separation. Women, on the other hand, are more sensitive to conflict, serious illnesses, or death happening in their close social network. In fact, research suggests that most of the stressful events that cause depression among women are related to their close social network, such as romantic and marital relationships, child-rearing, and parenting.

Research suggests that compared to men, women tend to ruminate (the technical term for “overthinking”) more about stressors and have negative thoughts that cause depression. And at least one study suggests that this explains the gender difference in the prevalence of depression. Rumination can make stress worse, and unfortunately, it is more common among women.

These findings suggest that psychosocial causes of depression may be at least partially gender-specific, and that these disparities are rooted in different life conditions – social inequalities – that men and women experience. And, in general, women tend to experience greater social inequality and social stress, and therefore depression, than men.

The gender gap in depression is largest in countries with the highest gender inequalities. Gender difference in the burden of depression is highest in the countries where women and men differ more in access to resources and social equity.

And that, oddly, might explain why men might be more susceptible to the depression-inducing effects of stress. They aren’t as used to dealing with it.

Men are more vulnerable to the effects of stress over time

In new research, my colleague Maryam Moghani Lankarani and I found that stressful life events are more likely to predict depression in men than in women.

In fact, men are more susceptible to the depression-inducing effects of each additional stressor over long-term periods.

We looked at data from a nationally representative study that examined how psychological factors affect the physical and mental health of individuals over time.

We studied the effects of stressful life events that men and women reported at the beginning of the study on their rates of depression 25 years later. We found that the effect of each life stressor on the risk of clinical depression was 50 percent stronger for men than for women.

These findings correspond with a study we published in late 2015 that showed white men may be most vulnerable to the effect of stress on depression, possibly because they have a lower exposure to stress compared to any other demographic group.

It’s possible that cumulative exposure to stress may build resilience or habituation to stressors. In other words, people who cope with stress all the time can get used to it.

So the social group exposed to the lowest stressors (living the most privileged life) may at the same time be most vulnerable to each additional stressor. They have not learned to cope with stress as effectively as those who experience it more.

This is potentially the cost of living an easier, and therefore, less stressful life.

Men who experience depression may not seek care

Men may also be vulnerable to the effects of stress because they may perceive depression as a weakness. They may also define talking about emotion and seeking help for an emotional problem, such as depression, as a weakness. This is especially the case in developing countries where traditional gender roles are more strongly endorsed.

These beliefs strongly shape the behaviors of men who are in need of mental health care, and make men vulnerable when stress and emotional problems happen. All these result in men ignoring depression when it develops, and avoiding care when needed, not to look weak.

This also partially explains why more men with depression kill themselves (particularly white men) than women with depression.

Gender influences our risk of depression in various ways. It determines our risk of exposure to adversity. It changes our vulnerability to stress. And it can also determine what resources we’ll be able to access to cope with stress or depression.

From the breakup of a relationship to losing a loved one, people are often told to find “closure” after traumatic things happen.

But what is closure? And should it really be the goal for individuals seeking relief or healing, even in these traumatic times of global pandemic, war in Ukraine, and mass shootings in the U.S.?

Closure is an elusive concept. There is no agreed-upon definition for what closure means or how one is supposed to find it. Although there are numerous interpretations of closure, it usually relates to some type of ending to a difficult experience.

As a grief expert and author of “Closure: The Rush to End Grief and What It Costs Us,” I have learned that the language of closure can often create confusion and false hope for those experiencing loss. Individuals who are grieving feel more supported when they are allowed time to learn to live with their loss and not pushed to find closure.

Why did closure become popular?

Closure is entrenched in popular culture not because it is a well-defined, understood concept that people need, but rather because the idea of closure can be used to sell products, services, and even political agendas.

The funeral industry started using closure as an important selling point after it was criticized harshly in the 1960s for charging too much for funerals. To justify their high prices, funeral homes began claiming that their services helped with grief, too. Closure eventually became a neat package to explain those services.

