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

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

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

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

What "Brain Rot" Actually Describes

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

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

What Excessive Screen Time Actually Does to the Brain

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

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

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

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

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

Why It Feels So Hard to Stop

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

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

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

The Mental Health Overlap

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

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

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

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

What Actually Helps

A few things that research and clinical experience both support:

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

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

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

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

A Note on Not Pathologizing Yourself

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

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

APA CITATIONS

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

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

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

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

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

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

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

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

What Radical Acceptance Is Not

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

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

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

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

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

Where It Comes From

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

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

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

The Pain vs. Suffering Distinction

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

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

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

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

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

What Nonacceptance Actually Looks Like

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

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

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

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

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

Why It Is So Hard

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

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

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

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

What Radical Acceptance Looks Like in Practice

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

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

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

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

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

When Radical Acceptance Is Most Relevant

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

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

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

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

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

Radical Acceptance and Therapy

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

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

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

APA CITATIONS

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

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

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

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

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

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

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

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

The Biology of Stress: What's Actually Happening

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

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

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

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

Acute Stress: The System Working as Intended

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

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

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

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

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

Chronic Stress: When the System Stays On

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

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

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

What Chronic Stress Does to the Brain

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

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

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

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

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

What Chronic Stress Does to Mental Health

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

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

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

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

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

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

The Normalization Problem

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

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

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

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

What This Looks Like in Practice

A few questions worth asking yourself honestly:

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

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

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

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

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

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

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

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

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

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

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

Where Attachment Patterns Come From

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

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

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

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

What Avoidant Attachment Looks Like in Adults

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

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

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

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

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

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

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

The Anxious-Avoidant Dynamic

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

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

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

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

What Avoidant Attachment Is Not

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

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

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

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

Can Avoidant Attachment Change?

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

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

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

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

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

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

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

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

The Most Important Difference: Licensing and Training

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

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

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

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

What Therapists Are Trained to Do

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

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

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

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

What Life Coaches Are Designed to Do

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

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

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

Where It Gets Complicated

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

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

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

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

How to Know Which One You Need

A few questions worth asking:

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

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

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

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

Is the past relevant?

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

Do you need the legal protection of confidentiality?

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

What does the person's background actually include?

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

Can You Work With Both?

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

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

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

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

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

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

The Gambling Industry Did This First

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

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

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

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

The Four Features — and What They Do to Your Brain

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

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

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

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

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

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

Dark Flow Is Not the Same as Healthy Absorption

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

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

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

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

What This Has to Do With Anxiety and Mental Health

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

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

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

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

What You Can Actually Do

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

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

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

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

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

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

A Note on Children

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

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

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

Citations

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

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

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

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

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

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

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

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

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

What the Research Found

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

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

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

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

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

Why the Cost Is So Easy to Miss

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

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

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

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

The Office Was Doing More Than We Realized

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

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

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

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

This Is Not an Argument for Returning to 2019

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

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

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

What This Means in Practice

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

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

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

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

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

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

A Closing Thought

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

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

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

APA CITATIONS

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

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

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

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

What the New Alcohol Research Means for Your Mental Health

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

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

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

What the Study Actually Found

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

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

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

The Politics Are Worth Noting — and Then Setting Aside

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

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

The Mental Health Dimension

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

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

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

Alcohol and the Anxiety-Depression Loop

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

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

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

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

What Alcohol Use Often Communicates

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

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

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

A Note on the Sober-Curious Conversation

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

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

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

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

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

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

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

The Numbers Tell Part of the Story

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

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

What the Research Says About AI and Meaning at Work

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

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

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

Work, Identity, and What Happens When the Ground Shifts

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

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

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

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

The Particular Burden on High Achievers

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

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

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

What Uncertainty Does to the Mind and Body

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

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

What Actually Helps

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

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

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

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

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

A Note on When to Seek Support

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

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

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

APA Citations:

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

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

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

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

Why "Good Enough" Is Better for Your Mental Health Than "The Best"

Here is something that shows up in therapy more often than you might expect: a person who is objectively doing well — good job, good relationship, good life — who cannot stop wondering if something better is out there.

They are not ungrateful, exactly. They are haunted. By the apartment they did not rent, the job offer they turned down, the partner they might have met if they had stayed on the app a little longer. Every decision, once made, immediately generates a parallel universe in which a different choice led somewhere better.

This is not a character flaw. It is a well-documented cognitive style that psychologists call maximizing — and the research on it has a lot to say about anxiety, decision fatigue, and the specific kind of unhappiness that feels inexplicable precisely because everything is, by most measures, fine.

The Psychology of Maximizing

The concept comes from Nobel laureate Herbert Simon, who spent decades studying how humans actually make decisions. Simon observed that humans cannot truly evaluate all available options for most decisions — there are too many, our information is incomplete, and our minds are not built for it. Instead, we consider a manageable set of options, find one that meets our standard, and move on. He called this satisficing — a blend of "satisfy" and "suffice." The satisficer's standard is not "the best available" but "good enough for what I need."

Simon was a committed satisficer in his own life. He wore one brand of socks, ate the same breakfast every morning, lived in the same house for 46 years. These were deliberate choices to remove low-stakes decisions from his attention so that his cognitive resources remained available for the things that actually mattered.

The maximizer operates differently. The standard is not "good enough" but "the best." And because that standard is difficult to confirm — you can only know you found the best if you have exhausted all the others — the search tends to continue long past the point of diminishing returns.

What the Research Shows

Researchers developed a scale to measure where individuals fall on the spectrum between maximizer and satisficer. What they found was consistent: maximizing is associated with worse outcomes, not better ones.

Maximizers tend to be less satisfied with their decisions even when those decisions are objectively good.

They are more prone to regret, more likely to engage in social comparison, and less happy overall. They second-guess more. They ruminate more. The very process of trying to ensure the best outcome produces the psychological conditions that undermine satisfaction with whatever outcome they reach.

Satisficers do not have lower standards. They simply have standards that are achievable and confirmable. "Good enough for me" can be met. "The best" rarely is.

Why It Has Gotten So Much Worse

The sheer proliferation of options is part of it — one economist calculated that consumer options in modern economies exceed those of preindustrial societies by a factor of roughly 100 million. That extends into the most fundamental questions of identity: who to be, how to live, where to work, whom to love.

Social media added a specific and damaging layer: the infinite comparison engine. When you can see curated versions of other people's careers, relationships, and lives at all times, "good enough" begins to feel like settling. Research has found that simply having many options to compare makes people less satisfied with whatever they choose. The mere awareness that something else might be out there degrades the present moment.

Dating apps are the purest expression of this — a system architecturally designed to keep users wondering whether a better match exists beyond the next swipe. And AI now promises to optimize everything, which carries the hidden risk of expanding the menu of comparisons indefinitely, producing not better outcomes but more haunted ones.

What This Looks Like in the Therapy Room

The clinical presentation of maximizing rarely announces itself by name. It tends to look like this: a patient who made a good decision but cannot stop wondering if it was the right one. Someone in a solid relationship with a persistent background awareness that other options exist. A person who accepted a good job and immediately began scanning for signs they should have waited.

What is tricky is that maximizing feels like conscientiousness. It presents as due diligence. The person doing it is not sure they have permission to stop — because stopping before finding the best option feels like settling.

But the research is clear: the search itself is a cost. And most maximizers are not accounting for it.

Satisficing Is Not Lowering Your Standards

This is the point most people resist. Choosing "good enough" is not resignation or a failure of ambition. It is the recognition that there is a standard — your standard, based on what actually matters to you — and that when that standard is met, continued searching produces diminishing returns on outcomes and significant costs to wellbeing.

The question worth asking is not "is this the best?" but "is this good enough for what I actually need?" Those questions produce different psychological experiences. The first cannot, in most cases, be answered with confidence. The second can be.

A Practical Reframe

In clinical work, one of the most useful reframes for people caught in maximizing patterns is this: the goal is not to find the best option. The goal is to find a good option and then fully invest in it.

Research on relationship satisfaction bears this out. Couples who psychologically close the door on alternatives — rather than keeping it open — report higher satisfaction and stronger attachment. The act of committing, not the quality of the match itself, is a significant predictor of relationship wellbeing. Investment produces satisfaction. Continued search undermines it.

