As a psychotherapist, I have been working with clients for whom growing political, environmental, and social threats are compromising their mental health. In some cases, existing symptoms are exacerbated and in other cases, they are experiencing symptoms that are new to them. While many threats are deeply distressing, others are truly existential. Moreover, other factors such as smart phones, which connect us nearly perpetually to social media and a 24/7 news cycle, are also significantly compromising wellbeing for many people.

Within the U.S., since the last presidential election, changes in very long-standing programs, regulations, and precedents, along with increasing divisiveness and political extremism have been deeply unsettling to many people. Recent research shared on a Hidden Brain podcast about group think, has found that over the last several years, for example, the psychology of group membership has shifted, particularly on the right, from the positive effects of belonging to negative effects of greater fear and hatred for outsiders.

Although Donald Trump himself is an individual figure, he is an archetype or icon for much of the political divisiveness we are experiencing. His own behaviors and pronouncements are significant in their own right relative to the mental health of many Americans. What would explain this?

From a psychological (not political) perspective, for many people Trump often represents a narcissistic, predatory, bigoted, dishonest, and sociopathic (non caring) persona, which feels foundationally “unsafe,” particularly for those who have been hurt previously by similar personalities and for those who are not white, male, binary, Christian, heterosexual, and in the mainstream. The perception that Trump can act without accountability further exacerbates these fears, reminiscent of past abusers who faced no consequences. The finely tuned gaslighting from the administration is equally distressing and often reminiscent of previous experiences. Even individuals who may feel “demographically acceptable” to Trump often experience significant dissonance due to his statements and actions that often appear to conflict with basic human decency. The fact that armed federal agents also seem to be acting at his behest, with impunity, intensifies distress for many people because the fear is not just of Trump, but also of his proxies. Again, although the context may be political, the effect is psychological.

As a result of the environmental, political, social, and technological threats described at the beginning of this post many, if not most, of my clients frequently present with clinically significant emotional distress including anxiety, depression, insomnia, and re-triggered trauma symptoms, among others. Some clients are also reporting “medical” symptoms such as headaches, gastrointestinal issues, and loss of appetite, most likely psychogenic and related to the psychological symptoms previously noted. The depth and breadth of this psychological distress is widely discussed among mental health clinicians and has been documented in surveys and empirical research going back to the 20-teens, with more severe symptoms among some groups such as teens and young adults, LGBT+ populations and people of color. The COVID 19 pandemic served as a catalyst for worsening mental health for many Americans.

Another destabilizing factor that often comes up with my clients related to Donald Trump specifically is the underlying aggression and “bullying” inherent in Trump’s approach, without meaningful challenge or accountability. Moreover, the ease with which Trump dehumanizes others is particularly distressing to some of my clients. In fact, the White house frequently uses AI to “doctor” images in official government social media accounts to create misrepresentations of political foes and protestors that are objectively false. This is certainly not unique to Trump, but coming from the president, the affect seems to be even more dislocating.

Whether or not symptoms reach clinical significance, it is evident that compound threats, as described above, are profoundly disturbing to many people. The fact that they are also primarily beyond our control, increases a sense of vulnerability and powerlessness. Fortunately, there are strategies that I have offered to clients, that anyone can use to find ways to alleviate those feelings and improve wellbeing.

• Limit the toxicity: Limit or even eliminate your exposure to news media and social media. Like a lake contaminated by mine tailings, until the contamination source is removed, the lake remains polluted. This also includes avoiding people and places that perpetuate toxic messages and behaviors.

• Find outlets for advocacy and/or activism: While it is impossible to individually control what Trump says or does, voicing dissent and advocating for those at risk can provide a sense of empowerment and purpose, which is often healing.

• Practice mindfulness: Whether through meditation, prayer, communing with nature, or other forms of present-moment awareness, mindfulness can create space between oneself and daily stressors, offering a mental break and somatic calming.

• Pursue safe socialization: Engaging with challenging perspectives is generally beneficial, but during times of sometimes vicious divisiveness and personal attacks, it may be healthier to associate with those who share and validate your views, distinguishing between a supportive environment and a mere echo chamber.

• Enjoy life: Continue to make space for activities you find enjoyable, rewarding, and nourishing. Even in the midst of things you find distressing or even frightening, allowing yourself simple pleasures can be rejuvenating and provide a more balanced perspective.

• Accept what you cannot control: My clients are experiencing many challenges related to political, environmental, and social threats, and most of them are beyond their control. Yes, a person who is astonishingly self-serving and often indecent was elected president. There is nothing anyone can do about that. On the other hand, when you let go of things you cannot change, you free up bandwidth for things you can influence or even control.

• Defend your own humanity: Among the list of things you still have influence and control over is your own humanity. Defend it with ferocity. External threats may be the source of anything from feeling disconcerted to being re-traumatized, but one place you can assert yourself is through maintaining your own humanity and resisting the urge to dehumanize others.

It is unfortunate that we find ourselves in such a distressing period, facing so many external threats, extremism, and divisiveness. While not unprecedented in American history, some elements, such as violation of even sacred norms and the effects of technology, have conspired to create levels of psychic distress that seem to be qualitatively different and more challenging.

If you are also experiencing some level of distress as a result of the trials we are all facing, I hope that the strategies provided above can provide some relief.

Image Credit: Gallup

“New Gallup data confirm that the personal and professional environment of U.S. workers was worse at the end of 2025 than at any point in the past three years across several important metrics”—and more are struggling than thriving for the first time since Gallup has been collecting this data. “This is coupled with U.S. worker engagement dropping to the lowest level on record in the past decade at 31%.”

This decline in worker wellbeing is significant, because it’s not just about the workplace—it’s also about perceptions of personal life as well.

While it is not the job of leaders to address challenges in their workers’ personal lives, it is critical that leaders create work environments that recognize that employees are human beings and don’t stop being human at work. What we know from this and previous Gallup data is that the typical workplace is currently causing more distress for employees on top of what they are dealing with in their personal lives.