In the 1990s, death penalty advocates used the concept of closure to reshape their political discourse. Arguing that the death penalty would bring closure for victims’ family members was an attempt to appeal to a broader audience. However, research continues to show that executions do not bring closure.

Still today, journalists, politicians, businesses, and other professionals use the rhetoric of closure to appeal to people’s emotions related to trauma and loss.

So what is the problem with closure?

It is not the mere presence of closure as a concept that is a problem. The concern comes when people believe closure must be found in order to move forward.

Closure represents a set of expectations for responding after bad things happen. If people believe they need closure in order to heal but cannot find it, they may feel something is wrong with them. Because so many others may tell those grieving they need closure, they often feel pressure to either end grief or hide it. This pressure can lead to further isolation.

Privately, many people may resent the idea of closure because they do not want to forget their loved ones or have their grief minimized. I hear this frustration from people I interview.

Closure frequently becomes a one-word description of what individuals are supposed to find at the end of the grieving process. The concept of closure taps into a desire to have things ordered and simple, but experiences with grief and loss are often longer-term and complex.

If not closure, then what?

As a grief researcher and public speaker, I engage with many different groups of people seeking help in their grief journeys or looking for ways to better support others. I’ve listened to hundreds of people who share their experiences with loss. And I learn time and again that people do not need closure to heal.

They can carry grief and joy together. They can carry grief as part of their love for many years. As part of my research, I interviewed a woman I will call Christina.

Just before her 16th birthday, Christina’s mom and four siblings were killed in a car accident. Over 30 years later, Christina said that people continue to expect her to just “be over it” and to find closure. But she does not want to forget her mother and siblings. She is not seeking closure to their deaths. She has a lot of joy in her life, including her children and grandchildren. But her mom and siblings, who died, are also part of who she is.

Both privately and as a community, individuals can learn to live with loss. The types of loss and trauma people experience vary greatly. There is not just one way to grieve, and there is no time schedule. Furthermore, the history of any community contains a range of experiences and emotions, which might include collective trauma from events such as mass shootings, natural disasters, or war. The complexity of loss reflects the complexity of relationships and experiences in life.

Rather than expecting yourself and others to find closure, I would suggest creating space to grieve and to remember trauma or loss as needed. Here are a few suggestions to get started:

• Know people can carry complicated emotions together. Embrace a full range of emotions. The goal does not need to be “being happy” all the time for you or others.

• Improve listening skills and know you can help others without trying to fix them. Be present and acknowledge loss through listening.

• Realize that people vary greatly in their experiences with loss and the way they grieve. Don’t compare people’s grief and loss.

• Bear witness to the pain and trauma of others in order to acknowledge their loss.

• Provide individual and community-level opportunities for remembering. Give yourself and others freedom to carry memories.

Healing does not mean rushing to forget and silencing those who hurt. I believe that by providing space and time to grieve, communities and families can honor lives lost, acknowledge trauma, and learn what pain people continue to carry.

Nancy Berns Professor of Sociology

A new year brings both hopes and anxieties. We want things to be better for ourselves and the people we love, but worry that they won’t be, and imagine some of the things that might stand in the way. More broadly, we might worry about who’s going to win the election, or even if our world will survive.

As it turns out, humans are wired to worry. Our brains are continually imagining futures that will meet our needs and things that could stand in the way of them. And sometimes any of those needs may be in conflict with each other.

Worry is when that vital planning gets the better of us and occupies our attention to no good effect. Tension, sleepless nights, preoccupation, and distraction around those very people we care for, worry’s effects are endless. There are ways to tame it, however.

As a professor of medicine and population and quantitative health sciences, I’ve researched and taught mind-body principles to both physicians and patients. I’ve found that there are many methods of quieting the mind and that most of them draw on just a few straightforward principles. Understanding those can help in creatively practicing the techniques in your everyday life.