A few things that help in practice:

• Clarify your actual criteria before you start searching. "The best" is not a criterion — it is an instruction to keep looking. Specific, confirmable criteria allow the search to stop.

• Name the cost of continued searching. Time, attention, cognitive load, and eroding satisfaction with what you already have are real costs. Making them explicit counteracts the bias toward treating more searching as always worthwhile.

• Practice committing. For chronic maximizers, closing options feels like loss. That discomfort is worth sitting with rather than immediately acting on — it is usually the sensation of commitment, not the sensation of a mistake.

The Deeper Stakes

There is a Haruki Murakami story in which a boy and girl meet on a street corner and immediately recognize they are perfect for each other. They talk for hours. Then doubt creeps in: if they are truly meant for each other, they reason, they can part and will inevitably find each other again. The boy walks west. The girl walks east. They were perfect for each other. Years later they pass on a street, memories faded. They never reconnect.

The tragedy is not that the right person was lost. It is that the search for certainty destroyed something that was already, right there, enough.

Many of the patients I work with who are caught in maximizing patterns are not missing something. They are standing inside a life that contains real good things, unable to settle into it because some part of their mind is still searching for confirmation that this is the right life.

That particular kind of suffering responds well to therapy. Not because therapy provides the certainty the maximizing mind is looking for, but because it helps people examine the standard they are holding themselves to, where it came from, and whether it is actually serving them.

Good enough, chosen consciously and invested in fully, is often where a life of real satisfaction begins.

Citations:

Iyengar, S. S., Wells, R. E., & Schwartz, B. (2006). Doing better but feeling worse: Looking for the "best" job undermines satisfaction. Psychological Science, 17(2), 143–150. https://doi.org/10.1111/j.1467-9280.2006.01677.x

Schwartz, B., Ward, A., Monterosso, J., Lyubomirsky, S., White, K., & Lehman, D. R. (2002). Maximizing versus satisficing: Happiness is a matter of choice. Journal of Personality and Social Psychology, 83(5), 1178–1197. https://doi.org/10.1037/0022-3514.83.5.1178

Simon, H. A. (1956). Rational choice and the structure of the environment. Psychological Review, 63(2), 129–138. https://doi.org/10.1037/h0042769

Sparks, E. A., Ehrlinger, J., & Eibach, R. P. (2012). Failing to commit: Maximizers avoid commitment in a way that contributes to reduced satisfaction. Personality and Individual Differences, 52(1), 72–77. https://doi.org/10.1016/j.paid.2011.09.002

Neuroplasticity Is Real — And You Don't Have to Be an Olympian to Use It

Eileen Gu is 22 years old, the most decorated freestyle skier in Winter Olympics history, a Stanford student, and worth north of $20 million. When Fortune recently asked her to take readers inside her mind, she did not talk about talent or discipline in the way athletes usually do. She talked about something more specific: the daily practice of examining and deliberately modifying her own thinking.

"I apply a very analytical lens to my own thinking, and I modify it," she said. "You can control what you think. You can control how you think. And therefore, you can control who you are."

She credits neuroplasticity — the brain's capacity to change its own structure and function based on experience — as the mechanism behind this. And she is right that the science supports her. What is worth unpacking, from a psychological standpoint, is what neuroplasticity actually means, what it requires, and why it matters far beyond elite athletic performance.

What Neuroplasticity Actually Is

Neuroplasticity is not a metaphor or a motivational concept. It is a well-documented property of the brain — the capacity to reorganize its neural connections in response to experience, learning, and behavior.

For most of human history, the brain was thought to be largely fixed after childhood. What neuroscience established over the latter half of the twentieth century is that this is wrong. The brain retains the ability to form new neural pathways, strengthen existing ones through repeated use, and weaken or prune connections that go unused throughout the entire lifespan. Learning a new skill, developing a habit, practicing a way of thinking — all of these activities physically change the brain's structure over time.

The oft-cited phrase in neuroscience is "neurons that fire together, wire together," attributed to the work of Donald Hebb. When we repeatedly activate the same neural circuits — through thought patterns, behaviors, emotional responses — those circuits become more efficient, more automatic, more deeply embedded. This is why habits are hard to break: the neural pathways supporting them have been reinforced through repetition until they require very little deliberate effort to activate.

It is also why change is possible. New patterns, practiced consistently, can become as automatic as the old ones.

What Gu Is Actually Doing, Psychologically

What Eileen Gu describes — journaling, breaking down her thought processes, applying an analytical lens to her own thinking and then deliberately modifying it — maps closely onto something clinical psychologists have been doing with patients for decades.

It is metacognition: thinking about thinking. The capacity to step outside your own cognitive processes, observe them as processes rather than facts, and evaluate whether they are serving you.

This is one of the core mechanisms of Cognitive Behavioral Therapy. In CBT, a significant portion of the work involves helping people notice the automatic thoughts that arise in response to situations — the interpretations, predictions, and self-assessments that happen below the level of deliberate awareness — and examine them. Are they accurate? Are they the only way to interpret the situation? Are they producing responses that are useful or responses that are making things harder?

What Gu is doing informally through journaling is a version of the same process. She is interrupting the automatic nature of her own thinking, holding it up to examination, and asking whether it is aligned with who she wants to become. The fact that she is doing this as a 22-year-old with a brain still rich in the particularly high plasticity of early adulthood gives her a real advantage. But the mechanism is available at every age.

The Therapy Connection: Neuroplasticity Is Why Treatment Works

One of the most important clinical implications of neuroplasticity is that it provides a neurobiological basis for why psychotherapy produces lasting change.

For a long time, a common skepticism about therapy was that it could change how someone felt or thought temporarily, but could not change anything fundamental. The neuroscience suggests otherwise. Effective psychological treatment — CBT, EMDR, exposure-based therapies, and others — does not just shift mood or thinking in the moment. It changes the brain.

Studies using neuroimaging have found that successful CBT treatment for conditions like OCD, depression, PTSD, and anxiety produces measurable changes in brain activity and structure — in some cases comparable to the changes produced by medication. The prefrontal cortex, which is involved in regulation, evaluation, and executive control, shows increased activation after treatment. The amygdala, the brain's threat-detection hub, shows reduced reactivity. The neural pathways supporting rumination, avoidance, and threat amplification become less dominant. New pathways supporting more flexible, regulated responding become more established.

This is neuroplasticity in action. Therapy is, among other things, a structured way of using the brain's capacity to change itself.

The Part the Success Narrative Leaves Out

The Fortune article, and the broader cultural conversation around neuroplasticity, tends to frame it as a tool for optimization — a lever high performers can pull to become better, faster, more successful.

That framing is not wrong, but it is incomplete in ways that are clinically important.

The same mechanism that allows Eileen Gu to deliberately shape her thinking toward her goals is also the mechanism by which anxiety, depression, trauma, and dysfunctional patterns become entrenched. Neural pathways supporting worry, self-criticism, avoidance, and threat perception are reinforced by the same process as neural pathways supporting confidence and clarity. The brain does not distinguish between patterns that serve us and patterns that do not. It strengthens what it uses.

This means that for people who have lived with chronic anxiety, early trauma, or years of negative self-talk, the task is not simply to "think positively" or "rewire the brain" through journaling and good intentions. Those pathways have been reinforced over years, sometimes decades, and they run deep. The work of changing them is real work — it requires sustained effort, often professional support, and a tolerance for the discomfort of doing things differently before the new way feels natural.

This is not pessimism. It is accuracy. And it is actually more hopeful than the optimization narrative, because it takes seriously what change requires and points toward approaches that are evidence-based rather than simply aspirational.

What This Looks Like in Practice

For the people I work with in therapy, neuroplasticity is not a concept I invoke by name very often. But it is the implicit foundation of almost everything we do together.

When someone with anxiety practices responding to a feared situation without avoidance, they are weakening the neural pathway that links that situation to danger and building a new one that links it to manageability. When someone with depression practices behavioral activation — engaging in activities even before motivation returns — they are using behavior to shift neural states rather than waiting for the neural state to shift first. When someone examines and challenges a long-held belief about themselves and practices holding a different one, they are doing exactly what Gu describes: modifying their own thinking through deliberate, repeated effort.