Why does this matter for leaders?

In a typical organization, only thirty percent of your workforce is engaged and nearly a fifth is actively disengaged! In other words, about half of your workforce is doing all the work that matters. Employee engagement is now core to a leader’s role. It is probably the single greatest competitive advantage and organization can have.

In short, “the percentage of workers who are thriving in their lives has hit a new low. For leaders and managers, this poses a significant risk to performance. Declining engagement and thriving have well-documented effects on productivity, retention and customer outcomes.” At a time in which the operational environment is more challenging than ever, relying on half of your workforce to achieve critical organizational goals is not only risky, it’s existential.

Fortunately, the Transformation Collaborative’s Leadership Discovery program is designed specifically to support leaders’ efforts to build engagement in their employees and sustainability in their organizations.

Learn more about the Leadership Discovery Program

(Based in part on this NYT Article)

Short-Term Effects on the Brain and Body

Alcohol (ethanol) quickly affects the brain by increasing dopamine, which creates pleasurable feelings, and altering GABA (enhancing) and glutamate (inhibiting), which slows brain activity. It also activates endogenous opioids which further contribute to central nervous system depression. This leads to relaxation, lowered inhibitions, impaired judgment, and reduced motor control. At very high levels, alcohol can suppress brain activity enough to cause unconsciousness or even death. These effects vary among individuals due to factors such as genetics, frequency of use, body weight, other drugs, overall health, etc., but as a general rule, if you are feeling any effects (buzz, sleepy, etc.) from alcohol, then your brain chemistry is under the influence of alcohol. In some studies, brain function is affected at very low blood alcohol levels (.01-.05%), which although “subliminal” in terms of psychoactive effect, may affect things such as reaction time and judgement.

How Effects Increase with Dosage

In effect, alcohol works from “the top down” in the brain, starting with higher cortical functions and proceeding all the way to the brain stem, which is responsible for autonomic functions such as heart rate and respiration.

Blood Alcohol Level	Effects	Brain Region Affected
Low (0.02–0.05%)	Relaxation, mild euphoria	Prefrontal cortex (inhibition relaxed)
Moderate (0.05–0.10%)	Impaired judgment, slowed reflexes	Frontal lobes, cerebellum
High (0.10–0.20%)	Slurred speech, poor coordination	Cerebellum, motor cortex
Very high (0.20–0.30%)	Confusion, stupor	Limbic system, wider brain
Dangerous (0.30%+)	Loss of consciousness, respiratory depression	Brain stem (life-threatening)[1]

Alcohol’s Effect on Mood

For many people, alcohol initially can “improve” mood with dopamine induced euphoria and reduced inhibitions, which can seem to support social interaction and sense of wellbeing. Central nervous system depression can also feel like calm and even temporary relief from anxiety and worry. As blood alcohol levels increase, the increased disinhibitory effect can lead to more “outlandish” or regrettable behavior including things such as promiscuity, self-endangerment, rage, and aggression among other behaviors, which is often not remembered once the alcohol is metabolized out of the body. This is because ethanol also affects the limbic system, and in particular the hippocampus, which is where memories are made and stored.

Next day effects on mood often include anxiety, irritability, brain fog, fatigue, regret, and low mood. The toxic effects of ethanol and acetaldehyde on the body such as headache, nausea, “cotton mouth,” and other symptoms also tend to have a depressive effect on mood. Research suggests that people who are hungover may also have more difficulty regulating emotions. In some cases, dopamine levels don’t just return to baseline, they actually go below baseline as the brain attempts to regain homeostasis, resulting in mood being lower than it was before using alcohol.

Several factors contribute to these emotional hangovers:

• Neurotransmitter rebound as the brain returns to baseline after alcohol’s effects
• Disrupted sleep, since alcohol reduces REM sleep
• Dehydration, which may affect mood
• Memory impairment, which can lead to worry about regretted behaviors

Long-term effects:
Ethanol and its metabolite, acetaldehyde, are toxic to living cells. Over time, regular alcohol use can harm multiple body systems:

• Brain: Associated with reduced brain volume over time, possibly due to inflammation and damage to neurons.
• Mouth and throat: Alcohol is converted to acetaldehyde, a carcinogenic compound that damages DNA and increases the risk of cancers of the mouth, throat, larynx, and esophagus.
• Heart and cardiovascular system: Alcohol temporarily dilates blood vessels but regular use can raise blood pressure, increase risk of hypertension and atrial fibrillation, and may raise breast cancer risk in women due to increased estrogen levels. Evidence on moderate drinking and heart attack or stroke risk remains mixed.
• Digestive system: Alcohol can cause acid reflux, stomach inflammation, intestinal damage, and increased risk of colorectal cancer.
• Liver and Pancreas: The liver metabolizes alcohol and is especially vulnerable, while a byproduct of ethanol, acetaldehyde, can cause severe inflammation and cellular destruction in the pancreas. Heavy drinking can lead to fatty liver disease, inflammation, fibrosis, cirrhosis, and liver cancer as well as both acute and chronic pancreatitis. Early damage to both organs can sometimes be reversed if drinking stops.

Research suggests that chronic alcohol use can also change the brain’s base-line neurotransmitter levels resulting in both neural hypo and hyperactivity with sudden cessation of drinking. This can lead to multiple symptoms from irritability, anxiety, depression and panic to tremors. In terms of withdrawal from severe chemical addiction, some detox symptoms such as seizure are significant enough to require medical interventions.

Risk levels
Although there is likely no completely safe amount of ethanol, health risks are generally low at about one drink per day or less, but risks increase significantly with heavier drinking (around 8–14 drinks per week or more). In short, any level of inebriation indicates likely pathological effects on brain and body. Genetics and existing health conditions also influence how alcohol affects individuals. Reducing or stopping heavy drinking can reverse some of the damage.

