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.
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:
Welcome it with curiosity — treat anxiety as a well-meaning but misguided friend, not an enemy
Sit with it — notice how it feels without resistance
Talk to it — engage it as non-threatening, almost child-like
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.
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.
Traumatic brain injury is commonly understood as an injury to the brain caused by a concussive, accelerative, or percussive blow that physically injures brain cells. Brain injury also results from stroke, oxygen deprivation, malnutrition, surgical removal of brain tissue, infection, tumors, and toxicity among other causes. However, there is another type of brain injury that may be as common, although much less well known, which results from psycho-emotional trauma without a blow to the head or other direct physical damage to the brain.
The impact of emotional trauma on the brain can be both functional, i.e., interruption of function via metabolic and electrical changes without significant physical damage to neurons as well as through direct physical injury to nerve cells or breakage of connections between cells. Due to cerebral plasticity, people can often heal from both types of pathology, but some damage may be permanent. Importantly, both psychological and concussive trauma occurring during critical developmental windows can permanently alter the trajectory of neural maturation, particularly in circuits governing emotion regulation and executive control. Relatedly, not all individuals exposed to the same trauma experience the same effects on the brain due to genetic and environmental moderators.
Public Health Implications
Extensive evidence from clinical psychology, cognitive neuroscience, neuroendocrinology, developmental science, functional imaging, and epidemiology demonstrates that many cognitive difficulties observed in individuals across the general population are directly linked to psychological trauma, including acute emotional concussion (see Appendix 1). Nonetheless, despite substantial empirical support, there is no established diagnosis for trauma-based cognitive impairment per se, let alone for trauma-induced brain injury, nor is emotional concussion recognized as a medical condition. Moreover, given that the number of adults self-reporting symptoms such as “brain fog,” short-term memory and recall issues, as well as deficits in attention, concentration, and problem solving, has doubled since 2013, it is very likely that a significant proportion of psychological trauma-related cognitive impairment within the general population remains undiagnosed, misunderstood, and untreated. For example, popular, frequently accessed websites where people “research” their own cognitive impairment symptoms such as WebMD and the Cleveland Clinic note many causes of cognitive impairment, including TBI and “mental health” issues, but make zero reference to psychological trauma as a source of compromised brain function, reflecting the huge gap between research and clinical practice. Moreover, common protocols for clinical diagnosis also completely ignore “emotional concussion” as a potential etiology for brain injury symptoms. The American Association of Family Physicians, for example, defines concussion only as “direct or indirect external trauma to the head resulting in shear stress to brain tissue from rotational or angular forces” (Scorza et al., 2019, p 426). Related AAFP diagnostic protocols do not include a single criterion related to symptom etiologies that suggest potential brain injury but that are not caused by external trauma to the head. This is significant because primary care physicians represent the first line of care for most symptomatic patients. In short, compromised brain function related to emotional concussion and complex trauma histories appear to constitute a critical, poorly understood, untreated healthcare challenge that has yet to be broadly acknowledged.
Neurophysiology of Brain Injury
The neural circuits listed below are highly vulnerable to injury via both emotional and physical concussion, but are likely more vulnerable to the neuro-endocrine floods and electrical hyperactivity present in psychological trauma induced brain injury than are other neural circuits which are less sensitive to overload from neurotransmitters and electrical hyperactivity.
1. Long White Matter Tracts (The “Highways”)
These are the communication cables of the brain, consisting of myelinated axons. They are particularly susceptible to shearing in physical injuries (diffuse axonal injury) and microstructural changes in emotional trauma. Primary among these highways are:
Corpus Callosum: The primary bridge between the left and right hemispheres. It is a frequent site of axonal damage in TBI and can show reduced size or integrity following severe emotional trauma.
Superior Longitudinal Fasciculus: Connects the front and back of the brain. Damage here often leads to slowed information processing.
Fornix: A critical C-shaped tract that carries signals from the hippocampus. It is extremely fragile; damage here is strongly linked to associative memory deficits.
