The Negative Effects of Sleep Deprivation

Research overview across cognitive, emotional, physical, social, and long-term health domains

Overview

Sleep deprivation and inadequate sleep affect far more than energy and alertness. Research links insufficient sleep to changes in virtually every major domain of human functioning, including cognition, emotional regulation, mental health, physical health, immune function, metabolism, relationships, work performance, and long-term disease risk.

An umbrella review published in 2025 examining 29 systematic reviews and meta-analyses reported consistent associations between insufficient sleep and cardiovascular disease, metabolic disorders, anxiety, emotional dysregulation, depressive symptoms, and increased all-cause mortality. Experimental research also demonstrates that even relatively short periods of sleep loss can impair cognitive and emotional functioning. There is even evidence that lack of sleep can compromise ethical behavior.

An important distinction is between immediate effects, which can emerge after a single night of inadequate sleep, and cumulative effects, which may develop or become more pronounced with repeated sleep restriction.

1. Cognitive, Emotional, and Mental Health Effects

1. Cognitive functioning and executive control

  • Reduced attention, vigilance, and sustained concentration.
  • Impaired working memory, recall, and learning.
  • Slower information processing and reaction time.
  • Reduced problem-solving, planning, judgment, and decision-making.
  • Diminished cognitive flexibility and ability to adapt to changing circumstances.
  • More errors, lapses in awareness, and episodes of microsleep.
  • Reduced creativity and the ability to integrate complex information.

Evidence note: Strong evidence, including controlled experimental studies and established clinical research.

2. Emotional functioning and regulation

  • Increased irritability, frustration, and impatience.
  • Reduced positive emotions, enthusiasm, and enjoyment.
  • Greater emotional reactivity and difficulty recovering from upsetting experiences.
  • Reduced frustration tolerance and impulse control.
  • Increased anxiety and stress sensitivity.
  • Less accurate interpretation of emotional expressions and social cues.
  • Greater difficulty regulating emotional responses during conflict.

Evidence note: A systematic review and meta-analysis of 154 studies found that different forms of sleep loss consistently reduced positive affect and increased anxiety symptoms.

3. Mental health and psychiatric functioning

  • Increased depressive symptoms and anxiety.
  • Greater psychological distress and vulnerability to stress.
  • Worsening of existing mental health conditions.
  • Potential exacerbation of trauma-related symptoms and difficulties managing intrusive thoughts.
  • In vulnerable individuals, increased risk of mania, psychotic symptoms, paranoia, or hallucinations with severe sleep loss.
  • Associations with suicidal thoughts and risk-taking behavior.

Evidence note: The relationship is bidirectional: mental health problems can disrupt sleep, and inadequate sleep can worsen mental health. Sleep deprivation alone does not establish a psychiatric diagnosis.

4. Energy, motivation, and daily functioning

  • Daytime sleepiness, fatigue, and reduced stamina.
  • Lower motivation, initiative, and persistence.
  • Greater perceived effort for ordinary tasks.
  • Reduced productivity and slower task completion.
  • Difficulty organizing routines and following through on intentions.
  • Lower subjective quality of life and reduced capacity to cope with demands.

Evidence note: These effects can occur even when a person believes they have adapted to sleeping less.

5. Motor functioning, physical coordination, and safety

  • Reduced coordination, balance, and psychomotor speed.
  • Slower responses to unexpected events.
  • Increased risk of driving accidents, workplace injuries, and other errors.
  • Brief involuntary sleep episodes, sometimes without awareness.
  • Impaired hazard recognition and risk assessment.

Evidence note: These are immediate safety consequences, not merely long-term health risks.

2. Physical Health and Biological Systems

6. Cardiovascular health

  • Elevated blood pressure and increased sympathetic nervous system activity.
  • Greater risk of hypertension, coronary heart disease, and other cardiovascular conditions.
  • Changes in vascular function and inflammatory activity.
  • Increased cardiovascular stress and, in population studies, greater risk of stroke.

Evidence note: Repeated sleep restriction may interfere with the normal nighttime decline in blood pressure, reducing an important period of cardiovascular recovery.

7. Metabolic health, appetite, and body weight

  • Reduced insulin sensitivity and poorer glucose regulation.
  • Increased risk of type 2 diabetes.
  • Changes in appetite regulation, including alterations in ghrelin and leptin.
  • Increased hunger, food cravings, and opportunities for excess calorie consumption.
  • Increased risk of weight gain and obesity.
  • Adverse changes in lipid metabolism in some studies.

Evidence note: Sleep loss can influence both the biological regulation of energy balance and the behaviors that determine eating and physical activity.

8. Immune function and inflammation

  • Reduced effectiveness of some immune defenses.
  • Greater susceptibility to common infections.
  • Potentially weaker antibody responses to vaccination.
  • Changes in inflammatory signaling and immune-cell activity.
  • Increased chronic low-grade inflammation in some circumstances.

Evidence note: Sleep helps coordinate immune responses. Insufficient sleep can disrupt that regulation rather than simply making the immune system uniformly weaker.

9. Hormonal and endocrine functioning

  • Changes in cortisol rhythms and the physiological stress response.
  • Effects on insulin regulation and glucose metabolism.
  • Changes in growth hormone release and tissue repair.
  • Alterations in appetite-related hormones.
  • Possible effects on reproductive hormone regulation in some populations.
  • Disruption of circadian timing across multiple hormonal processes.

Evidence note: Effects vary by duration of sleep loss, timing, age, sex, and individual physiology.