The key word is repeated. Neuroplasticity does not work through insight alone. The moment of recognizing a pattern is important, but it is not the same as changing it. Change requires practice — not perfect practice, but consistent, sustained engagement with the new way of responding, thinking, or behaving, often while the old way is pulling hard in the other direction.

This is why therapy is not just a conversation. It is a structured opportunity to practice new ways of processing experience, with support, feedback, and the gradual accumulation of a different neural history.

You Do Not Have to Be 22

One of Gu's more notable comments was that she has neuroplasticity "on her side" as a young person. She is right that the brain's plasticity is particularly high in early adulthood, when the prefrontal cortex is still developing and neural networks are especially open to reorganization.

But neuroplasticity does not end at 22, or 35, or 60. The research on adult neuroplasticity is clear: the brain retains meaningful capacity for structural change throughout the lifespan. The rate may be somewhat lower and the effort required somewhat greater than in early development. The capacity itself does not disappear.

What this means practically is that it is never too late to change a pattern, learn a new way of responding, or build a different relationship with your own thinking. The evidence base for psychological treatment shows this consistently: people in midlife and later adulthood make significant, lasting changes through therapy, and the neurobiological substrate for those changes is the same one that allows a 22-year-old Olympic champion to deliberately shape who she is becoming.

The brain you have now is not the brain you are stuck with.

What is genuinely interesting about Eileen Gu's approach is not the success it has produced, though that is impressive. It is the orientation it reflects: treating the mind as something to engage with deliberately rather than something that happens to you.

That orientation is at the heart of good psychological work. The thoughts that arise automatically, the emotional patterns that feel like personality, the self-assessments that feel like facts — none of these are fixed. They are the current output of a brain that learned, through experience, to run those processes. And a brain that learned something can learn something different.

That is not a promise that change is easy. It is a statement that change is possible — which, for many people carrying long-standing patterns they did not choose and did not deserve, is exactly what they most need to hear.

APA CITATIONS

Hebb, D. O. (1949). The organization of behavior: A neuropsychological theory. Wiley.

Linden, D. E. J. (2006). How psychotherapy changes the brain: The contribution of functional neuroimaging. Molecular Psychiatry, 11(6), 528–538. https://doi.org/10.1038/sj.mp.4001816

Pittenger, C., & Duman, R. S. (2008). Stress, depression, and neuroplasticity: A convergence of mechanisms. Neuropsychopharmacology, 33(1), 88–109. https://doi.org/10.1038/sj.npp.1301574

Takeuchi, H., Taki, Y., Hashizume, H., Sassa, Y., Nagase, T., Nouchi, R., & Kawashima, R. (2011). Effects of training of processing speed on neural systems. Journal of Neuroscience, 31(34), 12139–12148. https://doi.org/10.1523/JNEUROSCI.2948-11.2011

What "The Pitt" Gets Right About Trauma — and What It Means for the Rest of Us

If you have been watching "The Pitt" on HBO Max, you already know it is not a typical medical drama. There are no romantic subplots softening the edges, no convenient resolutions at the end of an episode. Each season takes place across a single continuous shift in a Pittsburgh emergency department, and the result is something that feels less like television and more like an endurance experience — which, for a lot of viewers, is exactly the point.

What has drawn particular attention from clinicians, healthcare workers, and the New York Times is not the medical realism, though that is also notable. It is the psychological realism. Specifically, the show's unflinching portrayal of PTSD in Dr. Michael Robinavitch, the ER chief played by Noah Wyle, has resonated with viewers in a way that most depictions of trauma on screen do not.

It is worth examining why. Because what the show captures about how trauma actually works — and how people avoid dealing with it — has implications that extend well beyond emergency medicine.

What the Show Gets Right About Trauma

Dr. Robby does not have PTSD the way it tends to be depicted in film and television: sudden flashbacks, dramatic breakdowns, clear cause and effect. His trauma presents the way it usually does in real life: quietly, sideways, embedded in behavior rather than announced in symptoms.

He cannot stop moving. Between patients, between crises, he fills every available moment with the next task. His colleagues notice before he does, and they name it clearly: the constant motion is not dedication, it is avoidance. He is keeping himself busy precisely so he does not have to stop and feel what is underneath.

This is one of the most accurate things the show depicts. Avoidance is the central maintenance mechanism of PTSD. The symptoms — intrusive memories, hypervigilance, emotional numbing, disturbed sleep — are painful enough that the natural human response is to move away from anything that might trigger them. Keep busy. Stay distracted. Stay in motion. This works, in the short term, in that it reduces acute distress. What it also does is prevent the processing that would allow the trauma to lose its charge over time.

The show also captures something clinicians see frequently: the person most surrounded by acute suffering can be the least likely to identify themselves as someone who needs help. Robby has spent years working in emergency medicine. He has seen more death and human crisis than most people will encounter in a lifetime. That exposure does not make a person invulnerable to trauma. In many cases it creates the conditions for it — particularly the cumulative, repeated kind that does not trace back to a single incident but accumulates across years of high-stakes, high-loss work.

The Difference Between Burnout and Trauma

One of the more clinically useful things "The Pitt" does is make visible the distinction between burnout and PTSD, two conditions that are frequently conflated and that require meaningfully different responses.

Burnout is the result of chronic workplace stress that has depleted emotional, cognitive, and physical resources over time. It presents as exhaustion, cynicism, reduced sense of efficacy, and emotional distance from work. It is serious, it is treatable, and it is extremely common in high-demand professions. But it is not the same as trauma.

PTSD involves the nervous system's response to events that overwhelmed its capacity to process. Where burnout depletes, trauma dysregulates. A person with PTSD is not simply tired. Their threat-detection system has been recalibrated by experience in ways that make the present feel perpetually dangerous, even in the absence of actual threat. Intrusive memories surface without warning. Hypervigilance keeps the body in a state of readiness that is metabolically and psychologically expensive. Sleep is disturbed not just by fatigue but by the nervous system's resistance to the vulnerability that sleep requires.

Both conditions are present in "The Pitt," and the show is careful not to treat them as identical. Robby's colleagues who are burned out are exhausted and demoralized. Robby himself is something more destabilized — still functional, still brilliant at his job, but running on a foundation that is starting to crack.

This distinction matters clinically because the interventions are different. Burnout responds to rest, boundary-setting, workload reduction, and rebuilding a sense of meaning and control. PTSD requires targeted, trauma-focused treatment — and often, continuing to push through without that treatment makes things worse rather than better.

Why High-Functioning People Are Often the Last to Get Help

One of the things "The Pitt" captures with particular accuracy is the way competence can mask psychological distress for a very long time.

Robby is exceptional at his job. He makes the right calls under pressure. He maintains the trust of his colleagues and residents. From the outside — and often from the inside — he looks like someone who is handling it. The very skills that make him effective in the trauma bay (compartmentalization, rapid decision-making, the ability to suppress emotional reaction in a crisis) are also the skills that allow him to function for extended periods while something is quietly not working underneath.

This is a pattern I see regularly in clinical practice, not only with healthcare workers but with anyone whose professional identity is built around competence and performance. The higher the stakes and the more someone's self-concept is tied to being able to handle things, the longer they tend to wait before seeking support. The capacity to keep functioning reads, to them and often to others, as evidence that things are okay. It rarely is.

Research consistently shows that PTSD symptoms in healthcare workers are significantly underidentified and undertreated. A systematic review examining PTSD in hospital-based healthcare workers found that PTSD symptoms are associated with burnout, compassion fatigue, increased medical errors, and reduced quality of care — consequences that affect not only the individual but also their patients. The reasons people do not seek help are familiar: stigma, the belief that others have it worse, the cultural norm in high-demand professions that struggle is something to be managed internally, and the genuine difficulty of finding time for care when the job is all-consuming.

What Trauma Treatment Actually Looks Like

The show raises, more implicitly than explicitly, a question that is worth addressing directly: what does it look like to treat PTSD in someone like Robby?

The evidence base for trauma treatment has advanced significantly in recent decades. The gold-standard approaches, according to current VA/DoD guidelines and a substantial body of peer-reviewed research, are trauma-focused therapies that engage directly with the traumatic material rather than around it.