2. Frontal-Subcortical Circuits (The “Control Centers”)
These pathways connect the frontal lobes to deeper structures and are vital for behavior and emotional control.
Dorsolateral Prefrontal Circuit: Modulates executive functions like working memory and decision-making. It is easily disrupted, leading to “brain fog” and difficulty prioritizing.
Orbitofrontal Circuit: Responsible for social behaviors and impulse control. Injury here can lead to disinhibition or social “clumsiness”.
Anterior Cingulate Gyrus (ACG): A nodal point for emotional regulation. In both TBI and PTSD, this area often fails to “soothe” the brain’s fear responses.
3. Limbic System Pathways (The “Emotion Centers”)
These are the regions most sensitive to the neurochemical “flood” of an emotional concussion.
Hippocampus: This region is uniquely vulnerable because it is highly sensitive to cortisol (the stress hormone). Chronic emotional trauma can actually cause the hippocampus to atrophy or shrink, leading to flashbacks and difficulty forming new memories.
Amygdala-Prefrontal Pathway: In a healthy brain, the prefrontal cortex regulates the amygdala’s alarm response. Trauma can weaken this connection, leaving the amygdala in a state of permanent “high alert”.
4. Grey-White Matter Junctions
Although physical shearing in grey-white matter junctions (connections between the cells) is primarily associated with concussive brain injury, there is some evidence that neurotransmitter flooding and high electrical activity may also weaken these connections, compromising the ability of white matter cells to support grey matter cells.
5. The Cerebellum
For most of modern brain science, cerebellar function was thought to be limited to motor function. A seminal paper published in 1998 found that the previous understanding was not only inadequate, it was fundamentally wrong. Subsequent research has found that due to the intense innervation and “far flung” connections between the cerebellum and cerebrum (“upper” brain), injury essentially anywhere in the brain involves the cerebellum and injury in the cerebellum itself has far reaching implications for “higher level” brain function and autonomic functions as well. Cerebellar injury often affects processing speed, language, social cognition, executive function, memory, attention, personality, visuospatial skills and very subtle “orchestration” of highly nuanced cross-domain neurophysiology, i.e., even if basic function remains, the fluidity and subconscious nature of that function may be impacted.
The Impact of Emotional Concussion on Specific Cognitive Functions
In the immediate aftermath, an “emotional concussion” psychological trauma can severely impair cognitive functions by diverting the brain’s resources toward survival and threat detection, leaving less mental “bandwidth” for higher-level cortical functions (thinking). EC can also cause long-term damage to neurocircuitry that can alter brain wave activity and physically damage or break connections in the brain, resulting in a number of cognitive processing problems. Some examples are listed below.
Trauma often causes a “system overload” (hyperactivation) in emotional centers like the amygdala, which forces the prefrontal cortex—the area responsible for logic and focus—to work harder and less efficiently.
Working Memory: This is often the most severely impacted area. Trauma disrupts the ability to hold and manipulate information in real-time, making it difficult to follow multi-step instructions, do mental math, or manage complex tasks.
Short-Term Memory: Brain injury affects the ability to learn and recall new, day-to-day information, such as what you ate for lunch or where you left your keys, even if your long-term memories remain vivid.
Train of Thought: Trauma can lead to “brain fog” or mental cloudiness. This often manifests as:
Getting easily distracted by minor background noises or internal thoughts.
“Word-finding” difficulties or losing your place mid-sentence.
A “molasses” feeling where processing information feels significantly slower than usual.
The inability to maintain a specific train of thought through to conclusion before “losing” it.
Executive Function: The ability to plan, organize, and make decisions often suffers. One may feel “paralyzed” by simple choices or find it nearly impossible to prioritize tasks.
Attention and Focus: Sustaining attention can become exhausting. This is partly due to hypervigilance, where the brain is constantly scanning for danger, leaving no energy for focused work.