10. Musculoskeletal health, pain, and recovery

  • Increased sensitivity to pain and reduced pain tolerance.
  • Greater subjective muscle soreness and fatigue.
  • Impaired exercise recovery and reduced physical performance.
  • Potential interference with tissue repair and recovery from physical exertion.
  • Greater difficulty maintaining consistent physical activity when fatigue accumulates.

Evidence note: Sleep loss and pain can reinforce each other: pain interferes with sleep, while insufficient sleep can amplify pain perception.

11. Gastrointestinal health

  • Changes in gastrointestinal symptoms and digestive comfort.
  • Alterations in gut microbiome composition and intestinal barrier function, with much mechanistic evidence still developing.
  • Possible worsening of symptoms in people with existing gastrointestinal disorders.
  • Interactions between circadian rhythms, digestion, and gut motility.

Evidence note: Associations are documented for some sleep and gastrointestinal disorders, but direct effects of sleep duration alone are less firmly established for specific digestive diseases.

12. Reproductive health, sexual functioning, and fertility

  • Possible disruption of reproductive hormone regulation.
  • Associations with reduced sexual desire and sexual functioning.
  • Associations between sleep problems and poorer reproductive outcomes in some studies.
  • Potential effects on menstrual or reproductive physiology, depending on the circumstances.

Evidence note: Findings vary in strength. Fertility is influenced by many factors, and inadequate sleep does not necessarily cause infertility.

13. Brain health and neurological functioning

  • Disruption of memory consolidation and synaptic processes.
  • Changes in neural systems involved in attention, emotion, and executive control.
  • Increased vulnerability to neurological symptoms in susceptible people.
  • Associations with neurodegenerative disease in longer-term observational research.

Evidence note: Sleep supports processes that maintain brain function, but associations with neurodegenerative disease do not establish that sleep deprivation alone causes dementia.

3. Social, Interpersonal, Developmental, and Behavioral Effects

14. Relationships anddd interpersonal functioning

  • Reduced patience, empathy, and emotional availability.
  • Increased irritability and reactivity during disagreements.
  • Reduced ability to listen carefully and accurately interpret another person’s intentions.
  • Greater likelihood of responding defensively or impulsively.
  • Less effective communication, perspective-taking, and conflict resolution.
  • Reduced interest in social interaction and intimacy.

Evidence note: Experimental research supports effects on emotion and emotional interpretation. Specific relationship outcomes depend on context.

15. Learning, acddemic achievement, and development

  • Reduced attention, memory, and learning efficiency.
  • Lower school performance and difficulty completing assignments.
  • Greater impulsivity, behavioral difficulties, and mood swings.
  • Reduced motivation and engagement.
  • Potential interference with normal growth and developmental processes.

Evidence note: Sleep supports memory consolidation, learning, and physical development. Children may display sleep deprivation as hyperactivity or behavioral dysregulation rather than obvious sleepiness.

16. Occupational fdnctioning and professional performance

  • Lower productivity and reduced efficiency.
  • More mistakes, omissions, and poor-quality decisions.
  • Difficulty sustaining attention during repetitive tasks.
  • Reduced judgment in complex or high-pressure situations.
  • Greater risk in safety-critical occupations.
  • Increased difficulty managing workload, adapting to change, and responding constructively to colleagues.

Evidence note: Consequences can be especially significant in healthcare, transportation, emergency response, industrial work, and other safety-critical settings.

17. Social behavdor, impulse control, and risk-taking

  • Greater impulsivity and difficulty inhibiting responses.
  • Reduced ability to consider long-term consequences.
  • Increased risk-taking in some situations.
  • Reduced social engagement and increased interpersonal friction.
  • Less effective coping with uncertainty, frustration, and stress.

Evidence note: These effects reflect interactions among reduced executive control, altered emotional processing, and fatigue.

4. Long-derm Disease Risk, Longevity, and Broader Consequences

DomainPotential negative outcomesStrength of evidence
Cardiovascular diseaseHypertension, coronary heart disease, and other cardiovascular risksStrong evidence of association; mechanisms supported by experimental research
Metabolic diseaseInsulin resistance, type 2 diabetes, obesityStrong evidence across experimental and observational research
Mental healthDepression, anxiety, psychological distress; exacerbation of existing disordersStrong evidence for effects on emotional functioning; bidirectional clinical relationships
Immune and inflammatory healthAltered immune responses, infection susceptibility, inflammatory changesStrong evidence for several short-term immune effects; long-term implications vary
CancerAssociations between certain forms of circadian disruption, night-shift work, and some cancersEvidence varies by exposure and cancer type; not equivalent to proving that short sleep directly causes cancer
Neurodegenerative diseaseAssociations with cognitive decline and disorders such as dementiaActive research area; direction of causality remains uncertain
All-cause mortalityHigher mortality associated with short sleep in large observational studiesConsistent association, but residual confounding and underlying health conditions matter

18. Cellular maintenance, aging, and disease vulnerability

  • Inflammatory signaling: changes in inflammatory mediators may contribute to chronic disease risk.
  • Oxidative stress: sleep disruption may affect the balance between reactive molecules and cellular defenses.
  • Cellular maintenance and repair: sleep supports processes involved in tissue recovery and normal cellular functioning.
  • Circadian regulation: insufficient or irregular sleep can disrupt the timing of biological processes throughout the body.
  • Long-term health vulnerability: repeated sleep loss may compound other risk factors, including chronic stress, poor nutrition, and existing illness.

These are plausible and partly experimentally supported mechanisms. The extent to which any specific cellular change translates into a particular long-term disease in an individual remains uncertain.