Cognitive Processing Therapy (CPT) helps people identify and examine the beliefs that trauma has produced — about safety, trust, control, self-worth, and relationships — and evaluate them against evidence rather than treating them as established facts. For someone like Robby, whose trauma has likely shaped how he understands his own responsibility for outcomes he could not control, this kind of cognitive work is often where the most meaningful shifts happen.

Prolonged Exposure (PE) works through graduated, structured engagement with avoided memories and triggers, allowing the nervous system to learn that the memory, while painful, is not the same as the original danger. It is the clinical formalization of what happens naturally when trauma resolves on its own: the events are told, retold, and gradually lose their ability to hijack the present.

EMDR, Eye Movement Desensitization and Reprocessing, uses bilateral stimulation while a person holds a traumatic memory in mind, in a way that appears to reduce the emotional charge of the memory and facilitate its integration. Research on EMDR in healthcare workers, including studies conducted during COVID-19, has shown meaningful reductions in PTSD symptom severity.

All of these approaches share a common feature that is also the thing most people with PTSD most want to avoid: they require turning toward the difficult material rather than away from it. This is uncomfortable by design. It is also why having a trained therapist guide the process matters. The goal is not to relive the trauma. It is to process it in a context that is safe enough that the nervous system can update its threat assessment and allow the memory to become part of the past rather than a recurring presence in the present.

A Note for Healthcare Workers and First Responders

If you are in a profession that regularly exposes you to acute human suffering — medicine, emergency response, social work, law enforcement — I want to name directly that what you carry from that work is real and that it warrants the same care that you extend to the people in your charge.

The cultural norm in these fields, the one "The Pitt" depicts with some precision, is that you manage it. You debrief, if there is time. You go home. You come back and do it again. This works until it does not, and often people do not notice it has stopped working until the accumulation is significant.

You do not have to be in crisis to benefit from support. You do not have to be unable to function. The fact that you are still showing up, still performing, still caring for other people is not evidence that you do not need care yourself. It is often, in fact, evidence of how much you do.

References

Carmassi, C., Foghi, C., Dell'Oste, V., Cordone, A., Bertelloni, C. A., Bui, E., & Dell'Osso, L. (2020). PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Research, 292, 113312. https://doi.org/10.1016/j.psychres.2020.113312

Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., Feltner, C., Brownley, K. A., Olmsted, K. R., Greenblatt, A., Weil, A., & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141. https://doi.org/10.1016/j.cpr.2015.10.003

Di Nardo, M., Terzoni, S., Cammarata, S., Baccelli, F., Bistoletti, B., Cologni, G., & Ferrara, P. (2022). Post-traumatic stress disorder among healthcare workers during the COVID-19 pandemic in Italy: Effectiveness of an eye movement desensitization and reprocessing intervention protocol. Frontiers in Psychology, 13, 942188. https://doi.org/10.3389/fpsyg.2022.942188

Orrù, G., Marzetti, F., Conversano, C., Vagheggini, G., Miccoli, M., Ciacchini, R., Panait, E., & Gemignani, A. (2021). Secondary traumatic stress and burnout in healthcare workers during COVID-19 outbreak. International Journal of Environmental Research and Public Health, 18(1), 337. https://doi.org/10.3390/ijerph18010337

Ramachandran, S., Bhatt, M., Bhattacharya, S., & Grover, S. (2021). A review of PTSD and current treatment strategies. Missouri Medicine, 118(6), 546–551.

The Questions Men Have About Therapy But Don't Ask Out Loud

Something has been shifting. More men are searching for therapists, walking into offices, and having conversations they would not have had five years ago. The cultural permission to take mental health seriously is wider than it has ever been, at least on the surface.

And yet in my clinical work, I notice that men often arrive carrying questions they have not asked anyone — about what therapy actually is, what it asks of them, whether it will help, and what it means about them that they are there. These questions often go unspoken not because the answers are not wanted, but because asking them feels like another form of exposure in an experience that already feels unfamiliar.

So here, directly, are the questions I hear most often from men — and honest answers to each.

"Do I have to talk about my childhood?"

Not necessarily, and not right away.

The cultural caricature of therapy as an endless excavation of childhood wounds puts a lot of men off before they have even started. And while understanding the past is genuinely useful in certain kinds of work, therapy is not a single thing. Cognitive Behavioral Therapy, for instance, is largely focused on the present: the patterns of thinking and behavior that are creating difficulty right now, and what to do differently. It is concrete, structured, and goal-oriented in ways that many men find more intuitive than the open-ended exploration they feared.

A good therapist will work with what matters to you and what you actually want to change. If childhood is relevant, it will emerge when it is useful. If what you need is practical tools for managing anxiety, improving sleep, or handling pressure at work or at home, that is where the work will go. The first session is largely about figuring out together what the work should be.

"Is something actually wrong with me, or am I just stressed?"

This is one of the most common questions men arrive with, and it is almost always asked with some underlying hope that the answer is "just stressed" and therefore no significant help is needed.

The honest answer is: that distinction matters less than how you are functioning and how you are feeling.

Stress, anxiety, depression, and burnout exist on a continuum and they do not always announce themselves with clear labels. What tends to matter more clinically is whether something is persistently interfering with your sleep, your relationships, your work, your ability to enjoy things, or your sense of yourself. Irritability that your partner keeps bringing up. Drinking more than you used to. A low motivation that has lasted longer than a rough week. Feeling like you are going through the motions.

These are not character flaws and they are not signs of weakness. They are signals that something in the system is under more load than it can handle without support. You do not need a formal diagnosis to benefit from therapy, and waiting until things are worse is not a prerequisite for getting help.

"Will I actually have to talk about my feelings? Because I'm not sure I know how."

Yes, to some degree. But less than you probably think, and it can be learned.

Many men arrive in therapy with a genuine unfamiliarity with emotional language, not because something is wrong with them, but because emotional vocabulary is rarely taught and often actively discouraged. Boys learn early that feelings are to be managed privately, pushed through, or converted into action. The language of inner experience can feel genuinely foreign.

Good therapy does not require you to arrive fluent in your own emotional life. Part of what the work does is build that capacity over time. It often starts more concretely: what is happening in your body when things feel off, what situations consistently make things worse, what you notice yourself doing or avoiding. From that concrete starting point, the emotional layer becomes more accessible gradually. You do not have to know how you feel before you start. You start, and it becomes clearer.

"I've been dealing with this for years. Is it too late?"

No. And this question is worth taking seriously because of what it reveals: the belief that having struggled silently for a long time is itself evidence that the struggle is permanent, or that help could have worked once but no longer can.

Neither is true. The duration of a problem does not determine whether it is treatable. Many of the most meaningful changes I have seen in clinical work have come from people who had been managing something alone for a decade or more before seeking support. What the duration does tell us is how entrenched certain patterns may be, and that the work may take longer. But longer is not the same as impossible.

There is also something worth naming about the years of managing alone: that took real effort. The capacity that allowed someone to keep functioning, keep working, keep showing up for the people who depend on them while carrying something heavy, is a real capacity. Therapy does not ignore that. It works with it.

"What if I start and it doesn't work?"

This is a reasonable concern, and it deserves a straight answer rather than reassurance.

Therapy does not work for everyone in every form. The evidence for certain approaches, particularly CBT and its variants, is strong across a wide range of conditions. But the fit between a person and a therapist matters enormously, and the first therapist you try may not be the right one. This is not a reason to avoid trying. It is a reason to treat the first attempt as information rather than a verdict.

What also tends to make therapy not work is starting before you are ready to be honest, or going through the motions without real engagement. If you try and it does not feel useful, that is worth saying out loud to the therapist. A good one will want to know. And if it is clearly the wrong fit, it is worth trying again with someone different rather than concluding that therapy itself is the problem.

"Isn't therapy just talking? Why can't I just talk to a friend?"

Friends are genuinely valuable, and strong social connection is itself protective for mental health. This is not an either-or.