Corrupted Cognitive Data

One very significant, but often overlooked problem with regular use of alcohol to intoxication is that while inebriated, even at modest levels, all of the “data” that is compiled by the brain is corrupted—every conclusion, memory, feeling, belief, sensory perception, etc. occurs during an altered state and is therefore at some level incomplete, inaccurate, or simply wrong. But it doesn’t end there. Even when we are no longer “under the influence,” we continue to access the same corrupted data from when we were inebriated to draw new conclusions, modify memories, confirm or deny beliefs, interpret feelings, solve problems, etc. This phenomenon at least partly explains the experience of growing clarity that heavy drinkers experience over extended periods of sobriety.

Summary

Alcohol can produce short-term pleasurable effects but carries increasing health risks with greater and longer-term consumption, affecting the brain, cardiovascular system, digestive tract, and liver & pancreas among other organs. It also often creates deleterious effects on mood and emotional health.

---

[1] Alcohol can be life threatening at relatively low blood alcohol levels even if the brain stem continues to support basic biological functions due to factors such as car accidents, self-endangerment, and suffocation from vomiting.

Image Credit: pngtree.com

A Brief Guide to the Biopsychosocial-Spiritual Model

We have known for a long time that good mental health is connected to biological, social, and psychological factors. Many people have also known intuitively that spiritual influences also often play a role in mental health. There is growing evidence that spirituality, often understood as meaning, purpose, transcendence, being part of something greater than self, and for some, religion, seems to mitigate against multiple mental health symptoms such as depression, suicidality, and anxiety. Those who practice spirituality also appear to live their lives with more hope and positivity and the concept of a spirit or soul as something beyond mind and body resonates with many people.

---

1. Expanding the Model of Mental Health

Traditional frameworks emphasize:

• Biological (genetics, neurochemistry, sleep, medication)
• Psychological (cognition, emotion, behavior)
• Social (relationships, community, culture)

Increasingly, research and clinical practice support inclusion of a fourth domain:

• Spiritual / Existential (meaning, purpose, values, connection, transcendence)

This expanded framework is often referred to as the biopsychosocial-spiritual model.

---

2. What Do We Mean by “Spiritual”?

In clinical research, spirituality typically refers to:

• Sense of meaning and purpose
• Connection to something larger than oneself
• Core values and guiding beliefs
• Experiences of awe, transcendence, or sacredness
• Existential coherence (Why am I here? What matters?)

Spirituality may also be religious — but does not have to be.

---

3. Major Organizations Recognizing Spiritual Dimensions

World Health Organization

The WHO’s quality-of-life instruments include spiritual well-being as a domain of health.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA’s recovery model includes:

• Health
• Home
• Purpose
• Community

“Purpose” and “community” frequently include spiritual dimensions.

---

4. Evidence Base: Key Findings

Depression & Anxiety

Research consistently shows:

• Greater meaning in life predicts lower depressive symptoms.
• Spiritual coping is associated with reduced anxiety in many populations.
• Religious/spiritual involvement correlates with lower suicide risk (in many cultural contexts).

Research summarized by Harold G. Koenig demonstrates associations between spiritual engagement and improved mental health outcomes.

---

Meaning & Existential Resilience

Viktor Frankl, in Man’s Search for Meaning, proposed that meaning is central to psychological survival.

Modern studies support:

• Meaning in life predicts resilience.
• Existential coherence reduces suicide risk.
• Purpose buffers physiological stress.

---

Positive Psychology

Martin Seligman includes “Meaning” in the PERMA model[1] of flourishing. Meaning involves contributing to something beyond the self.

---

Neurobiological Correlates

Studies (e.g., work by Andrew Newberg) show that:

• Meditation and contemplative practices alter self-referential brain networks.
• Spiritual practices reduce stress activation.
• Experiences of awe are associated with neurophysiological regulation.

---

5. Clinical Implications

When Spirituality May Be Protective

• Trauma recovery (post-traumatic growth)
• Grief and loss
• Chronic illness
• Addiction recovery
• Existential depression

When Spiritual Frameworks May Contribute to Distress

• Scrupulosity (pathological guilt about moral issues)
• Shame-based belief systems
• Spiritual bypassing (using spiritual beliefs and practices to avoid dealing with unresolved emotional issues or psychological wounds)
• Rigid or punitive interpretations

---

6. Exploring Spirituality

You might ask:

• “What gives your life meaning?”
• “When things are hard, what helps you make sense of it?”
• “Are spiritual or religious beliefs important in your life?”
• “Do you feel connected to something larger than yourself?”
• “Have any beliefs ever made coping harder?”

See Appendix 1 for an extended list of questions.

---

8. Conceptual Summary

Mental health is increasingly understood as involving:

• Brain and body regulation
• Emotional and cognitive processes
• Relational systems
• Meaning-making and existential coherence

Interestingly, it appears that spirituality may support better mental health and also be protective against influences that compromise mental health.

Appendix 1 – Questions for Exploring Spirituality

Spiritual well-being is not always required for mental health — but for many clients, it plays a significant protective role.

Here are some questions worth sitting with:

About meaning and purpose

• What gives my life a sense of meaning, and where does that meaning come from?
• What would I be willing to sacrifice for, and why?

About connection

• When do I feel most connected — to others, to nature, to something larger than myself?
• What relationships or experiences make me feel like I’m part of something bigger?

About belief

• What do I actually believe about life and death, and does that belief comfort or disturb me?
• Where do I think the universe came from, and does it matter to me?

About values and the inner life

• What do I consider sacred or non-negotiable in my life?
• When I’m at my most honest with myself, what do I think is truly real?
• What practices — prayer, meditation, time in nature, art — make me feel most alive or most myself?

About growth and doubt

• What beliefs have I inherited that I’ve never really examined?
• Where does my spiritual life feel alive, and where does it feel hollow or absent?