Our Brains Sabotage the Happier Present Moment

We’ve all experienced moments of flow, times when our attention is just effortlessly absorbed in what we are doing. And studies carried out in real time confirm an increase in happiness  when people can focus attention on what they are doing, rather than when their minds are wandering. It may seem odd then that we leave our minds to wander for something like half the day, despite the happiness cost.

The reason can be found in the activity of linked brain regions, such as the default mode network, that become active when our attention is not occupied with a task. These systems function in the background of consciousness, envisaging futures compatible with our needs and desires and planning how those might be brought about.

Human brains have evolved to do this automatically; planning for scarcity and other threats is important to ensure survival. But there’s a downside: anxiety. Studies have shown that some people prefer electric shocks to being left alone with their thoughts. Sound familiar?

Our background thinking is essential to operating in the world. It is sometimes the origin of our most creative images. We suffer from its unease when, unnoticed, it takes over the mental store.

Mindfulness, the practice of observing our mind’s activity, affords both real-time insight into this default feature of the mental operating system and a capacity to self-regulate it.

That is confirmed by studies showing increased attention regulation, working memory, and awareness of mind wandering that develop after only a couple of weeks of mindfulness training. Imaging studies, similarly, show that this kind of training reduces default mode activity and enriches neural connections that facilitate attentional and emotional self-regulation.

Evolution Prioritizes Survival Over Happiness

This default to planning is part of our evolutionary history. Its value is evident in the effortless persistence and universality with which it occurs. Mind-body programs like yoga and mindfulness are indicative of the yearning many people have to be in the happier present moment.

How we use our attention is central to our emotional well-being, and many mind-body programs are based on training our minds to be more skillful in this way.

Mindfulness training, for example, asks students to direct their attention to the sensations of breathing. And while that may seem easy, the mind resists tenaciously. So, despite repeated resolve, a person finds that, within seconds, attention has effortlessly defaulted to planning daydreams.

Just recognizing this feature is progress.

In those moments when you do manage to notice these thoughts with some detachment, their dogged concern with past and future becomes clear. And planning’s semi-vigilant (“What could go wrong here?”) orientation also becomes clear.

We begin to notice that this hoping, comparing and regretting is often concerned with family and friends, job and money – themes of relationship, status and power that are central to the survival of tribal primates. All set against the background knowledge of our passing.

Our Bodies Take Notice

Traditional meditation teachings attribute our everyday unease to the bodily tightening that naturally accompanies the possibility of loss, failure and unfulfilled dreams embedded within this narrative. It’s a tension that is often unnoticed in the midst of managing everyday demands, but its background discomfort sends us looking for relief in something more pleasant like a snack, a screen, a drink or a drug.

Mindfulness makes us more aware of these preoccupations and reorients attention to the senses. These, by their nature, are oriented to the present – hence the almost clichéd “being in the moment” idiom.

So, when you notice yourself tense and preoccupied with anxious thoughts, try shifting your attention to the sensations of your breathing, wherever you notice it in your body. Bodily tension naturally dissipates with the shift in focus, and a feeling of greater calm follows. Don’t expect attention to stay there; it won’t. Just notice that attention goes back to worries, and gently return it to breathing.

Try it for just a couple of minutes.

Other Mind-body Programs Use Similar Principles

It would be nearly impossible to design studies comparing all the techniques that cultivate mindfulness. But my more than four decades of experience as a practitioner, clinician and researcher of several popular mind-body programs suggests that most techniques use similar principles to recover the present moment.

Yoga and tai chi, for example, direct attention to the flow of sensations accompanying the sequence of movements. In contrast, systems such as cognitive therapy, self-compassion, prayer, and visualization counter the ambient narrative’s unsettling tone with more reassuring thoughts and images.

Just a little practice makes this universal mental tendency, and your ability to shift it, more apparent in the midst of activities. The reduced arousal that results means that stress-related hormones dissipate, allowing feel-good ones like serotonin and dopamine to be restored in the brain as the happier here and now becomes woven into the fabric of everyday life.

1. James Carmody Professor of Medicine and Population Health Sciences, UMass Chan Medical School