Why This Happens
Resource Rerouting: The brain may “abandon” or no longer have access to efficient neural pathways and use slower, more energy-intensive alternate routes to process information.
Hormonal Interference: High levels of stress hormones like cortisol can temporarily “shut down” the hippocampus, the brain’s primary memory-forming center. Over extended periods of cortisol exposure, the hippocampus actually shrinks in size.
Fatigue: The mental effort required to perform basic tasks while in a state of trauma leads to profound cognitive exhaustion, making symptoms worse as the day progresses.
Other Significant Changes that May Occur in the Brain as a Result of Emotional Concussion
1. Neurochemical Hijacking (HPA Axis)
Trauma triggers the hypothalamic-pituitary-adrenal (HPA) axis, releasing massive amounts of stress hormones like cortisol and adrenaline.
Persistent High Alert: While helpful for survival in the moment, chronic elevation of these hormones becomes toxic to brain tissue over time.
Impaired Recovery: These hormones can inhibit the growth of new brain cells (neurogenesis) and disable or destroy existing connections.
2. Structural Remodeling of Key Regions
Three specific areas are most vulnerable to psychological injury:
The Amygdala (The Alarm): This region often becomes hyperactive and enlarged. It stays stuck in the “on” position, scanning for danger and causing the person to feel perpetually on edge.
The Hippocampus (The Librarian): High cortisol levels can actually cause this area to shrink by up to 8–12%. This makes it difficult to process new memories or distinguish past trauma from the present, leading to flashbacks.
The Prefrontal Cortex (The Watchtower): Activity here often decreases or thins. Since this region handles rational thinking and emotional regulation, its suppression makes it harder to manage impulsive reactions or calm down after a trigger.
3. Disrupted Connectivity
The communication lines between the “rational” prefrontal cortex and the “emotional” limbic system can be damaged.
Functional Disconnection: Brain scans often show reduced signaling between these regions, meaning the “watchtower” can no longer send signals to the “alarm” to shut off when a threat has passed.
Network Disruptions: Networks like the Default Mode Network (DMN) (responsible for self-reflection and other unconscious processing) can become fragmented, affecting the person’s sense of identity and reality.
Additional communication links between the cerebellum and virtually every other part of the brain can also be interrupted, resulting in problems with regulation of neural circuits and loss of “fine tuning” in brain function across multiple domains.
4. Cellular and Genomic Changes
On a deeper level, trauma can reach the cellular and epigenetic levels:
Oxidative Stress: The brain experiences “internal rust” through oxidative stress, which damages cell membranes and energy production (ATP).
Gene Expression: Trauma can actually change which genes are “turned on” or “off” in the brain, creating a lasting biological blueprint that alters how the person reacts to future stress.
5. Motor Control Problems
When psychological trauma manifests as physical movements like involuntary spasms and psychogenic tremors, the brain’s motor control pathways have been disrupted by emotional distress.
In clinical terms, this is often categorized under Functional Neurological Disorder (FND). It isn’t that the muscles or nerves are damaged; rather, the “software” (the brain’s signaling) is misfiring due to the “hardware” (the nervous system) being overloaded.
Here is the neurological breakdown of what is happening:
The “Overflow” Effect (Limbic-Motor Interference)
The brain areas that process emotion (the amygdala and cingulate cortex) sit physically and functionally close to the areas that control movement (the motor cortex).
In cases of severe trauma, the emotional centers become so hyperactive that their electrical signals “leak” or overflow into the motor pathways.
This results in functional tremors or myoclonus (spasms) because the brain is attempting to discharge the massive amount of pent-up “survival energy” that was never “used up” during the initial traumatic event.
Disruption of the “Agency” Network
The brain has a specific network responsible for sense of agency—the feeling that “I am the one moving my arm.”
Research using fMRI shows that in people with psychogenic tremors, there is decreased connectivity between the temporoparietal junction (which handles self-agency) and the motor areas.