The most productive spiritual questions tend to be ones you can’t quickly answer — ones that stay open and keep inviting you back. The discomfort of not knowing is often where the real exploration begins.

---

[1] The PERMA model is a framework for understanding well-being, developed by psychologist Martin Seligman. It consists of five core elements: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment, which together contribute to a fulfilling and happy life. (Wikipedia)

Image credit: freepik.com

After decades of work in fairly traditional organizations, some with non-profit and some with for-profit tax statuses, I chose to radically change my career and my life. In particular, after roughly 20 years in executive roles in for profit contexts, I came to realize some uncomfortable truths. To be clear, profit is not inherently bad. In fact, the profit motive is central to economic growth and profit from one business or investment becomes the capital for future investment. Risk taking and hard work merit reward. The problem is that it is often possible to make more money, at least in the short term, by doing things that cause harm and/or are ethically questionable than by committing steadfastly to a set of consistent values and the collective good.

Over time, the dissonance caused by those truths became personally untenable. Of course, that is not true of all the businesses that I had leadership roles in. However, there are certain ownership models for which the core purpose is to generate as great a return on investment as possible, even if that comes at a cost to integrity and/or other stakeholders. Some of the things I came to understand include:

• From an ownership perspective, my job was primarily to make wealthy people more wealthy.
• I dedicated significant time, effort, skill, and commitment to things that often mattered more to other people than to me.
• At the individual level, whatever profit is realized from a business venture or investment is rarely enough. If there is a way to generate five times ROI vs. four times ROI, investors will typically choose that way even if there is collateral damage.
• Relatedly, very rarely is there enough discipline among investors or directors to sacrifice any amount of personal profit for other meaningful gains—long term revenue growth, mission, collective good—even innovation). Short term almost always trumps long term when profit is in question.
• Owners, investors, shareholders, directors, etc. are usually much better at saying the right thing than doing the right thing, particularly if the right thing has any material cost to it.
• My desire to be “successful” and well regarded contributed to my own myopia and allowed me to occasionally be complicit in decisions and actions that were not aligned with professed organizational values, let alone my own values.
• In retrospect, my naivete was stunning. I actually believed that focusing on things that were good for the organization and good for a broad range of stakeholders over time would be appreciated and rewarded. What I learned was that could only be true as an aside if I also overachieved the metrics that made key people more money—and usually in a short time frame.

At some point, the dissonance indeed became untenable, and I had to make what turned out to be some fairly radical changes for my own well being. I began by doing some deep personal work related to values and what I wanted to be true going forward. It started simply enough by shifting from “What is my next job?” to “What do I want to be true in my life and what role will my work play in achieving that truth?”

What I also learned is that if you are willing to make compromises with foundational things in your life, then you suddenly have many, many options open to you. For example, once I was willing to make much less money, live in a smaller home, give up the “status” of executive roles, etc., going back to school (for the fourth time) to complete a graduate degree in Clinical Mental Health became not only viable, but desirable. That decision turned out to be more aligned with what I want to be true in my life than any other professional decision I’ve ever made. It came with substantial sacrifices, but it not only relieved me of the cognitive and affective dissonance I was previously experiencing, it replaced it with a level of congruence that is grounding and sustaining.

Lastly, I still think about the cases in which my decisions and actions were not aligned with my values. I did not bring my best self to those situations and, as a result, was at some level complicit. However, that “failure” now serves as motivation to do better—to make the world at least a little better off as a result of my efforts. To anyone who was harmed by decisions that I did not resist and/or participated in, I am deeply sorry.

The basis of addiction is training the brain’s reward system to release dopamine (a feel-good neurotransmitter) based on a repeated stimulus. That could be an exogenous (outside the body) chemical such as alcohol or THC or cocaine or it could be a repeated behavior that results in the release of dopamine such as gambling or sex or social media scrolling on a smart phone. The takeaway here is that all roads lead to dopamine.

The problem with repeated use of substances or engagement in behaviors in pursuit of dopamine is that, over time, the same amount of the substance or behavior results in the need for more dopamine, which requires either more frequent use/activity, greater potency, or both. This applies to both substances and behaviors. Not only do we have to “up the ante” to achieve a similar level of dopamine—this is called tolerance—the receptors in neurons that are activated by dopamine become less sensitive as well, so the “feeling” is less intense. When we experience big, frequent releases of dopamine, our brain actually tries to force our reward system back into balance by releasing other neurotransmitters such as dynorphin and GABA, among others, that counteract dopamine, sending the pleasure system into a dopamine deficit.[1] At this point, we often use a substance or engage in a behavior just to feel “normal,” or less bad, rather than to feel good. Although most people are able to fully recover dopamine (D2) receptor sensitivity with extended abstinence, in some cases, over time, the brain’s effort to maintain homeostasis may result in a long-term dulling of the perception of pleasure (anhedonia) regardless of the substance or behavior, and, in rare cases, it appears this can be permanent.

Additional factors that may contribute to or mitigate against addiction include genetic propensity, environment, chronic stress, and age of initial use.

From a mental health perspective, when we choose to use a substance or engage in a behavior that causes significant problems in our lives—work, financial, relationships, etc.—and we keep using/doing it, along with a few other things like increasing tolerance and withdrawal symptoms[2] in the absence of the stimulus, that is referred to as “disordered” use, which is a diagnosis called “substance use disorder.”

Another important point related to addiction, and particularly withdrawal, is that substances that create psychoactive releases of dopamine also usually affect other neurotransmitters in the brain as well. For example, alcohol is a central nervous system depressant and a disinhibitory (we say and do things when inebriated that we wouldn’t when sober). Cocaine is a stimulant and an analgesic. Opioids are central nervous system depressants and powerful analgesics for which we have specific synaptic receptors that when activated, dramatically decrease the transmission of pain signals. Ironically, we have endogenous chemicals in the brain called endorphins that fit into the same receptors and also dull the perception of pain. Endorphins play a role, for example, in a runner’s “high” and often result in feeling diminished pain when an injury is first incurred.