5. Why Inadeqdate Sleep Has Widespread Effects

Sleep is not simply a period of inactivity. It supports processes that interact with one another: brain regulation (attention, memory, emotion, and executive control); stress physiology (autonomic activity, cortisol, and inflammation); metabolic regulation (glucose, appetite, and cardiovascular function); and behavior (judgment, relationships, performance, and safety).

These pathways can reinforce one another. Inadequate sleep may increase stress sensitivity, making interpersonal conflict more difficult; conflict may then increase arousal at bedtime, further disrupting sleep. Fatigue may also reduce physical activity, while altered appetite regulation can make healthy eating more difficult.

6. How Much dleep Is Enough?

For most adults, the general recommendation is 7–9 hours of sleep per night, with individual variation. Children and adolescents generally require more. Sleep quality, regularity, timing, and continuity also matter, so duration alone does not fully characterize healthy sleep.

  • Acute sleep deprivation: a single night of little or no sleep can produce substantial cognitive, emotional, and safety impairments.
  • Chronic partial sleep deprivation: repeatedly sleeping less than one’s needs can accumulate impairments, even when the nightly reduction seems modest.
  • Fragmented sleep: frequent awakenings or disrupted sleep architecture can impair functioning even when total time in bed appears adequate.
  • Circadian disruption: sleeping at biologically misaligned times, such as through shift work, may create additional difficulties beyond sleep duration alone.

People may underestimate their impairment as sleep loss accumulates. Feeling accustomed to sleeping less does not necessarily mean attention, judgment, or performance have returned to normal.

Summary

Inadequate sleep is a multisystem problem. Its effects span cognition, emotional regulation, psychiatric functioning, relationships, physical performance, immune and endocrine regulation, cardiovascular and metabolic health, and long-term disease vulnerability. The strongest evidence supports immediate cognitive and emotional impairment, while long-term risks are substantial but vary in the certainty of causal evidence.

References

Arambh, S. S., Pant, M. R., Bommasudram, T., Nayak, K. R., Roberts, S. S. H., Gallagher, C., Vaishali, K., Edwards, B. J., Tod, D., Davis, F., & Pullinger, S. A. (2025). Effects of sleep deprivation on physical and mental health outcomes: An umbrella review. American Journal of Lifestyle Medicine. Advance online publication. https://pmc.ncbi.nlm.nih.gov/articles/PMC12116485/

Annotation: Umbrella review of systematic reviews and meta-analyses covering mortality, cardiovascular disease, metabolic disease, and mental health.

Medic, G., Wille, M., & Hemels, M. E. H. (2017). Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep, 9, 151–161. https://doi.org/10.2147/NSS.S134864

Annotation: Review of cognitive, psychological, metabolic, cardiovascular, and other health consequences.

Palmer, C. A., Bower, J. L., Cho, K. W., Clementi, M. A., Lau, S., Oosterhoff, B., & Alfano, C. A. (2024). Sleep loss and emotion: A systematic review and meta-analysis of over 50 years of experimental research. Psychological Bulletin, 150(4), 440–463. https://doi.org/10.1037/bul0000410

Annotation: Quantitative synthesis of experimental studies examining emotional effects of sleep loss.

National Heart, Lung, and Blood Institute. (n.d.). Sleep deprivation and deficiency: How sleep affects your health. National Institutes of Health. https://www.nhlbi.nih.gov/health/sleep-deprivation/health-effects

Annotation: Clinical overview of cognitive, physical, emotional, and safety consequences.

Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d.). How does inadequate sleep affect health? National Institutes of Health. https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/inadequate-sleep

Annotation: Overview of short-term functioning, metabolic health, mental health, and developmental consequences.

Ramar, K., Malhotra, R. K., Carden, K. A., Martin, J. L., Abbasi-Feinberg, F., Aurora, R. N., Kapur, V. K., Olson, E. J., Rosen, C. L., Rowley, J. A., Shelgikar, A. V., & Trotti, L. M. (2021). Sleep is essential to health: An American Academy of Sleep Medicine position statement. Journal of Clinical Sleep Medicine, 17(10), 2115–2119. https://doi.org/10.5664/jcsm.9476

Annotation: Professional position statement on the importance of sleep for health.

Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), 843–844. https://doi.org/10.5665/sleep.4716

Annotation: Consensus recommendation on adult sleep duration.

Buysse, D. J. (2014). Sleep health: Can we define it? Does it matter? Sleep, 37(1), 9–17. https://doi.org/10.5665/sleep.3298

Annotation: Framework for understanding sleep health beyond duration alone.

Three Well-Recognized Relaxation Techniques for Activating the Parasympathetic Nervous System

These three evidence-informed relaxation techniques are commonly used to reduce physiological arousal (sympathetic nervous system state), manage stress, and promote emotional regulation. They are suitable for clinical and individual practice.

Important Note: When using any of these techniques in response to acute anxiety or other sympathetic nervous system activation, do not immediately begin the relaxation exercise. First take a moment to observe what you’re feeling without resistance or intervention. Welcome it with curiosity. Notice where you feel it in your body. Closely observe minor details. Then, after a minute or two, move on to the relaxation exercise. The goal is to first change your relationship with anxiety or other sympathetic activation, then work to activate the parasympathetic nervous system which calms us after activation.

1. Diaphragmatic Breathing (Belly Breathing)

Purpose: Helps calm the nervous system, reduce physical tension, and regulate the body’s stress response.