The Result: The brain generates a movement, but it fails to “tag” that movement as voluntary. To the person experiencing it, the limb feels like it has a mind of its own.
The “Gate Control” Malfunction
Under normal circumstances, the prefrontal cortex acts as a filter, inhibiting unnecessary movements.
When a brain injury from trauma occurs, this inhibitory filter weakens.
Just as a computer might glitch and run background programs it shouldn’t, the brain begins sending “noise” to the extremities, which manifests as shaking or rhythmic tremors.
Autonomic Nervous System Dysregulation
The tremors are often a physical manifestation of a dysregulated Autonomic Nervous System (ANS).
If the nervous system stays stuck in a “sympathetic” (fight/flight) state for too long, the muscles remain in a state of high tonus (tension).
Eventually, the muscles reach a breaking point of fatigue or over-stimulation, leading to visible tremors or sudden, jerky spasms as the nervous system “misfires” while trying to find equilibrium.
Summary Table: Physical vs. Psychogenic
Feature
Structural Injury (Physical Blow)
Psychological Trauma Injury
Primary Cause
Cell death or axonal shearing
Neurochemical/Network signaling “glitch”
Motor Control
Loss of function (paralysis/weakness)
Disrupted function (tremors/spasms)
Brain Imaging
Visible on standard MRI/CT
Visible on functional scans (fMRI/PET)
A Note on Recovery: Because psychogenic tremors are “functional” (meaning the wires are intact but the signals are wrong), the brain has a remarkable capacity to retrain these pathways through specialized physical therapy and trauma-informed processing.
Summary
Severe psychological trauma can cause brain injury (“emotional concussion”) comparable to physical traumatic brain injury (TBI), but through neurochemical flooding and electrical hyperactivity rather than by neuronal damage from a physical blow to the head. Despite compelling empirical research related to brain injury from psychological trauma in general and emotional concussion in particular, this type of brain injury remains broadly undiagnosed, untreated, and misunderstood. There is frankly a huge gap between research, which is fairly robust, and clinical practice, which is basically “in the dark.”
Mechanism of Injury
Massive release of neurotransmitters and other stress hormones and electrical overactivity damage brain connections.
Most vulnerable neurons: long-distance neural pathways, sparse connections, stress-sensitive circuits.
Most Affected Brain Regions
Long white matter tracts (corpus callosum, fornix) – communication highways
Frontal-subcortical circuits – executive function and impulse control
Limbic system (hippocampus, amygdala) – memory and emotion centers
Grey-white matter junctions – cellular support connections
Cognitive Impact
Working/short-term memory: Difficulty retaining new information
Motor symptoms: Tremors/spasms from limbic system overflow into motor pathways (Functional Neurological Disorder)
Important Note
Emotional trauma can compromise short term brain function and cause long term damage and changes via functional and structural injury. The distinction is typically related to the severity of the trauma and other factors related specifically to the individual experiencing the trauma. As Gabor Maté notes in his seminal book, The Myth of Normal, “trauma is brain injury.” It’s just a matter of degree.
Annotated Bibliography
Antypa, D., Barros Rodrigues, D., Billecocq, M., & Rimmele, U. (2022). Pharmacologically increased cortisol levels impair recall of associative background context memory in males, but not females. Psychoneuroendocrinology, 146, 105895. https://doi.org/10.1016/j.psyneuen.2022.105895
Annotation. This experimental study investigates the causal effects of elevated cortisol on memory by pharmacologically increasing cortisol levels in healthy adults. Results show selective impairment of associative contextual memory in males but not females, highlighting sex-specific stress–memory interactions. The findings provide direct evidence that stress hormones alone—absent physical brain injury—can disrupt hippocampal-dependent memory processes. This work is highly relevant to trauma models emphasizing cortisol-driven cognitive impairment and the importance of biological moderators.