A really important point about addiction is that when substance use and behaviors are used as coping mechanisms (self-medicating) for psychological distress or mental health symptoms, the user tends to experience more than just chemical addiction. There are frequently also psychological implications related to the addictive use and behaviors whether the individual knows they are self-medicating or not. For example, drinking heavily or gambling or playing video games for hours on end may be a means of avoiding the pain of previous trauma or shame or depression or a way of dulling social anxiety. The problem, of course, is that even when substances or behavior temporarily provide relief, the underlying cause of the symptoms we are medicating for often worsen and even the symptoms themselves may become more intense when we enter a dopamine deficit. In some cases we also get a “rebound” effect related to other neurotransmitters in which the symptom or feeling we are trying to avoid returns more intensely when the substance we are medicating with begins to wear off. This is true for both “recreational” and prescription drugs. This dynamic has significant implications for cessation of and recovery from substance use and behavioral addictions because it is very hard to stop self-medicating without a “backfill” for the substance or behavior we are using to “treat” the symptom(s).

The Good News about Dopamine (and other neurotransmitters)

Many activities and substances can generate modest releases of dopamine (and other feel-good neurotransmitters such as oxytocin, endorphins, norepinephrine, adrenalin, serotonin, etc.) that, due to lower amounts of dopamine and less frequent releases, provide pleasure without addiction or counter measures in pursuit of homeostasis in the reward centers of the brain. A beautiful sunset, a hike, intense exercise, lovemaking, a great song, or even a really good meal, all tend to produce feel good moments without risk of addiction. In some cases, one might experience low level “dependence,” which simply means that in the absence of the substance or activity (sugar, caffeine, sex, skiing) one is conscious of not having the positive feeling, and may even long for it, but that is different than addiction, which also includes increasing tolerance, neurobiological withdrawal, and the choice to continue using a substance or engage in a behavior despite it causing clinically significant negative outcomes in one’s life. Repeated hikes in the woods are not likely to lead to significant, negative outcomes and maladaptive behavior!

Figure 1. Neurochemical Responses to Dopamine Spikes (created by ChatGPT)

Summary

Addiction develops when repeated substance use or behaviors train the brain to release dopamine. Over time, tolerance builds—requiring more of the substance/behavior to achieve the same effect—while dopamine receptors become less sensitive. The brain counteracts excessive dopamine with opposing neurotransmitters, creating a deficit where people use just to feel normal rather than good. While most recover with abstinence, some experience long-term or permanent anhedonia.

Risk factors include genetics, environment, stress, and age of first use. Continued substance use or engagement in destructive behaviors despite significant negative outcomes, combined with increased tolerance and withdrawal symptoms, suggest a substance use or behavioral disorder.

Many substances affect multiple neurotransmitter systems beyond dopamine (alcohol depresses the CNS, opioids activate pain-relief receptors, cocaine stimulates). When substances are used to self-medicate psychological distress, addiction becomes more complex—underlying issues often worsen, symptoms intensify during dopamine deficits, and rebound effects occur. Recovery requires addressing both the addiction and the underlying issues being medicated.

The good news: Natural pleasures (exercise, nature, relationships, music) release modest amounts of dopamine without triggering addiction’s tolerance-withdrawal-compulsion cycle. Low-level dependence (missing your morning coffee) differs fundamentally from addiction, which involves escalating use despite serious negative consequences.

---

[1] It’s not possible in this article to go into detail about all of the ways the brain attempts to counteract dopamine, but the process includes releasing other hormones, “down regulating” dopamine (D2) receptors, and activating the HPA Axis (fight or flight system) to increase the presence of stress hormones among other actions. An infographic of this process is provided in this article.

[2] Withdrawal, sometimes called “detox,” refers to potentially intense negative, physical and psychological symptoms that are basically a response to a neurochemical imbalance that occurs when a substance the brain has become accustomed to is no longer present in the brain. Withdrawal symptoms are different depending on the drug, but in most cases, the brains plasticity will eventually achieve recalibration. Some substances present such intense withdrawal symptoms that they may need to be medically managed depending on the intensity of the chemical dependence.

Image Credit: enotalone.com

Defining Grief

Grief is the deep emotional suffering that follows a significant loss — most commonly the death of someone loved and/or deeply cared for, but also the loss of a relationship, a way of life, an identity, a sense of security, future plans, and connection that held profound meaning, among other potential losses.

Grief is both universal and intensely personal. Everyone experiences it, yet no two people grieve in quite the same way or on the same timeline. It typically involves a mix of emotions that can feel contradictory or overwhelming — sadness, anger, confusion, guilt, disorientation, relief, numbness, even moments of unexpected joy. It can also show up physically, as exhaustion, difficulty sleeping, changes in appetite, or a kind of heaviness in the body.

More recently, definitions of grief have expanded to include ambiguous grief (grieving someone still living, like in dementia or estrangement) and disenfranchised grief (losses society doesn’t always recognize or validate, like a pet, suicide, overdose, etc.). Disenfranchised grief can feel more distressing because it often doesn’t allow for shared, public grieving in the way that more traditional, tangible loss and grief does.

Some believe that grief is a reflection of how much the loss mattered—a means of maintaining connection with whom or what is gone.

The Act of Grieving

If grief is how we feel loss, grieving, or mourning, is how we experience and process that loss. Some frameworks, like Elisabeth Kübler-Ross’s well-known stages (denial, anger, bargaining, depression, acceptance), offer a loose map of the process — though most grief researchers today emphasize that these aren’t linear stages so much as states that come and go unpredictably. More recently, David Kessler, a grief and trauma researcher, added finding meaning in loss as a sixth stage to the model.