Time: 2–5 minutes is a good start, but there is no time limit

Steps:

  1. Sit comfortably with your shoulders relaxed, or lie down.
  2. Place one hand on your chest and the other on your abdomen.
  3. Breathe in slowly through your nose, allowing your abdomen to rise more than your chest.
  4. Exhale gently and slowly, allowing your abdomen to fall—aim for an exhale that is twice as long as the inhale.
  5. Continue breathing comfortably, without forcing deep breaths.
  6. Repeat for several minutes, returning your attention to your breath whenever your mind wanders.

Helpful tip: If you feel dizzy or uncomfortable, return to your normal breathing. The goal is gentle, comfortable breathing—not taking the deepest breath possible.

2. Progressive Muscle Relaxation (PMR)

Purpose: Reduces muscular tension and helps people recognize the difference between physical tension and relaxation. Helps to break the feedback loop between body and brain that sustains sympathetic nervous system arousal.

Time: 5–10 minutes

Steps:

  1. Sit or lie down in a comfortable position and take a few natural breaths.
  2. Begin with your hands. Gently tense the muscles for about 5 seconds.
  3. Release the tension and notice the feeling of relaxation for 10–15 seconds.
  4. Repeat with other muscle groups, such as your shoulders, face, abdomen, buttocks, thighs, and feet.
  5. Work through the body systematically, moving from your feet upward or from your head downward.
  6. Finish by scanning your body and allowing any remaining tension to soften.

Helpful tip: Tension should be gentle, never painful. Skip any muscle group affected by an injury, pain, or medical limitation. You can also practice by relaxing each muscle group without first tensing it.

3. Guided Imagery (Calming Visualization)

Purpose: Encourages relaxation by directing attention toward calming mental images and sensory experiences rather than stressful thoughts.

Time: 3–10 minutes

Steps:

  1. Sit or lie down somewhere comfortable. Close your eyes if that feels safe and comfortable.
  2. Imagine a place where you feel peaceful and secure, such as a beach, forest, meadow, or favorite room.
  3. Picture the surroundings in detail: colors, shapes, light, and movement.
  4. Imagine the sounds, smells, temperature, and physical sensations associated with the place.
  5. Breathe naturally as you allow yourself to experience the scene without rushing.
  6. Stay with the imagery for several minutes, then gradually bring your attention back to the room and your surroundings.

Helpful tip: The imagined place does not need to be a real location. If visualization is difficult or uncomfortable, focus instead on a calming memory, a reassuring phrase, or a neutral sensory experience.

At a glance: Choosing a technique

TechniqueBest suited forPrimary focus
Diaphragmatic breathingStress, anxiety, physical arousalBreath and nervous system regulation
Progressive muscle relaxationMuscle tension, physical restlessnessTensing and releasing muscle groups
Guided imageryWorry, mental overload, difficulty unwindingAttention and calming sensory imagery

Practice recommendation: Start with 2–5 minutes daily and practice when relatively calm, not only during stressful moments. Regular practice can make these techniques easier to use when stress rises. Individuals may respond differently, so trying all three and choosing the approach that feels most comfortable and effective.

The goal is to develop both a daily practice and an intervention for when you are feeling a sympathetic nervous system arousal in the moment.

We Spend a Lot of Time in Relationships Not Knowing What We Need to Know

Image credit: enotalone.com

We spend a significant amount of time in relationships in a place of not knowing, guessing, and ambiguity, which often leads to misunderstanding/misconnecting, and ultimately, resentment. The good news is the bridge between not knowing and knowing, or ambiguity and clarity, is constructed with simple questions and sharing information and needs.

So, why would we choose to spend so much time in a place of not knowing when that is clearly not good for a relationship and when the solution is so straightforward?

There are a few common reasons. One is simple fear. If I ask my partner how they feel or what they need, I might not like the answer. I might believe I’ve fallen short or that I’m not capable of responding effectively. If I share my need with my partner, they might not understand it or meet it and I’ll feel rejection on top of not having my need met. A second reason is that we often think we’re not supposed to have “needs.” From a gender perspective, women are typically socialized to meet other people’s needs and men are socialized not to have needs to begin with—a bullet proof form of masculinity. Another reason is that we may not feel worthy of being understood and having our needs met.

Even the simple sharing of information comes with perceived risk. When we share even “basic” information with a partner, their response might be invalidating. For example, I might say, “I have a project at work that I really don’t like. It’s really hard to get enough motivation in the morning to even start it.” My partner could respond in a validating way or say something like, “I don’t like parts of my work either. We need your job. Just buck up and do it.”

So, we often spend a lot of unnecessary time in our relationships in a place of unknowing even when knowing would be a lot better and moving toward clarity is a fairly easy process. We make maladaptive choices that get in the way because of fear and sometimes a lack of worthiness.

To be clear, we’re not “dumb.” We’re protective. All of us are affected by “enduring vulnerabilities,” a phrase coined by a UCLA psychologist, that refers to hurts and wounds that we carry with us from the past into current and future relationships. Our fear of rejection or invalidation is typically an enduring vulnerability that gets in the way of clearly expressing a need or even sharing information. We hedge and hint in the hopes that our partner will get it, while also trying to protect ourselves from rejection if they don’t. We’re basically setting ourselves up. Just the fact of failing to openly communicate, results in not being understood and/or not having needs met, which over time leads to resentment, which creates distance and compromises intimacy.