Aupperle, R. L., Melrose, A. J., Stein, M. B., & Paulus, M. P. (2012). Executive function deficits in posttraumatic stress disorder: A critical review and meta-analysis. Clinical Psychology Review, 32(6), 546–556.
Annotation. This meta-analysis synthesizes neuropsychological and neuroimaging research on executive functioning in PTSD. The authors identify consistent deficits in working memory, inhibitory control, and cognitive flexibility, largely associated with dysfunction in prefrontal and anterior cingulate circuits. Importantly, these impairments persist after controlling for comorbid conditions, supporting the conclusion that executive dysfunction is a core feature of PTSD rather than a secondary effect of depression or substance use.
Blithikioti, C., Nuño, L., Guell, X., Pascual-Diaz, S., Gual, A., Balcells-Olivero, M., & Miquel, L. (2022). The cerebellum and psychological trauma: A systematic review of neuroimaging studies. Neurobiology of Stress, 17, 100429. doi:10.1016/j.ynstr.2022.100429
Annotation.
This systematic review examines structural and functional neuroimaging studies investigating cerebellar involvement in psychological trauma and stress-related disorders. Across multiple studies, the authors identify consistent alterations in cerebellar volume, connectivity, and activation patterns, particularly within posterior cerebellar regions linked to emotion regulation and cognitive processing. The review provides converging evidence that the cerebellum participates in trauma-related neural circuitry, supporting models in which psychological trauma produces measurable brain changes beyond traditionally emphasized limbic structures. This article is especially relevant for arguments linking emotional trauma to cerebellar dysfunction and for extending cerebellar cognitive-affective models into trauma neuroscience.
Bremner, J. D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445–461.
Annotation. This review integrates findings from structural MRI, functional imaging, and neuroendocrine studies to document the effects of traumatic stress on the brain. Bremner reports evidence of hippocampal volume reduction, amygdala hyperreactivity, and reduced prefrontal regulation in trauma-exposed individuals. The article emphasizes stress hormones and altered neuroplasticity as key mechanisms, providing foundational support for conceptualizing trauma as a condition with identifiable neurobiological correlates.
Carrion, V. G., & Wong, S. S. (2012). Can traumatic stress alter the brain? Understanding the implications of early trauma on brain development and learning. Journal of Adolescent Health, 51(Suppl. 1), S23–S28.
Annotation. Focusing on childhood and adolescent trauma, this article examines how chronic stress during sensitive developmental periods alters brain maturation. The authors describe lasting changes in hippocampal, amygdala, and prefrontal development that impair learning, attention, and emotional regulation. This work is particularly relevant for explaining why early trauma often produces more pervasive and enduring cognitive and emotional effects than trauma occurring later in life.
Annotation. This practitioner-oriented article synthesizes empirical findings on trauma-related working memory impairment for a general audience. Comer highlights cortisol surges, prefrontal overload, and attentional fragmentation as mechanisms underlying common complaints such as brain fog and difficulty concentrating. While not a primary research source, the article is useful for psychoeducation and for translating neuroscience findings into accessible clinical language.
Daniels, J. K., Lamke, J. P., Gaebler, M., Walter, H., & Scheel, M. (2013). White matter integrity and its relationship to PTSD and childhood trauma—A systematic review and meta-analysis. Frontiers in Human Neuroscience, 7, 165.
Annotation. This systematic review and meta-analysis evaluates diffusion tensor imaging studies examining white matter integrity in PTSD and individuals with childhood trauma histories. The authors report consistent alterations in long white matter tracts, including the corpus callosum and cingulum bundle. These findings support models of trauma-related disruption to large-scale neural connectivity, particularly in long-distance communication pathways.
Annotation. Giotakos provides an overview of the neurobiological mechanisms associated with emotional trauma, including HPA-axis dysregulation, neurotransmitter imbalance, and functional network disruption. The article bridges clinical psychiatry and neuroscience, offering a concise synthesis of how chronic stress alters emotional and cognitive processing systems. It is useful as a general framework for understanding trauma-related brain changes.