Grieving is not necessarily about “moving on.” It’s about figuring out how to go forward and build a different life or world around the loss. Healthy grieving often requires cycling back and forth between:

• Loss-orientation: remembering, yearning, crying, meaning-making (past)
• Restoration-orientation: living, distracting, working, laughing, planning (future)

People sometimes worry they’re “doing it wrong” when they laugh or experience pleasure or relief while grieving — but the brain needs breaks to metabolize grief as well as to experiment with what a different, livable future might look like.

Some Helpful Steps for Grieving

1) Acknowledging the Reality of the Loss

It is usually helpful to be very open and direct about who or what was lost and that it/they are no longer here in a physical sense. This supports the brain to update its internal model of the world.

Behaviors that Often Help

• Saying the person’s name out loud
• Talking about how they died (at a pace you can tolerate)
• Participating in rituals (funeral, memorial, private goodbye)
• Encountering reminders instead of permanently avoiding them
• Using concrete language (“died” rather than euphemisms)

2) Allowing Emotional Processing (Not Just Expression)

Grieving isn’t only crying. It includes many emotions that need permission to coexist. Try not to resist emotions, even when intense.

Common emotions include, but are not limited to:

• Sadness
• Anger (at the person, doctors, self, God, randomness)
• Relief (very common but often hidden)
• Guilt
• Confusion
• Fear
• Numbness

Effective processing often looks like:

• Naming emotions instead of explaining them away
• Moving in and out of feeling (oscillation)
• Tolerable doses, although sometimes it will be flooding

3) Supporting Continuing Bonds (This is Not “Letting Go” or Forgetting)

Modern grief research shows adaptation happens by changing the relationship with whom or what was lost, not ending it.

Healthy Activities:

• Talking to the person internally
• Writing letters
• Living by their values
• Keeping and revisiting certain objects
• Telling stories about them
• Rituals that maintain connection
• Making/eating their favorite meal or going to their favorite place
• Asking “what would they say?”

Goal:
To move the sense of what was loss from physical presence → psychological/spiritual presence

4) Social Witnessing

When appropriate, and with people who can be supportive, sharing grief in the presence of others is often healing.

5) Finding Meaning in the Loss

Eventually the mind asks: “Given this happened… who am I now and what does my life look like going forward?” Finding meaning doesn’t mean finding a reason the loss happened, or deciding it was somehow “worth it” or “for the best.” The loss itself may have no good reason. Rather, it’s about finding meaning after the loss — in how you live, what you do, who you become in its wake. Is there something to learn? Is there a legacy you can honor? Is there a purpose you can pursue? Meaning making is less about having answers and more about creating a workable narrative to support going forward.

6) Gradual Rebuilding of Life around the Loss

This is not betrayal of the loss — it’s neurological necessity.

Healthy Activities

• Plan one thing in the future (even a week ahead)
• Try a new routine once weekly
• Re-engage a hobby, even at low intensity
• Learn something unrelated to the loss
• Volunteer in low emotional exposure roles

Signs of Integration

• Pleasure without guilt (eventually)
• Thoughts about the future
• Fond/warm memories
• The loss becomes part of your story, not the whole story

Activities to Support Wellness While Grieving

When someone is grieving, “wellness” doesn’t mean feeling better — it means keeping the nervous system flexible and stable enough to metabolize grief.

1) Giving Your Brain Recovery Breaks (Nervous System Reset)

Grief is physiologically exhausting. Restoration is not avoidance — it is required processing time.

Regulating Activities

• Walking outdoors (especially rhythmic walking)
• Repetitive tasks using the hands (cooking, knitting, woodworking, puzzles)
• Warm water (shower, bath, hot tub)
• Watching familiar shows (predictability calms threat systems)
• Gentle cleaning or organizing
• Artwork
• Time with animals

2) Activities That Maintain Connection with Others (Social Regulation)

Helpful activities

• Sit with someone without needing conversation
• Run errands with someone
• Go to a movie or art show
• Attend grief groups (structured witnessing)
• Briefly engage “strangers”

This isn’t about being “cheered up” — it’s about being in the company of others while sad.

3) Activities That Support the Body (Biological Stabilization)

Grief disrupts sleep, appetite, and hormones — stabilizing the body prevents emotional spiraling.

Small, Realistic Choices

• Eat smaller amounts more regularly and avoid processed food and sugar
• Limit caffeine, alcohol, and other psychoactive substances
• Get regular sunlight exposure, particularly in the morning (5–10 min)
• Commit to consistent bed and wake times
• Stay hydrated
• Gently stretch a few times throughout the day
• Drink warm, non-caffeinated, non-alcoholic drinks in the envening (behavioral cue for sleep)

When Grief Gets Stuck

Sometimes, grief hangs on for months or even years in ways that compromise living an enjoyable life. This doesn’t mean something is “wrong with you;” it simply means that the loss was overwhelming and you are struggling to grieve in a way that provides relief.

Some Indicators of Prolonged Grief

• No oscillation (all avoidance or all immersion)
• Persistent disbelief or denial
• Identity frozen at the time of the loss
• No new friendships or activities months or years later
• Inability to experience any pleasant emotion (anhedonia)
• Physical symptoms or health issues

Sometimes, when grief is overwhelming and the grieving process is stuck, it is helpful to reach out to a therapist with training in grief therapy who is skilled in the tools noted below.

• Reality integration (activities that make the loss tangible, real, and difficult to deny).
• Redefining the relationship with the loss (continuing bonding activities alternated with present day activities not related to the loss)
• Building post-loss identity
• Building a “new” life
• Reducing rumination

Therapists will often use integrated interventions such as Cognitive Behavior Therapy (CBT), Internal Family Systems (IFS), Eye Movement and Desensitization (EMDR), Narrative therapy, Acceptance and Commitment therapy, and others to address prolonged grief.

Grieving Worksheet

1. Naming the Loss

Grief follows meaningful change. Start by defining what was lost.

Who or what was lost?

What did this person/role/relationship/future give you?

What parts of life feel different now?

---

2. Acknowledging the Reality

Write about the reality of the loss using clear language.