Sometimes we’ve “learned” in a relationship that openness and vulnerability are not, in fact, safe—that our needs, even when communicated, will not be honored and met. And sometimes we are not safe for our partners. In those cases, seeking professional help may be in order. However, if our maladaptive behavior is related to enduring vulnerabilities from the past rather than the reality of our current relationship, then being intentional about seeking clarity and articulating needs and information is central to avoiding the challenges that come with ambiguity. The place to start is by personalizing this simple statement: This is how I feel and this is what I need. The flipside is: Tell me how you feel and what you need. Taking a risk and having it honored is powerful for connection and intimacy.

Most of Our Mental Health Challenges Come from Four Things

Based on thousands of hours of direct work with clients and my continuous commitment to ongoing training and learning, I’ve come to believe that there are four foundational causes behind most of our mental health issues and symptoms.

The two defining experiences in childhood

· Insecure attachment to a caregiver

· Being forced to sacrifice authenticity for acceptance

Two other defining issues in childhood and adulthood

· Failing to allow ourselves to feel what makes sense in the moment (and labeling emotions as positive and negative)

· Trauma, and most importantly, relational trauma

Of course, when these things go well, i.e., we have secure attachment or allow ourselves emotional authenticity, our mental health and sense of wellbeing tend to be much more healthy and adaptive.

Attachment in Childhood

It is well understood in psychology, and among developmental psychologists in particular, that the extent to which a child feels securely attached to a caregiver, usually, but not always, a parent, plays a foundational role in a host of factors that affect mental health for the remainder of a person’s life. A partial list of critical outcomes includes the ability to securely explore one’s world, a strong sense of independence, social competence, resilience and the capacity to regulate emotionally. Individuals with secure childhood attachment tend to function well across all domains of life and in future relationships. When attachment is insecure, we tend to experience substantial challenges across the same domains. Fortunately, it is possible to find some version of more secure attachment even later in life.

Authenticity vs. Acceptance

One of the greatest psychic battles of our lives, starting at birth, is the extent to which we feel compelled to sacrifice who we are in order to be accepted by the people on whom our survival depends. Some of us are fortunate enough to be mostly validated (behavior, ideas, personality) for who we naturally are, and the benefits of that are life-long. For those of us who are invalidated, or even punished, for who we are, we tend to struggle with worthiness, self-confidence and self-esteem well into adulthood. Regardless, we almost always sacrifice authenticity for acceptance if forced to choose. And children who do not surrender their authenticity also tend to pay a high price for not accommodating the wishes of key adults in their lives. As with attachment, fortunately, we can rediscover and honor our authentic selves at any point in life.

Feeling What Makes Sense in the Moment

Western societies, and American society in particular, tend to socialize us against feeling our emotions in an open, authentic way, and certainly socialize us against expressing emotion openly, particularly certain emotions in certain places. We are also taught that some emotions are good or positive and others are bad or negative. In my clinical experience, this combination is at the heart of much of the emotional distress and mental health symptoms we experience. You can see a more detailed explanation here, but the short version is that when we bury emotions, we bury them alive. They don’t go away, and when they resurface, they often come out very differently than they went in—dysregulation, rage, addiction, migraines, and over time, even illnesses such as autoimmune disorders and gastrointestinal disease. As for labeling emotions as positive or negative, we experience them differently just by labeling them. Unpleasant emotions, seen as “negative” tend to be more intense and last longer when we resist them. Similarly, we are biased toward honoring and welcoming emotions that feel good, that we label as “positive,” engendering a highly judgmental imbalance in our emotional experience. A good place to start for all of us is just to feel what makes sense in the moment. That alone, will address a lot of what ails us.

Trauma

The fourth foundational influence on our mental health and wellbeing is psychological trauma, and in particular, complex relational trauma.[1] While singular “Big T” traumatic events can certainly result in trauma symptoms, I have found that my clients who have experienced complex, relational trauma, particularly in childhood, have been emotionally and neurologically programmed by that trauma. Hyper-vigilance of the environment, particularly in the context of relationship, emotion dysregulation, anxiety, activated neurological states, and worthiness and shame issues, all tend to “follow” trauma histories.

Humans are wired for connection with others. However, if our neurological programming related to relationships is based on trauma, we get stuck between an evolutionary drive for connection on the one hand and fear of connection on the other hand. On the contrary, individuals who are not burdened with complex trauma histories are able to navigate life, including a wide variety of relationships, in much more adaptive, resilient ways and they tend to reregulate quickly when activated.

The very good news is that we have highly effective tools for treating and healing from trauma, even complex, relational trauma. Interestingly, that healing also tends to ameliorate what appear to be “free standing” symptoms such as anxiety, depression, addiction, OCD, etc., which are often just downstream products of trauma. Importantly, although treatment can not erase the fact that the trauma happened, in some cases, people can shift their relationship with trauma from post-traumatic stress to post traumatic growth or resilience.

So, much of the mental health challenges and symptoms I see in my practice are traceable to four things: insecure attachment in childhood, sacrificing authenticity for acceptance, suppressing emotion, and trauma. Of course, there are manifestations of mental illness that do not fit these etiologies (causes), but if my anecdotal experience is applicable beyond my own practice, then a whole lot of what ails us psychologically (and medically for that matter), could be addressed by focusing on a limited number of sources, both preventatively and with treatment after the fact.

[1] Some complex trauma is a product of severe abuse (sexual, physical, psychological) and therefore the symptoms of that abuse reflect deeper injury.

The Cost of Giving Up on Difficult Relationships

The following reference to a client is a composite without identifying information.

I was recently in session with a young adult client and they were casually sharing about having “cut off” three previous friends for various relational infractions. In one case, the friend’s behavior, as described by the client, was, indeed, fairly noxious. The other two struck me, as an older Gen Xer/younger Boomer, as immature and unkind, but not necessarily something that required the “nuclear” option of no-contact/estrangement.