Hayes, J. P., Hayes, S. M., & Mikedis, A. M. (2012). Quantitative meta-analysis of neural activity in posttraumatic stress disorder. Biology of Mood & Anxiety Disorders, 2(1), 9. https://doi.org/10.1186/2045-5380-2-9
Annotation. This quantitative meta-analysis synthesized functional neuroimaging studies examining neural activity in individuals with posttraumatic stress disorder (PTSD). The authors identified consistent patterns of amygdala hyperactivation alongside reduced activation in medial prefrontal and anterior cingulate regions implicated in executive control and emotion regulation. These findings demonstrate that psychological trauma is associated with systematic alterations in functional brain activity, providing strong neurobiological evidence that trauma compromises brain function rather than merely producing subjective distress.
Javanbakht, A., Liberzon, I., Amirsadri, A., et al. (2011). Event-related potentials in posttraumatic stress disorder. Clinical Neurophysiology, 122(12), 2463–2471. https://doi.org/10.1016/j.clinph.2011.04.006
Annotation. This study used event-related potentials (ERPs) to examine information-processing abnormalities in individuals with PTSD. Results showed altered neural responses during attentional and cognitive tasks, indicating impaired early sensory processing and reduced efficiency of higher-order cognitive control mechanisms. The findings provide objective electrophysiological evidence that trauma exposure disrupts brain function at the millisecond level, supporting claims of compromised cognitive processing following psychological trauma.
Kessler, R. C., et al. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), 1353383. https://doi.org/10.1080/20008198.2017.1353383
Annotation. Drawing on large-scale epidemiological data from the WHO World Mental Health Surveys, this study examined the prevalence and consequences of trauma exposure across diverse countries. The authors identified strong dose–response relationships between trauma exposure and mental health outcomes, including cognitive and functional impairment. This work provides population-level evidence that trauma is a major determinant of impaired psychological and cognitive functioning worldwide.
Maté, G., & Maté, D. (2022). The myth of normal: Trauma, illness, and healing in a toxic culture. Avery.
Annotation. This book situates trauma within broader social, cultural, and medical contexts, arguing that chronic stress and disconnection are normalized drivers of illness. Drawing on clinical experience and research in stress physiology, immune function, and neurodevelopment, the authors link trauma to both psychological and physical disease. Although not a technical neuroscience text, the book provides an integrative perspective that contextualizes individual brain changes within systemic influences.
Op den Kelder, R., Van den Akker, A. L., Geurts, H. M., Lindauer, R. J. L., & Overbeek, G. (2018). Executive functions in trauma-exposed youth: A meta-analysis. European Journal of Psychotraumatology, 9(1), 1450595. https://doi.org/10.1080/20008198.2018.1450595
Annotation. This meta-analysis synthesized findings from 30 studies examining executive functioning in children and adolescents exposed to psychological trauma. Trauma-exposed youth demonstrated significant impairments across multiple executive domains, including working memory, inhibition, cognitive flexibility, and planning, compared with non-exposed peers. The authors argue that chronic stress and trauma during development disrupt prefrontal cortex–mediated cognitive processes, contributing to persistent cognitive vulnerabilities. This study provides strong quantitative evidence linking trauma exposure to measurable cognitive deficits and supports trauma-informed models of psychopathology.
Pagani, M., Amann, B. L., Landin-Romero, R., & Carletto, S. (2017). Eye movement desensitization and reprocessing and brain plasticity in posttraumatic stress disorder: A PET study. PLoS ONE, 12(9), e0184674. https://doi.org/10.1371/journal.pone.0184674
Annotation. This positron emission tomography (PET) study investigated neural changes associated with EMDR treatment in individuals with PTSD. Results demonstrated functional reorganization in brain regions involved in memory, emotional processing, and executive regulation following treatment. These findings support the concept of trauma-induced but reversible alterations in brain function and highlight neural plasticity as a key mechanism in trauma recovery.