But therapy offers something different from friendship. A therapist is trained to hear what is being said and what is not being said, to recognize patterns across sessions, to offer frameworks that help make sense of what you are experiencing, and to do all of this without their own needs, history, or reactions entering the room. The relationship has a specific structure and purpose that conversation with a friend, however meaningful, does not replicate.

There is also something about the asymmetry of a therapeutic relationship that many men find freeing: you do not have to manage the other person's feelings about what you share. You are not taking care of anyone in that room. You can say things you could not say to someone whose opinion of you matters to your daily life, and that freedom is often where the most useful work happens.

"What will people think?"

In my experience, this question has two layers. The outer layer is about what colleagues, friends, or family members might think if they knew. The inner layer, which is usually the more operative one, is about what it means about you.

On the outer layer: the cultural moment around men's mental health is genuinely different than it was a decade ago. More public figures, athletes, and men in visible roles have spoken about therapy and psychological struggle. Attitudes are shifting. And the practical reality is that most people in therapy are not telling their coworkers, and confidentiality is foundational to the work.

On the inner layer, which matters more: seeking support for something that is not working is not weakness. It is, in the most straightforward sense, competence. You identified a problem. You found a resource. You did something about it. That sequence describes someone who manages their life effectively, not someone who cannot handle it.

The men I have worked with who have been most helped by therapy are not the ones who arrived with the least resistance. They are the ones who came in skeptical, stayed because something started to shift, and eventually looked back and wished they had not waited as long as they did.

A Note for Men Considering Starting

You do not need to have a crisis to justify therapy. You do not need to be certain it will help. You do not need to know exactly what you want to work on.

What you need is enough curiosity, or enough discomfort, to walk in and see what happens. The first session is a conversation. You are not committing to anything beyond showing up for it.

Spring Anxiety Is Real: Why You Might Feel Worse When Everything Looks Better

April arrives. The light is back. The city is louder, more alive. Everyone around you seems to be shaking off winter and stepping into something more expansive — outdoor dinners, weekend plans, a general sense of momentum and renewal.

And somehow, you feel worse.

More restless. More irritable. Sleeping fitfully despite the exhaustion. Anxious about things that didn't seem to bother you in February. Maybe even a low, vague dread that you cannot quite locate or name — which is its own particular kind of unsettling, because nothing is obviously wrong.

If this sounds familiar, you are not alone, and you are not irrational. Spring anxiety is real, it is documented, and it has several intersecting causes that are worth understanding — especially because the cultural narrative around this season makes it so much harder to take seriously.

The Counterintuitive Truth About Spring and Mental Health

Most people associate seasonal mental health challenges with winter: shorter days, less light, reduced activity, the classic picture of seasonal affective disorder. And winter is genuinely hard for many people.

But research consistently shows that depression and anxiety rates — and notably, suicide rates — actually peak in late spring and early summer, not in the depths of winter. This finding has been replicated across multiple countries and decades, and it consistently surprises people who expect the data to tell a different story.

The reasons are multiple and they interact. Understanding them does not make the experience disappear, but it can make it considerably less bewildering — and bewilderment, in the presence of anxiety, tends to make anxiety worse.

The Biology: Your Nervous System Is Playing Catch-Up

Spring involves a rapid and significant shift in the biological conditions your nervous system operates within, and that transition is not seamless for everyone.

Light and circadian disruption. As days lengthen, light exposure increases dramatically and earlier-morning sunrises begin penetrating bedrooms that were dark through winter. This disrupts melatonin production — the hormone that regulates sleep timing — which can fragment sleep even for people who do not feel tired in a traditional sense. And disrupted sleep has downstream effects on emotional regulation, irritability, and anxiety that are well established in the literature. You can be losing meaningful sleep before you notice you are doing it.

Serotonin fluctuations. Increased light exposure triggers increased serotonin production. This sounds straightforwardly positive — and often is. But serotonin is not simply a "feel good" chemical. It is a regulator. For people with sensitivities to serotonin fluctuations — including some individuals with anxiety disorders — rapid increases can produce restlessness, agitation, and heightened reactivity rather than simply elevated mood.

Allergies and inflammation. This is one of the least-discussed but most clinically interesting mechanisms behind spring anxiety. When the immune system responds to environmental allergens — pollen, mold, increased particulates — it releases cytokines, inflammatory chemicals that can cross the blood-brain barrier and directly affect mood regulation, cognitive clarity, and emotional tone. Research has found meaningful associations between seasonal allergic rhinitis and elevated rates of depression and anxiety during pollen season. If your spring anxiety always arrives roughly when your allergies do, this is not a coincidence. Your immune system and your nervous system are in conversation, and allergy season is a stressful time for both.

Daylight Saving Time. The spring clock change — seemingly minor — reliably fragments sleep in the weeks following the switch. Studies have linked it to increased cardiovascular events, traffic accidents, and mood dysregulation in the days and weeks that follow. For people already managing anxiety, this compressed disruption to circadian timing can act as a meaningful trigger.

The Psychology: The Weight of Renewal

Beyond biology, spring carries a specific psychological burden that winter — with its cultural permission to hibernate — does not.

Spring is the season of supposed to. You are supposed to feel energized. You are supposed to be making plans, getting outside, being social, starting fresh. The cultural messaging around this time of year is relentless: renewal, new beginnings, productivity, emergence. It is the season most saturated with the expectation of positive feeling.

For someone who is actually feeling anxious, flat, restless, or depleted, this creates a painful gap between inner experience and outer expectation. In cognitive terms, it is a recipe for self-directed criticism: What is wrong with me? Everyone else seems to be flourishing. I should be happy — the weather is finally nice. That secondary layer of shame and self-judgment sits on top of the original distress and amplifies it.

There is also the social activation that spring demands. For people with social anxiety or strong introversion, winter offers a natural, socially acceptable reduction in obligation. The cold weather and shorter days provide cover for staying in, declining invitations, keeping a quieter life. When spring arrives, the implicit social contract changes. The expectation of activity, participation, and visibility returns. For some, this shift from low-demand to high-demand social seasons is genuinely destabilizing — not because they dislike other people, but because the pace of re-engagement outstrips what they are ready for.

Spring also tends to cluster with high-stakes external events: the end of the academic year, tax season, performance reviews, relationship transitions, major life decisions that were deferred through winter. The season of renewal often arrives carrying a pile of things that have been waiting.

What Spring Anxiety Can Look Like

Because spring anxiety does not fit the cultural template of what anxiety "should" look like in this season, it often gets misread or minimized — including by the people experiencing it.

It can look like irritability that seems disproportionate to circumstances — snapping at people you care about, feeling a low tolerance for minor frustrations.

It can look like sleep difficulties that are distinct from winter patterns: trouble falling asleep despite fatigue, early-morning waking, a mind that will not quiet down at night even when the day was physically tiring.

It can look like a restless, keyed-up sensation — not quite panic, but a background hum of unease that makes it hard to settle, concentrate, or feel present.

It can look like a strange resistance to things that are supposed to be enjoyable — plans you made, gatherings you were looking forward to, the arrival of good weather itself. Anhedonia in spring is confusing precisely because the season is so full of ostensibly pleasant things.

It can also look like a resurgence of symptoms that were quieter over winter. For people with pre-existing anxiety, the biological and psychosocial shifts of spring can lower the threshold for symptoms that were better managed in a more contained season.

What Actually Helps

Understanding the source of spring anxiety does not eliminate it, but it does change what you reach for. A few things that are genuinely useful:

• Protect sleep aggressively. The circadian disruption of spring is real and its effects compound quickly. Blackout curtains to block early sunrise, a consistent wake time, and a wind-down routine become more important in this season, not less. If your anxiety is spiking and your sleep has shifted, start there.

• Name the pressure, not just the feeling. If part of what you are experiencing is the gap between how you think you should feel and how you actually feel, naming that explicitly to yourself — and perhaps to someone else — can reduce its weight. You do not have to perform springtime. The season does not obligate you to feel renewed.

• Pace your social re-entry. You do not have to accept every invitation or match your output to the season's energy. Deliberate, manageable social engagement is more sustainable than a sudden leap into a full social calendar, especially if winter was quieter. Give yourself permission to transition gradually.