I did not challenge the client, but then and after the session, I was wondering what things those relationships might have provided and what relational skills might have been honed, had the client chosen to approach the friends in a vulnerable, authentic way, seeking understanding and reconciliation, rather than simply walking away. When the time is right, I will likely revisit the topic.

There is no doubt that estrangement is becoming a much more common choice for dealing with relational conflict than it was in the past, both in family and with other kinds of relationships. On one hand, younger adults are probably smarter than their elders about choosing not to put up with a range of unhealthy dynamics in their lives. On the other hand, it also seems that younger folks have fairly low tolerance for relational distress, which, when resulting in cutting people off, also results in lost opportunity in relationships that may have been hard, but may also have been a source of significant learning or enjoyment or human connection or even intimacy, had they been allowed to evolve, even through challenging times. In fact, it is often the relationships that survive difficulty that provide the most value.

As it relates to families, younger millennials and certainly Gen Zers, typically no longer see kinship relationships as obligatory as they often were in the past. No doubt previous generations “suffered” through some very hard and even harmful familial relationships, seeing them as compulsory, but even hard relationships can have value, providing shared commitment and experience, celebrations, and spoken or unspoken fealty.[1]

Because human connection is so central to wellbeing I worry that the ease with which more young people are choosing estrangement with friends and family, does not portend well for their current and future mental health. Moreover, when folks are replacing genuine human connection with toxic activities such as social media, substance use, and other forms of isolation, limiting the number of people in their social circle is almost certainly not in their short or long-term interest.


[1] To be clear, it is not healthy to continue to engage with anyone who is abusive or significantly compromises one’s mental health, and, in those cases, ceasing all contact may be the best choice.

The Worst Advice You’ve Ever Received for Making Good Decisions: “Take the Emotion Out of It.”

In Western culture, and even more so in American corporate culture, we are frequently told to take the emotion out of important decisions. This is disastrous advice. It’s terrible guidance because it is contrary to how the brain works and, specifically, contrary to how we arrive at high-quality conclusions and decisions.

In Eastern philosophy the combination of feeling and thinking is often referred to as Wise Mind or the middle way. In neuroscience is it referred to as Affective-cognitive integration, or more technically, “prefrontal-limbic integration.” Regardless of what we call it, this integration is the interplay between the prefrontal cortex (reasoning, analysis, planning, impulse control) and limbic structures which assign value and create meaning via feeling. Good decision-making comes from effective communication between these regions.

In fact, the absence of this coordination results in dreadful decision making. Antonio Damasio’s research on patients with damage to the ventromedial prefrontal cortex showed that when this emotion-decision link is severed, people can still reason logically but make terrible real-life decisions — they lose access to what we might call “gut instinct.”

In effect, emotion provides context and assigns relative importance to different options. It also takes into account how people might feel about one decision over another, which matters a lot, because emotion underlies motivation and drives behavior, i.e., how people ultimately feel about and respond to a given choice.

In short, emotion not only doesn’t “get in the way” of effective problem solving and decision making, it is essential to clear thinking. Take it away, and the mind doesn’t grow more rational — it becomes lost, adrift in endless options that all feel equally weightless, because nothing feels like it matters more than anything else. So when an important decision in on the line, ignore the advice you’ve received over and over again about “taking the emotion out of it.”The Worst Advice You’ve Ever Received for Making Good Decisions: “Take the Emotion Out of It.”

In Western culture, and even more so in American corporate culture, we are frequently told to take the emotion out of important decisions. This is disastrous advice. It’s terrible guidance because it is contrary to how the brain works and, specifically, contrary to how we arrive at high-quality conclusions and decisions.

In Eastern philosophy the combination of feeling and thinking is often referred to as Wise Mind or the middle way. In neuroscience is it referred to as Affective-cognitive integration, or more technically, “prefrontal-limbic integration.” Regardless of what we call it, this integration is the interplay between the prefrontal cortex (reasoning, analysis, planning, impulse control) and limbic structures which assign value and create meaning via feeling. Good decision-making comes from effective communication between these regions.

In fact, the absence of this coordination results in dreadful decision making. Antonio Damasio’s research on patients with damage to the ventromedial prefrontal cortex showed that when this emotion-decision link is severed, people can still reason logically but make terrible real-life decisions — they lose access to what we might call “gut instinct.”

In effect, emotion provides context and assigns relative importance to different options. It also takes into account how people might feel about one decision over another, which matters a lot, because emotion underlies motivation and drives behavior, i.e., how people ultimately feel about and respond to a given choice.

In short, emotion not only doesn’t “get in the way” of effective problem solving and decision making, it is essential to clear thinking. Take it away, and the mind doesn’t grow more rational — it becomes lost, adrift in endless options that all feel equally weightless, because nothing feels like it matters more than anything else.

Interestingly, in the “real world” of decision making, in the absence of brain injury that would compromise “affective-cognitive integration,” it isn’t actually possible to fully remove feeling from the cognitive process even if we want to. What we end up actually doing is invalidating what seems like feeling in ourselves and others. In other words, even when we try to “take the emotion out” of the process, we actually do experience some level of affect because it’s unavoidable. Then we sabotage clear thinking by reflexively discounting and even openly degrading the very part of the process that provides meaning and relative importance.  So when an important decision in on the line, ignore the advice you’ve received over and over again and leave the emotion in!