Reumers, S.F.I., Bongaerts, F.L.P., de Leeuw, FE. et al. Cognition in cerebellar disorders: What’s in the profile? A systematic review and meta-analysis. J Neurol272, 250 (2025). https://doi.org/10.1007/s00415-025-12967-8
Annotation. This systematic review and meta-analysis synthesizes contemporary neuropsychological findings in patients with cerebellar disorders, showing significant cognitive deficits across domains such as processing speed, language, social cognition, executive function, memory, attention, and visuospatial skills compared with controls. It offers an updated, comprehensive profile of non-motor impairment linked to cerebellar pathology.
Sanger, B. D., Alarachi, A., McNeely, H. E., McKinnon, M. C., & McCabe, R. E. (2025). Brain fog and cognitive dysfunction in posttraumatic stress disorder: An evidence-based review. Psychology Research and Behavior Management, 18, 589–606. https://doi.org/10.2147/PRBM.S461173
Annotation. This evidence-based review synthesizes research on subjective brain fog and objective cognitive impairment in PTSD. Integrating neuropsychological testing, neuroimaging, and patient-reported outcomes, the authors conclude that cognitive dysfunction is a central feature of PTSD. The review is particularly valuable for legitimizing patient-reported cognitive symptoms and linking them to identifiable neural mechanisms.
Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1), 169–191.
Annotation. This article presents a widely cited model of fear and stress circuitry involving the amygdala, hippocampus, medial prefrontal cortex, and anterior cingulate cortex. The authors explain how trauma disrupts inhibitory control over fear responses, resulting in persistent hyperarousal and impaired emotion regulation. This work is foundational for understanding trauma-related dysfunction as a network-level disturbance.
Annotation. This seminal clinical–neuroanatomical study systematically documents a constellation of cognitive, linguistic, and affective impairments following focal cerebellar lesions, introducing the concept of Cerebellar Cognitive Affective Syndrome (CCAS). Using detailed neuropsychological assessments and lesion localization, the authors demonstrate deficits in executive functioning, visuospatial cognition, language prosody, and emotional regulation that cannot be explained by motor impairment alone. This article is widely regarded as the foundational work establishing the cerebellum’s role in higher-order cognition and affect.
Schmahmann, J. D. (2004). Disorders of the cerebellum: Ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome. Journal of Neuropsychiatry and Clinical Neurosciences, 16(3), 367–378. https://doi.org/10.1176/jnp.16.3.367
Annotation. This narrative review integrates clinical, neuropsychological, and neurobiological research on the cognitive consequences of severe and chronic trauma. The authors document consistent trauma-related impairments in attention, memory, processing speed, and executive functioning, linking these outcomes to dysregulation of stress-response systems and alterations in hippocampal and prefrontal networks. The review also discusses clinical implications for assessment and intervention, emphasizing that cognitive symptoms are a core feature of trauma exposure rather than secondary effects of comorbid psychiatric diagnoses. This article supports the existence of multi-level evidence connecting trauma to cognitive dysfunction.
Scorza, K. A., & Cole, W. (2019). Current concepts in concussion: Initial evaluation and management. American Family Physician, 99(7), 426–434.
Annotation. This clinical review provides a comprehensive overview of the diagnosis and management of concussion (mild traumatic brain injury) in primary care settings. The authors describe concussion as a functional brain injury caused by biomechanical forces that disrupt neural activity without necessarily producing structural abnormalities on imaging. The article outlines key symptom domains—including physical, cognitive, and emotional/behavioral—and emphasizes that emotional symptoms such as irritability, anxiety, and mood changes are common and clinically significant. It also highlights best practices in evaluation, including ruling out more severe injury, and supports individualized management strategies involving brief cognitive and physical rest followed by gradual return to activity. This source is widely used in clinical and educational contexts to support the understanding of concussion as a multidomain condition involving emotional as well as neurological dysfunction.