What happened? (At your own pace)

What moments make it feel most real?

Reminders I tend to avoid:

•  
•  

One reminder I could gently approach this week:

---

3. Emotional Awareness

Circle or add emotions you’ve experienced:

Sadness | Anger | Relief | Guilt | Fear | Confusion | Numbness | Loneliness | Gratitude | Other: ________

Right now I mostly feel:

Where do I feel this in my body?

What the emotion might be trying to say:

---

4. Continuing Bonds (Maintaining Connection)

Grief does not require forgetting. Identify ways you stay connected.

Something I want them to know today:

A value or trait I carry forward from them:

One ritual, object, place, or activity that helps me remember:

If they could respond to me today, they might say:

---

5. Sharing the Grief (Witnessing)

Support helps the brain process loss.

Safe people I can share with:

•  
•  

Type of support I need right now (check): ☐ Listening ☐ Distraction ☐ Practical help ☐ Quiet company ☐ Advice (only if asked) ☐ Other: __________

---

6. Meaning Reconstruction

Meaning is not explaining the loss — it is shaping life after it.

How has this loss changed what matters to me?

What have I learned about myself?

A way I might honor this loss moving forward:

---

7. Rebuilding Life Around the Loss

Choose small steps toward living while grieving.

One small future plan:

A routine I could gently restart or try:

One manageable activity this week:

---

8. Daily Regulation Check‑In

Aim for one from each category daily.

Feel: (journal, cry, memory, letter)

Restore: (walk, shower, repetitive task, familiar show)

Connect: (text, sit with someone, brief conversation)

Maintain: (eat, hydrate, sleep routine, sunlight)

---

9. Body Care

Check what you practiced today: ☐ Ate regularly ☐ Drank water ☐ Morning light exposure ☐ Gentle movement/stretching ☐ Limited substances ☐ Consistent sleep routine

---

Closing Reflection

Today, grief felt like:

Today, life also included:

Both can exist at the same time.

Support Circle

Put yourself in the center of the diagram, then fill each external circle going outward, with the most important, safe, dependable people (or animals) you can share your grief with and count on to be there for you, closest to you, with people who can support you in less intimate ways in the outer rings.

Image Credit: wallpapers.com

1. Why Arguments Go Off the Rails

Arguments that are unpleasant or leave hurt feelings are often not about the surface issue itself, but about the patterns people fall into while arguing. These patterns tend to involve defensiveness, avoidance, assumptions about the other person’s intent, or emotional escalation.

Importantly, the triggers embedded in these patterns often predate the argument—and sometimes the relationship itself. Because of this, undoing unhealthy argument patterns is not only about changing behaviors; it is also about identifying and defusing the triggers that drive those behaviors.

While deeper trigger work is beyond the scope of this worksheet, keeping it in mind is essential for lasting change.

A Common Unhealthy Pattern

Trigger → Defensive/Protective Response → Counterattack → Escalation or Shutdown → Dysregulation

Once an argument reaches the counterattack stage, the pattern is in control—not the people. At that point, productive disagreement becomes extremely difficult. This is why the primary goal is to interrupt destructive patterns early, before escalation occurs.

---

2. What You Can Address Right Now

A. Your Attitude About Arguing

Healthy conflict starts with mindset. Productive arguments require shifting from:

• Winning → Understanding and resolution
• Being “right” → Being understood
• Disproving the other person → Understanding their perspective
• Listening to respond → Listening to understand
• Accusing → Questioning
• Argument as battle → Argument as opportunity for connection and growth
• Condemnation → Curiosity

Additional mindset anchors:

• Assume good faith unless clearly proven otherwise.
• Compromise as a sign of strength and commitment to resolution.
• Remember: Conflict is not the problem—unhealthy conflict is.

---

3. The Process of Arguing Well

Because arguments easily fall into negative, triggering patterns, it’s essential to replace unhelpful patterns with intentional, functional ones. This can be done even before addressing deeper triggers.

Step 1: Agree on Rules for Arguing

Examples:

• Each person speaks until they say, “I’m done with that point.”
• The listener asks for clarification and reflects understanding before responding.
• If either person becomes triggered or dysregulated, the discussion pauses immediately for re-regulation.
• No character attacks or inflammatory language (e.g., “you always,” “you’re an idiot”). Comments stay focused on the issue, not the person.

Step 2: Clarify the Purpose of the Argument

Avoid arguing for its own sake. Before proceeding, establish:

1. What the disagreement is about and why it matters to one or both people
2. What an acceptable resolution would look like
3. Each person’s role or responsibility, and what remains unresolved

---

4. Best Practices for Mitigating Destructive Patterns

• Only begin difficult conversations when both people are relatively calm.
• Ensure the argument is about the actual issue, not a hidden agenda.
• When in doubt, ask questions before making statements.
• Use “I” statements instead of “you” statements.
• Use “and” instead of “but.”
• Don’t start arguments without enough time to finish them well.
• Repair early and often: “That came out harsher than I intended—I’m sorry.”
• Validate where possible: “That’s a fair point—thanks”
• Argue in a neutral, distraction-free environment—no multitasking.

---

5. Emotion Regulation Is Non-Negotiable

Arguments reliably deteriorate when one or both people become dysregulated. When dysregulated, people operate from fear, anger, or distress—and say or do things that sabotage resolution and often hurt the other person.

If Dysregulation Appears:

Pause for 60–120 seconds (together or separately). This is not an excuse for avoidance or stonewalling. Do not return to the argument if either person is still dysregulated.