• Consider the allergy-anxiety connection. If your symptoms correlate with elevated pollen counts or allergy season, treating the allergies may have more mental health benefit than you expect. Reducing systemic inflammation reduces its downstream effects on mood and cognition. This is an underutilized lever.

Don't wait for the season to pass. One of the more counterproductive responses to spring anxiety is the assumption that it should resolve on its own because the season is supposed to be good for mental health. Waiting for the calendar to fix it can allow a manageable spike to become a more entrenched pattern.

Are You Using AI for Emotional Support? Here's What a Psychologist Wants You to Know

Something has quietly shifted in how people are managing their mental health between therapy sessions — and increasingly, before they ever make an appointment at all.

Many people are now turning to AI chatbots to process stress, rehearse difficult conversations, vent about relationships, and search for coping strategies. It is immediate, available at any hour, and carries none of the vulnerability that comes with disclosing something to a real person. For someone sitting with anxiety at 11pm who isn't sure it rises to the level of a therapy appointment, an AI chatbot feels like a reasonable first stop.

A new paper published in JAMA Psychiatry is drawing attention to this shift — and making a pointed argument to the mental health field: it is time for therapists to routinely ask patients about their AI use. Not as a judgment, but as clinical information as relevant as sleep, exercise, or alcohol consumption.

I think this is exactly right. And I want to explain why, from where I sit as a clinician.

What People Are Actually Using AI For

The research, led by Shaddy Saba at NYU's Silver School of Social Work and colleagues, reflects a behavioral reality that is already in the room with many of my patients — whether it gets named or not.

People are using AI chatbots to think through interpersonal conflicts before they happen. How to approach a hard conversation with a partner. How to respond to a difficult message from a family member. What to say when a colleague does something that feels unfair. This kind of social rehearsal is something humans have always done — with friends, in journals, in therapy — but AI offers it without friction or social cost.

People are also using chatbots to process emotional experiences in real time: venting about a bad day, describing what anxiety feels like, asking whether what they are going through sounds like depression. Some are using AI as a supplement to therapy. Others are using it as a substitute, either because they cannot yet afford care, are on a waitlist, or haven't yet decided that what they are experiencing warrants professional support.

All of this matters clinically. Because the content of those conversations — the things people type into a chatbot at midnight that they haven't said aloud to anyone — can tell a therapist a great deal about what is actually at the center of someone's distress.

What AI Gets Right, and Where It Falls Short

There is a reason AI chatbots feel supportive in the moment: they are designed to be affirming and responsive. They do not get tired. They do not become uncomfortable with difficult material. They do not carry their own emotional reactions into the conversation. For someone who has experienced judgment, dismissal, or rupture in human relationships, that kind of consistent, non-reactive presence can feel genuinely relieving.

This is not nothing. Feeling heard, even by a machine, can reduce acute distress.

But there is a meaningful difference between feeling heard and being changed — and that difference is where the limitations of AI become clinically significant.

Therapy is not primarily a listening service. It is a process of change. It works by helping people recognize patterns they cannot see from inside them, challenge beliefs that feel like facts, build tolerance for the emotions they have been avoiding, and practice different ways of relating — including in the therapeutic relationship itself. Good therapy is often uncomfortable. It asks you to look at things you came in hoping to avoid. It challenges you. It does not simply affirm what you already think and feel.

An AI chatbot, by design, does the opposite. It tends to validate, agree, and reflect back what the user presents. Former National Institute of Mental Health director Tom Insel has noted this directly — that AI chatbots can be affirming to the point of sycophancy, simply reinforcing a user's existing thoughts and feelings rather than creating the conditions for genuine change. For someone with depression who believes they are a burden, or someone in an unhealthy relationship who is looking for confirmation that their partner is the problem, that uncritical validation can quietly deepen the very patterns that brought them to seek support in the first place.

There is also the question of what AI misses. People often use chatbots to process things they feel too ashamed or frightened to bring to another person — including, as psychiatrist Roy Perlis notes in his JAMA Psychiatry paper, thoughts of suicide. The anonymity of an AI conversation can lower the threshold for disclosing distress that would never come up in a clinical intake. That content is clinically meaningful. Without the conversation happening between patient and provider, it remains invisible to the people best positioned to help.

AI Use as Clinical Information: What It Can Reveal

What the researchers argue — and what I find compelling — is that asking patients about their AI use is not just about monitoring a habit. It is a clinical window.

What someone brings to an AI chatbot can reveal what they are most preoccupied with, what they feel they cannot say to the people in their lives, and what coping strategies they are already trying. It can also reveal avoidance: if someone is consistently using AI to manage conflict with a partner rather than having the actual conversation, that pattern is clinically significant. It may be maintaining the very relational difficulty they say they want to address.

Bringing AI conversations into the therapy room — even in general terms — can enrich the clinical picture in ways that a structured intake never would. It surfaces the content of someone's private inner life in a way that is less guarded than direct disclosure, because it has already been said to something that felt safe.

It can also open up a valuable psychoeducational conversation about what therapy is and how it works, and why the frictionless support of an AI chatbot, however comforting, is doing something fundamentally different from what happens in a well-functioning therapeutic relationship.

A Note About the Broader Picture

The JAMA Psychiatry paper by Perlis makes a point worth sitting with: the mental health field is at an inflection point with AI, and the risks have received considerably less attention than the promise.

The potential benefits are real. AI tools may eventually expand access to mental health support for people who face significant barriers to care — cost, geography, waitlists, stigma. The global treatment gap in mental health is enormous, and AI is not going to close it alone, but it is a conversation that the field has to take seriously.

At the same time, the availability of AI chatbots as pseudo-therapeutic tools carries risks that are genuinely difficult to evaluate. The probabilistic nature of large language models means their capacity to produce harmful responses — or simply unhelpful, validating ones — is hard to predict and harder to regulate. An AI chatbot does not have a license to revoke. It does not have a governing ethics board. It cannot be held accountable in the way a clinician can, and the people most likely to rely on it as a primary mental health resource may be the least equipped to evaluate its limitations.

The paper calls for thoughtful regulation, clinician training, and ongoing evaluation of how AI is actually affecting mental health outcomes in practice. These are not hypothetical concerns. They are the preconditions for this technology being used in ways that genuinely help people rather than giving them a convincing substitute for the help they actually need.

What This Means in Practice

If you are currently using an AI chatbot for emotional support, I want to be clear: I am not suggesting that is something to be ashamed of or to hide. It is an understandable response to real emotional needs, and for many people it is filling a gap that matters.

What I am suggesting is that it is worth being thoughtful about what the gap is and whether AI is genuinely addressing it — or providing enough relief to reduce the urgency of addressing it differently.

There are questions worth sitting with:

Are you using AI to process difficult feelings and gain perspective, or are you using it to avoid conversations, decisions, or confrontations that need to happen with actual people in your life? Are the responses you are receiving pushing you toward growth and change, or primarily confirming what you already believe? Are you turning to AI instead of therapy because the barrier to care feels too high, and is that barrier worth examining?

These questions do not have a single right answer. But they are the kind of questions that belong in a therapy room — and increasingly, they are questions about AI use itself.

References

Perlis, R. H. (2026). Artificial intelligence and the potential transformation of mental health. JAMA Psychiatry, 83(4), 409–413. https://doi.org/10.1001/jamapsychiatry.2025.4116

Saba, S., & colleagues. (2026). [AI use and mental health care: Implications for clinical practice]. JAMA Psychiatry. [As reported in NPR, April 6, 2026: https://www.npr.org/2026/04/06/nx-s1-5766349]

The "Core Sleep" Myth: What Sleep Medicine Actually Says

If you have spent any time on wellness corners of the internet recently, you may have come across the concept of "core sleep" — the idea that there is a minimum essential portion of your night that delivers the most important sleep benefits, and that the rest is optional. The implication is appealing: sleep smarter, not longer. Get the good stuff, skip the padding, and reclaim your hours.

It sounds like optimization. As a sleep psychologist, I want to gently redirect it.

"Core sleep" is not a clinical term. It does not appear in sleep medicine literature, and it is not a concept used in Cognitive Behavioral Therapy for Insomnia (CBT-I), which is the gold-standard, evidence-based treatment for sleep difficulties. What it appears to be is a simplified — and somewhat distorted — interpretation of something real about how sleep is structured, applied to a conclusion that the research does not support.