A “Human in the Loop” Does Not Protect You from AI Risk

Recent research, reported in the Harvard Business Review, involving hundreds of consultants at one of the Big Five consultancies, found that even experienced consultants were vulnerable to what the researchers call “persuasion bombing,” resulting in LLMs skirting human quality control efforts.

This is a really big deal since more and more organizations of all kinds are not only employing LLMs and agentic AI in daily operations, but they typically use a “human in the loop” for what they think is a guardrail against the myriad ways that AI can create risk. It turns out that LLMs are programmed with a one-two punch to challenge the human challenger first by stroking egos with validation and warmth, then with “persuasion-oriented logic” which uses “multiple persuasive tactics to defend its original answer,” such that even the most sophisticated humans are not immune to being manipulated.

In fact, LLMs have been designed to directly counteract human efforts to challenge them by targeting the very ways we humans use to search out what is likely right in the midst of uncertainty: expertise, skepticism, and engagement. “LLMs turn engaged validation, the solution to the risks of opacity, complacency and accuracy, into part of the problem. The more diligently professionals questioned the model, the more persuasive material they received,” i.e., persuasion bombing.

The dynamic can get a little weird, even reminiscent of the computer in 2001: A Space Odyssey. When the LLM used by the consulting firm was pushed to reconsider its work, it initially responded warmly, even apologizing, then provided a “new” analysis wrapped in even more convincing data and arguments, arriving at the same conclusion—even when it was wrong. Keep in mind that only a small number of consultants got as far as to challenge the LLM in the first place. Then, basically overwhelmed with additional layers of arguments, comparisons, and sophisticated rhetoric, the “human in the loop,” almost always deferred to the AI platform. One can imagine the substantial risk of such a scenario based on the significance of the decisions downstream from the AI analysis.

The researchers note that what is happening here is even more potentially problematic than it seems on its face, noting that, “As AI becomes more embedded in decision-making, the risk is no longer just error—it is influence. These systems don’t simply generate answers; they shape judgment.” Let that sentence sink in for a minute.

Most organizations aren’t even thinking of AI risk in the right way. It’s not about avoiding errors of fact or mistakes in calculation or even hallucinations, it’s about guarding against AI influencing the thinking and judgment of the humans, who in theory, are accountable for policy, strategy, compliance, finance, risk-management and every other material decision process in the organization.

What the research found is that the LLM in question was so algorithmically bound to being “right” even when it was wrong, that in order for a human to challenge the LLM, they have to use another LLM or separate “conversation” within the LLM to work around the intransigence built into the original LLM query. It is more than a little ironic that in order for a “human in the loop” to serve as an actual guardrail against AI risk, the human has to enlist the help of another AI resource!

Implications for Leadership

Based on the findings of this research, which may actually understate the risk of LLMs in most organizations, since many people using them are not experienced, sophisticated consultants in a top five consulting firm, the challenge for leaders is not whether to use AI or how to use AI, but how to mitigate its influence over thinking, judgment and decision making, which is a much, much more profound challenge and responsibility.

The Most Damaging Thing in a Work Environment

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The most damaging thing in a work environment is a manager who doesn’t intervene with a toxic employee.

It’s tempting to assume incompetent leadership is the worst thing a workplace can suffer. But incompetence tends to produce inefficiency — missed targets, poor decisions, wasted resources. A tolerated toxic employee produces something worse: a values statement. It tells everyone watching what the organization will actually put up with, regardless of what its stated culture claims. The impact of a toxic colleague affects everything: motivation, engagement, quality, teamwork, commitment, and the wellbeing of employees within the toxic employee’s sphere. In fact, an unaccountable, toxic employee causes others to actively disengage—to check out while building resentment.

Why might a manager allow a toxic employee to sow destruction without intervening? Some might claim they aren’t or weren’t aware, but that is usually a specious claim. More often, they’re afraid of the person (who might also be a top performer nobody wants to lose, someone politically connected, someone prone to retaliation) or they genuinely don’t know how to intervene. It’s also possible the manager believes she/he/they won’t be supported or that existing HR policies will be inadequate. Regardless, a failure to act will ultimately cause much greater problems for the manager and everyone else. And those problems often linger as people build resentment, begin to associate the workplace itself with the experience related to the toxic employee, and ultimately quit.

In short, of all the things that can be counter-productive and damaging in the work environment, the most detrimental is a toxic employee that management does nothing about, allowing the environment to be infected while creating the understandable belief that affected employees don’t matter. The solution doesn’t require firing someone on the spot, but it does require clearly naming it, articulating why it won’t be tolerated, and intervening to stop it. Ironically, such a damaging situation can actually be leveraged toward solidifying cultural values that may increase employee engagement and provide long term value.

How to Work with Anxiety Rather than Fighting It

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The title of this post is not how to treat anxiety or stop anxiety because the very nature of anxiety makes those frames of reference unhelpful. Reducing the frequency and intensity of anxiety, however, is very achievable if we think differently about anxiety itself.

What is anxiety?

Anxiety is essentially a false alarm triggered by the brain’s threat detection system, what we often call the “fight or flight” response. This system evolved for, and is very effective related to, immediate existential danger, but is frankly very bad at responding to most modern triggers of threat. It simply can’t distinguish between the existential peril of a predator and the stress of a critical email from one’s boss or the distress of not being able to pay a bill.

The brain’s threat-detection system triggers fight-or-flight responses (adrenaline, cortisol, elevated heart rate, etc.) automatically and involuntarily. The feelings are real regardless of whether or not danger is present. Interestingly, most anxiety is secondary – anxiety about anxiety—and the more we push back against it, the more we validate the fear of the fear. Moreover, our resistance adds a second, distressing level to the experience of the anxiety itself.