Helpful regulation tools:

• Take 5 slow breaths (longer exhale than inhale)
• Put both feet on the ground and name 5 things you can see
• Deliberately drop your shoulders

---

6. Active / Reflective Listening

How people communicate matters as much as what they communicate. Active or reflective listening dramatically increases the likelihood of productive outcomes. (A brief reference guide can be found in Appendix 1)

---

7. A Structured Model for Arguing Effectively

1. Speaker A shares their concern or request clearly and in good faith.
2. Listener B reflects on what they heard and asks for clarification.
   Stay here until there is shared understanding.
3. Listener B shares where they agree or disagree.
4. Speaker A reflects B’s position and asks for confirmation/clarification.
5. Both parties describe what resolution would look like for them.
6. Each person states what they are willing to do to support resolution.
7. Conduct a post-argument debrief: What worked? What didn’t? What improved? Note small victories.

---

8. When You Hit a Wall During Conflict

• If the dialogue is deteriorating or either person is repeating him or herself, take a 1–3 minute break.
• If you reach an impasse, call a time-out and return later. Some issues require multiple conversations.
• This is preferable to continuing to argue with a destructive dynamic.

---

9. Reality Check

This process will likely feel:

• Slower than you want
• Artificial or awkward at first
• Emotionally vulnerable

That’s not failure—it’s evidence that you are replacing old patterns with new ones.

---

10. Longer-Term Work (Beyond This Worksheet)

• Identify your default conflict patterns honestly (I… withdraw, dominate, intellectualize, emotionalize, attack, etc.).
• Examine what you’re actually defending via negative patterns (competence, worth, safety, control).
• Build positive interactions—relationships typically need about 5 positives for every negative.
• Consider whether the conflict pattern serves an unacknowledged function (distance, intensity, protection, avoidance).
• What issues existed before you came to the relationship (fear of abandonment, attachment style, relational trauma, etc.)

---

11. The Value of Professional Help

If sincere effort doesn’t change entrenched patterns, a skilled relationship therapist can help identify the underlying dynamics and introduce alternatives. Sometimes, simply having a neutral third party present is enough to shift the dynamic.

A difficult truth: someone has to go first—and both people have to change.

---

12. A Helpful Reframe

Healthy conflict is a way of disagreeing that strengthens understanding and trust rather than eroding it. It treats conflict as information and an opportunity for growth—not a threat—and helps clarify needs, values, and boundaries while protecting the relationship.

---

Summary

Most painful arguments are driven not by the topic itself, but by unconscious conflict patterns triggered by past experiences. Once these patterns take over, productive disagreement becomes nearly impossible.

The Problem

Unhealthy conflict follows a predictable cycle:
Trigger → Defensiveness → Counterattack → Escalation or Shutdown → Dysregulation

The Solution

Change the process of arguing before trying to solve the content of the disagreement.

What Makes Conflict Healthier

• A shift in mindset (from winning to understanding and resolution)
• Clear rules for arguing
• Active / reflective listening
• Early interruption of escalation
• Strong emphasis on emotional regulation
• Frequent repair and validation

Practical Structure

Healthy conflict involves:

1. Clear expression without provocation
2. Reflection and confirmation of understanding
3. Disagreement without character attack
4. Explicit discussion of resolution
5. Willingness from both parties to adjust
6. Debriefing to strengthen future conflict resolution

Reality Check

Healthy conflict feels slower, more deliberate, awkward, and more vulnerable—especially at first. That discomfort signals pattern replacement, not failure.

Longer-Term Growth

Lasting change often requires identifying personal conflict styles, underlying vulnerabilities, and the hidden functions conflict may serve. When patterns persist, professional help can be transformative.

Bottom Line

Conflict isn’t the problem. Unexamined, dysregulated conflict patterns are.

Healthy conflict uses disagreement to increase clarity, trust, and connection rather than fear or resentment.

Appendix 1 – Reflective Listening

Definition of Reflective Listening

1. Hearing and understanding what the other person is communicating through words and “body language” to the best of your ability.
2. Responding to the other person by reflecting the thoughts and feelings you heard in his or her words, tone of voice, body posture, and gestures.

Some Key Purposes of Reflective Listening

1. To help the listener confirm that he/she did, in fact, understand the other person
2. To help the speaker feel heard and validated
3. To interrupt unproductive tendencies of the listener (on topic vs off topic)
4. To achieve better communication
5. To build greater personal connection

Tips

• Attending to the listener via eye contact, body language, and facial expressions
• Allowing for interested silence
• Reflecting smaller bits of information with brief summaries
• Reflecting feelings/emotions as well as words and thoughts
• Asking open ended and follow up questions
• Practice reflective listening in low-stakes situations first

Examples of Reflective Language

• I hear you saying…
• My sense is that you…
• My understanding is that…
• You sound…
• You seem…
• I think you feel…

Things to Avoid

• Evaluating/judging
• Solving/fixing (unless asked)
• Focusing on anything other than the speaker and/or interrupting

Adapted from:

N. Katz & K. McNulty. 1994. Reflective listening. https://www.maxwell.syr.edu/uploadedFiles/parcc/cmc/Reflective%20Listening%20NK.pdf

Appendix 2 – Healthy vs. Unhealthy Conflict

Dimension	Healthy Conflict	Unhealthy Conflict
Goal	Understanding, problem-solving, or honest airing of differences	Winning, self-protection, control, or emotional discharge
Emotional tone	Strong feelings allowed with regulation	Strong feelings without regulation
View of the other	“You’re different from me, not against me”	“You are the problem / threat”
Language	“I feel… I need… Help me understand…”	“You always… You never… What’s wrong with you?”
Listening	Active, curious, reflective	Interrupting, defensive, dismissive
Responsibility	Owns impact even if intent was good	Denies impact, blames, or reverses blame
Power dynamics	Relatively balanced; both voices matter	One dominates, intimidates, or withdraws to control
Boundaries	Limits are named and respected	Boundaries are ignored, mocked, or punished
Memory use	Stays mostly present-focused	Brings up past grievances as ammunition
Physiology	Arousal rises but returns to baseline	Escalation or shutdown persists
Repair attempts	Apologies, softening, humor, reassurance	Repair bids rejected or weaponized
Aftermath	Clarity, relief, or closeness	Resentment, fear, emotional distance