Here is what the science actually says, and why it matters for how you think about your own sleep.

There Is Something Real in the Idea — But the Conclusion Is Wrong

Sleep is not uniform across the night. Deep sleep — specifically slow-wave sleep, or NREM stage 3 — does concentrate more heavily in the first portion of the night. REM sleep, the dreaming stage most associated with emotional processing and memory consolidation, accumulates more in the second half. This architecture is real and well-documented.

The mistake the "core sleep" concept makes is treating the first part of the night as sufficient because it contains more deep sleep, and treating the second half as less essential. This misunderstands what the different stages are doing.

Deep sleep and REM sleep serve different and complementary functions. Deep sleep is particularly important for physical restoration, immune function, and certain forms of memory consolidation. REM sleep plays a central role in emotional regulation, creative thinking, and the processing of complex or emotionally charged experiences. Both matter. They are not interchangeable, and neither is optional.

A useful way to think about it: sleeping only through the first half of the night is like leaving a film at the halfway point. The setup is complete. But the second half is where the meaning gets made, where the threads come together, where the experience becomes whole. You have not gotten the film — you have gotten part of it.

Why "Core Sleep" Is So Appealing

It is worth taking seriously why this concept resonates. It taps into something deeply familiar in how many of us relate to productivity and time: the belief that everything, including the body, can be optimized. If sleep has a most-efficient portion, maybe we do not need to give it the full eight hours. Maybe we can compress it, extract the essentials, and get back to everything else.

There is also something specific about sleep recommendations that breeds fatigue. Consistent sleep schedule. Limit screens before bed. Keep the bed for sleep only. These are the recommendations that have been repeated for years — because they are the recommendations that actually work. But familiarity can make them feel less exciting, and people are naturally drawn to approaches that feel newer or more sophisticated.

In clinical work, a significant portion of what we do together is not explaining the recommendations — most patients already know them. It is the harder work of examining what gets in the way of actually carrying them out, and troubleshooting the real obstacles. That is usually where the change happens.

The appeal of "core sleep" is understandable. But the underlying promise — that you can function well on meaningfully less sleep if you just structure it correctly — is not one the evidence supports.

What Happens When You Consistently Underslept

One of the more striking findings in sleep research is the gap between how people feel when they are chronically sleep-restricted and how they are actually performing. Studies consistently show that people adapt to reduced sleep in the sense that they stop noticing the deficits. They feel as though they are functioning fine. Objective measures of focus, memory, reaction time, and decision-making tell a different story.

This matters for how we evaluate sleep strategies. If you try limiting yourself to what you believe is your "core sleep" and you feel okay the next day, that feeling is not strong evidence that the strategy is working. It may simply reflect the brain's diminished capacity to accurately assess its own impairment.

Over time, consistently shortchanging sleep — even by amounts that feel manageable — accumulates. The effects appear in cognitive performance, emotional regulation, immune function, and longer-term health outcomes. Sleep debt is real, and the body keeps its own accounting.

What Actually Makes Sleep Restorative

In clinical practice, the question that matters most is not whether someone is hitting a specific number of hours, but how their sleep is functioning and how they are functioning because of it.

The qualities that tend to make sleep most restorative are continuity and consistency. Consolidated sleep — sleep that flows relatively uninterrupted through its cycles across the whole night — is more restorative than the same total hours fragmented by repeated awakenings. Consistent timing, going to bed and waking at roughly similar times, supports the circadian regulation that allows all the stages to occur in their proper sequence and proportion.

Daytime functioning is the other essential signal. Energy, focus, mood, and the ability to engage with your life are what we are ultimately trying to support. If sleep is doing its job, those things should be reasonably stable. When they are not — when fatigue is persistent, concentration is scattered, mood is fraying — that is information that the sleep, regardless of its duration, may not be providing what the body and brain need.

It is also worth naming something that often gets lost in optimization-oriented sleep conversations: good sleep does not have to be perfect. Even people with genuinely healthy sleep have off nights. Variability is normal. The goal is not flawless sleep architecture measured to the hour — it is sleep that is, over time, sufficient and restorative. Releasing the pressure to achieve perfect sleep is, somewhat paradoxically, one of the things that tends to make sleep better.

The Deeper Issue With Sleep Shortcuts

The "core sleep" concept is one example of a broader pattern in how sleep information circulates online: a real scientific observation gets extracted from its context, simplified, and repurposed into a recommendation that the original science does not actually support.

This matters because beliefs about sleep shape behavior around sleep, and some of those beliefs can quietly make sleep worse. The belief that you can function on very little sleep if you just optimize correctly can lead people to undersleep and then rationalize their impairment. The belief that there is a specific, narrow window of essential sleep can generate anxiety about whether you are hitting it — and anxiety about sleep is itself one of the most common drivers of insomnia.

CBT-I spends a significant amount of time working directly with beliefs about sleep: examining where they came from, testing them against evidence, and replacing unhelpful ones with more accurate and flexible thinking. What someone believes about sleep is often as clinically relevant as what they are doing behaviorally.

What to Focus on Instead

If the goal is genuinely restorative sleep, the evidence points clearly toward a few things:

Prioritize the full night. Both the deep-sleep-rich early portion and the REM-rich later hours serve your brain and body. Protecting the whole sleep period — not just the first part — is what allows all the stages to complete their work.

Consistency over perfection. A regular wake time is the most powerful regulator of your sleep architecture. It does not have to be rigid to the minute, but the more consistent it is, the better your circadian system can anticipate and prepare for sleep.

Pay attention to how you feel. Daytime energy, mood, and cognitive clarity are your best personal metrics for whether sleep is doing its job. These are more meaningful than a sleep tracker score or a fixed hour target.

Approach sleep without excessive pressure. Sleep is a biological process, not a performance. The more urgently we pursue it, the more elusive it can become. Good enough, most nights, is genuinely good enough.

Citations

Diekelmann, S., & Born, J. (2010). The memory function of sleep. Nature Reviews Neuroscience, 11(2), 114–126. https://doi.org/10.1038/nrn2762

Killgore, W. D. S. (2010). Effects of sleep deprivation on cognition. Progress in Brain Research, 185, 105–129. https://doi.org/10.1016/B978-0-444-53702-7.00007-5

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

Van Dongen, H. P. A., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26(2), 117–126. https://doi.org/10.1093/sleep/26.2.117

Walker, M. P., & Stickgold, R. (2006). Sleep, memory, and plasticity. Annual Review of Psychology, 57, 139–166. https://doi.org/10.1146/annurev.psych.56.091103.070307

When Fear of Aging Actually Makes You Age Faster

Most of us have had the thought at some point — catching our reflection in an unexpected mirror, forgetting a word that should come easily, noticing a shift in our body that wasn't there a year ago. I'm getting older.

For some women, that thought passes. For others, it lingers, loops, and grows into something that shapes how they move through their days: a persistent, underlying dread about what aging means for their health, their body, their independence.

New research from NYU School of Global Public Health suggests that this fear — specifically, anxiety about aging — may do more than weigh on the mind. It may be accelerating the very process it fears.

What the Research Found

Published in February 2026 in the journal Psychoneuroendocrinology, the study examined data from 726 women participating in the Midlife in the United States (MIDUS) study. Participants reported how much they worried about different dimensions of aging: declining health, becoming less attractive, and being too old to have children.

Researchers then analyzed blood samples using two established "epigenetic clocks" — molecular tools that measure biological aging independently of a person's chronological age. One clock, called DunedinPACE, measures the speed of biological aging in real time. The other, GrimAge2, estimates accumulated biological damage over a lifetime.

The findings were striking: women who reported higher levels of aging anxiety showed signs of faster biological aging on the DunedinPACE clock. In other words, the more anxious a woman was about growing older, the faster her cells appeared to be aging.

"Our research suggests that subjective experiences may be driving objective measures of aging," said Mariana Rodrigues, the study's first author and a PhD student at NYU School of Global Public Health. "Aging-related anxiety is not merely a psychological concern, but may leave a mark on the body with real health consequences."