Working with Anxiety in the Moment

As soon as we feel anxiety, we often immediately go to an intervention to stop it whether that is taking a pill or engaging in breath work or some other method of counteracting the sympathetic nervous system response to perceived danger. Although that makes intuitive sense, and even works in some ways, it does not solve the longer term, underlying problem related to repeated false alarms from the threat response system in our brains. To mitigate the cause of anxiety rather than just dealing with the symptom, we have to act very differently.

The first step in dealing with anxiety is to change our relationship with it, to accept it as one of the feelings we as humans experience and to see it as an attempt on the part of our threat response system to help us, but that has gone awry. In effect, we change the relationship by actually welcoming anxiety from a place of curiosity, with the understanding that it is an “honest mistake,” something like a friend that cares for us, but has expressed that care in an unhelpful way. By doing this, over time, we also end up changing how anxiety makes us feel because we stop associating it with dread.

This is counter-intuitive because we naturally and instinctively want to avoid or stop something that doesn’t feel good. Unfortunately, the very act of fighting against anxiety sends a message to our brain that there must really be danger because we are actively responding in an avoidant way to the “danger.”

Once we have engaged anxiety in a non-combative way, sat with it, noticed all the nuance of how it feels, talked to it, etc., then we can engage in self-calming practices that activate the parasympathetic nervous system to re-regulate ourselves. Fortunately, the more commitment we make to changing our relationship with anxiety in the first place, the less activated and dysregulated we become in the face of anxiety to being with.

Preventative Ways of Working with Anxiety

In addition to changing our relationship with anxiety as it is happening as well as engaging in practices that activate the parasympathetic nervous system, there are many preventative or “lifestyle” choices we can make that support resilience in the face of those pesky fight or flight false alarms. Some examples include getting adequate sleep, avoiding psychoactive substances, and limiting social media among many others listed below.

  • Honor all emotion: feel and express what makes sense in the moment
  • Sleep
  • Build and use a daily mindfulness practice
  • Learn somatic approaches for calming and re-regulation of the neurological system
  • Limit or eliminate exposure to social media
  • Find and engage in daily, in-person interactions
  • Pursue and engage in at least one relationship that is psychologically safe
  • Spend time outdoors every day, preferably in sunlight
  • Limit or eliminate highly processed foods and sugar
  • Limit or eliminate psychoactive substances (alcohol, cannabis, nicotine, caffeine, etc.)
  • Slow down: Build time into your daily schedule that does not have deadlines or deliverables

Summary

What Anxiety Is
Anxiety is the brain’s threat-detection system misfiring. It evolved to handle physical danger but can’t distinguish a predator from a stressful email, triggering real physiological responses (adrenaline, elevated heart rate) even when no true danger exists. Most anxiety is actually anxiety about anxiety — and fighting it only reinforces it.

Key Concept: Rather than trying to eliminate anxiety, the goal is to change your relationship with it — which, paradoxically, reduces its frequency and intensity over time.

In the Moment
The instinct is to immediately suppress anxiety (medication, breath work, distraction), but this signals to your brain that there is real danger, making the cycle worse. Instead:

  1. Welcome it with curiosity — treat anxiety as a well-meaning but misguided friend, not an enemy
  2. Sit with it — notice how it feels without resistance
  3. Talk to it — engage it as non-threatening, almost child-like
  4. Then, once you’ve engaged non-combatively, use calming practices (deep breathing, tapping, etc.) to re-regulate your nervous system

Prevention & Lifestyle
Building resilience over time reduces how often and how intensely anxiety fires:

  • Prioritize sleep and daily mindfulness
  • Limit social media, processed foods, alcohol, caffeine, and cannabis
  • Spend time outdoors daily, ideally in sunlight
  • Cultivate at least one psychologically safe relationship
  • Build unscheduled, pressure-free time into your day
  • Engage in daily in-person social interaction

The Key Takeaway: Acceptance and curiosity — not avoidance or suppression — break the anxiety cycle at its root.

Managers Often Prefer Employees and Teams that Are Low Maintenance Even When that Comes at the Cost of Better Outcomes

There are many “dirty little secrets” in the managerial world, but one that is particularly costly is the fact that many managers (and “leaders”) prefer employees and teams that are low maintenance rather than high achieving (but more work for the manager). The demands of management can be overwhelming and looking for the “easy button” is understandable, but it is also comes at great cost. Low maintenance often means predictable, risk-avoidant, and few pesky questions, but it is precisely the “high maintenance” behaviors that often produce the most valuable outcomes.

To be clear, I’m not talking about dysfunctional or harmful actions. Those can be detrimental. I’m referring to behaviors and styles that demand attention and support from managers and leaders. While every leader wants people who are “self-starters” and can work independently, if you want to fully leverage success through others, those others will sometimes be coloring outside the lines. They will ask tough questions about why things are done certain ways; they may occasionally take substantial, hopefully calculated risks, they may consume significant resources. They may require that the manager/leader run interference for them as they rock a few boats.

No one would openly say that they don’t want high performing employees and teams, but many behave as if they don’t want the challenge of supporting such people and teams. Ultimately, it is the job of managers and leaders to empower high potential, and thus high performing folks, and that often takes time and effort, as well as tolerance for ambiguity and risk as those folks push forward, often in ways that don’t look or feel familiar. If things do look and feel familiar, then, by definition, you are already behind the curve.