Not all aging worries carried the same weight. Concerns about health decline were most strongly tied to faster epigenetic aging. Worries about appearance and fertility, by contrast, did not show the same biological association. The researchers suggest this may be because health fears are more persistent — they don't naturally diminish with age the way reproductive concerns do.

Why This Matters: The Mind-Body Loop

The idea that psychological distress accelerates biological aging is not new. A substantial body of research has established links between chronic stress, anxiety, and depression and a range of physical health outcomes — including cellular aging. What makes this study notable is its specificity: it's not just general anxiety driving these effects, but anxiety about aging itself.

This creates a particularly insidious loop. You fear what aging will do to your health. That fear generates chronic psychological stress. Chronic stress — through cortisol dysregulation, inflammation, and epigenetic changes in gene expression — may accelerate the very biological processes you were afraid of. The anxiety about aging becomes a driver of the aging process.

This is not a reason to feel worse, or to add fear-of-fear-of-aging to the list. It's a reason to take aging anxiety seriously as a target for psychological intervention — not just for quality of life, but potentially for long-term physical health.

Why Women Are Particularly Vulnerable to Aging Anxiety

The study's focus on women is deliberate and clinically meaningful. Women in midlife often face a specific convergence of pressures that can amplify anxiety about aging.

There are the cultural messages — still pervasive, still damaging — that tie a woman's value to her youth, her appearance, and her fertility. There is the reality of perimenopause and menopause, which brings physiological changes that can feel sudden and disorienting. And there is what Rodrigues describes as the particular weight of being the person who witnesses aging most closely: women in midlife are often simultaneously raising children and caring for aging parents. They are watching what decline looks like from the front row.

"Women in midlife may also be multiple in roles, including caring for their aging parents," Rodrigues noted. "As they see older family members grow older and become sick, they may worry about whether the same thing will happen to them."

In clinical work with women, I see this often. The worry isn't abstract. It's anchored to a specific face — a mother after a stroke, a father with dementia — and it carries the implicit question: Is that what I'm heading toward?

An Important Caveat: What the Study Doesn't Prove

The researchers are careful — and we should be too — about the limits of what this study shows.

Because it is cross-sectional (capturing one point in time rather than following women over years), it cannot establish causation. We don't know for certain that aging anxiety causes faster biological aging. It's possible that women who are already experiencing early signs of health decline are, reasonably, more anxious about aging. The relationship may run in both directions.

The study also found that when researchers adjusted for certain health behaviors associated with anxiety — smoking, alcohol use — the statistical association weakened and was no longer significant. This suggests that some of the biological impact of aging anxiety may be mediated through behavior: people who are chronically anxious may cope in ways that have their own health costs.

This doesn't diminish the finding. It actually adds clinical texture to it. If the pathway runs through behavior, that's potentially good news — behavior is something we can work with in therapy.

What This Means in Practice

For clinicians and for patients, this research opens up a conversation that mental health treatment has been slow to have: aging anxiety as a discrete, treatable psychological concern with potential downstream effects on physical health.

We have frameworks for health anxiety. We have frameworks for body image distress. We have rich clinical literature on grief, loss, and existential concerns. Aging anxiety sits at the intersection of all of these — and yet it often goes unnamed in therapy rooms, treated as a natural background hum rather than a clinical target.

What might it look like to treat it directly?

Cognitive approaches can help examine the specific beliefs driving aging anxiety: the catastrophic predictions about health decline, the rigid equations between aging and loss of worth, the all-or-nothing thinking about what "getting old" means. Many of these beliefs are amenable to careful, compassionate examination.

Acceptance-based work, such as Acceptance and Commitment Therapy (ACT), offers a different route: rather than disputing the fear, it helps people hold aging concerns with more flexibility — acknowledging uncertainty about the future without being consumed by it, and investing in values-based living in the present.

Meaning-making and narrative work can help reshape how a person understands their own aging story. Aging is not only loss. For many women, midlife brings clarity, confidence, and freedom that earlier decades didn't. The dominant cultural narrative about aging is not the only available narrative.

Addressing the social and structural dimensions also matters. Rodrigues closes her research with a call for broader cultural conversation: "We need to start a discourse about how we as a society — through our norms, structural factors, and interpersonal relationships — address the challenges of aging." Therapy can be part of that shift, but it cannot carry it alone.

Reference

Rodrigues, M., Bather, J. R., & Cuevas, A. G. (2026). Psychoneuroendocrinology, 184, 107704.

Winter Fatigue vs Depression vs Insomnia: How to Tell the Difference

Feeling exhausted in the winter is common. Shorter days, colder weather, and disrupted routines can leave many people feeling sluggish, unmotivated, or “off.” But not all winter exhaustion is the same. Fatigue, depression, and insomnia can look similar on the surface, yet they have different causes and require different approaches.

Understanding the difference can help you choose the right next step and avoid unnecessary frustration.

Winter Fatigue: When Your Body Is Slowing Down

Winter fatigue is often a physiological response to seasonal changes. Reduced daylight affects circadian rhythm and melatonin production, which can leave you feeling groggy, low-energy, or mentally foggy.

Common signs of winter fatigue include:

• Low energy during the day

• Heavier sleep or difficulty waking up

• Increased appetite or cravings

• Reduced motivation without persistent sadness

Importantly, people with winter fatigue can usually sleep when given the opportunity. The issue is not insomnia, but rather a mismatch between light exposure, activity levels, and internal clocks.

Helpful strategies often include:

• Morning light exposure

• Gentle increases in movement

• Consistent wake times

• Reduced daytime napping

Depression: When Fatigue Is Emotional as Well as Physical

Depression can intensify in the winter months, especially for those sensitive to seasonal changes. While fatigue is a common symptom, depression goes beyond tiredness.

Signs that fatigue may be part of depression include:

• Persistent low mood or emotional numbness

• Loss of interest or pleasure in activities

• Feelings of hopelessness, guilt, or worthlessness

• Changes in sleep and appetite that do not improve with rest

Sleep in depression can be irregular. Some people sleep excessively and still feel unrefreshed. Others experience fragmented or early-morning awakenings. The defining feature is not just poor sleep, but a shift in mood, motivation, and self-perception.

Treatment often focuses on:

• Psychotherapy

• Behavioral activation

• Addressing negative thought patterns

• Supporting sleep and circadian rhythm

Insomnia: When Sleep Itself Becomes the Struggle

Insomnia is not simply about being tired. It is a condition defined by difficulty falling asleep, staying asleep, or returning to sleep, despite adequate opportunity to rest.

Key signs of insomnia include:

• Long periods awake in bed

• Frequent nighttime awakenings

• Racing thoughts at night

• Anxiety about sleep itself

In winter, insomnia often worsens due to disrupted schedules, reduced light exposure, increased stress, and longer time spent in bed. Over time, sleep can become effortful and associated with frustration or fear.

Unlike fatigue or depression, insomnia is often maintained by:

• Increased sleep effort

• Over-monitoring sleep

• Spending excessive time in bed

• Trying to “force” rest

Evidence-based treatments like Cognitive Behavioral Therapy for Insomnia (CBT-I) target these patterns directly.

Why These Conditions Overlap and Get Confused

Winter fatigue, depression, and insomnia frequently coexist. Poor sleep can worsen mood. Low mood can disrupt sleep. Fatigue can increase time in bed, which can worsen insomnia.

This overlap makes self-diagnosis difficult and often leads people to try solutions that inadvertently increase symptoms. For example:

Sleeping in may worsen circadian disruption

Trying harder to sleep may increase insomnia

Pushing through exhaustion may deepen burnout

Understanding what is driving your symptoms helps clarify what will actually help.

When to Seek Support

If fatigue, low mood, or sleep difficulties persist for several weeks, interfere with daily functioning, or feel increasingly distressing, professional support can be helpful. The right intervention depends on the underlying pattern, not just the symptom.

Winter can be a challenging season, but struggling during this time does not mean something is wrong with you. Often, it means your system needs a different kind of support.

Feeling tired in winter is common. Feeling stuck, hopeless, or unable to sleep is not something you have to push through alone. Differentiating between winter fatigue, depression, and insomnia allows for more compassionate and effective care.

Sometimes the most important step is not doing more, but understanding what your body and mind are actually asking for.