Theodoratou, M., Kougioumtzis, G. A., Yotsidi, V., Sofologi, M., Katsarou, D., & Megari, K. (2023). Neuropsychological consequences of massive trauma: Implications and clinical interventions. Medicina, 59(12), 2128. https://doi.org/10.3390/medicina59122128
Annotation. This narrative review integrates clinical, neuropsychological, and neurobiological research on the cognitive consequences of severe and chronic trauma. The authors document consistent trauma-related impairments in attention, memory, processing speed, and executive functioning, linking these outcomes to dysregulation of stress-response systems and alterations in hippocampal and prefrontal networks. The review also discusses clinical implications for assessment and intervention, emphasizing that cognitive symptoms are a core feature of trauma exposure rather than secondary effects of comorbid psychiatric diagnoses. This article supports the existence of multi-level evidence connecting trauma to cognitive dysfunction.
van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Annotation. This influential book integrates neuroscience, psychiatry, developmental psychology, and somatic therapies to describe how trauma is encoded in both brain and body. Van der Kolk emphasizes altered brain rhythms, limbic hyperreactivity, and impaired integration of memory and bodily awareness. While integrative rather than strictly empirical, the book has significantly shaped trauma-informed clinical practice and public understanding.
Vasterling, J. J., Brailey, K., Constans, J. I., & Sutker, P. B. (1998). Attention and memory dysfunction in posttraumatic stress disorder. Neuropsychology, 12(1), 125–133.
Annotation. This early neuropsychological study demonstrates that PTSD is associated with measurable impairments in attention, working memory, and verbal learning. Using standardized testing, the authors show that these deficits persist beyond general distress or mood symptoms. The study remains foundational in establishing cognitive dysfunction as an intrinsic component of PTSD.
Weis, C. N., Webb, E. K., deRoon-Cassini, T. A., & Larson, C. L. (2022). Emotion Dysregulation Following Trauma: Shared Neurocircuitry of Traumatic Brain Injury and Trauma-Related Psychiatric Disorders. Biological psychiatry, 91(5), 470–477.
Annotation. This review synthesizes evidence that traumatic brain injury (TBI) and trauma-related psychiatric disorders share overlapping neural circuitry underlying emotion dysregulation. The authors highlight convergent dysfunction across prefrontal, limbic, and salience networks, including impaired top-down regulation of affective responses. Importantly, the paper reframes emotional symptoms following trauma not as purely psychological sequelae, but as neurobiologically grounded outcomes of disrupted brain systems. This work is frequently cited to support transdiagnostic models of trauma-related emotional dysregulation and is relevant for conceptualizing emotional disturbance as a form of brain-based injury rather than solely a psychiatric reaction.
Wong, K.-H., Anderson, C. D., Peterson, C., Bouldin, E., Littig, L., Krothapalli, N., Francis, T., Kim, Y., Cucufate, G., Rosand, J., Sheth, K. N., & de Havenon, A. (2025). Rising cognitive disability as a public health concern among US adults: Trends from the Behavioral Risk Factor Surveillance System, 2013–2023. Neurology, 105(8), e214226. https://doi.org/10.1212/WNL.0000000000214226
Annotation. Using a decade of nationally representative Behavioral Risk Factor Surveillance System data, this study examines trends in self-reported cognitive disability among U.S. adults. The authors report a significant increase in the prevalence of cognitive difficulty over time, including among younger adults, indicating that population-level cognitive complaints are both common and rising. Although the survey does not identify specific causes, the findings support public-health concerns about widespread, functionally meaningful cognitive impairment that may not be fully explained by neurodegenerative disease, reinforcing the need to investigate under-recognized contributors such as psychological and environmental stressors.
Appendix 1- Methods-by-Evidence Table: Psychological Trauma and Compromised Brain Function
Research Method
What Is Measured
Key Findings
What This Demonstrates
Representative Landmark Citations
Functional neuroimaging (fMRI, PET)
Brain activation patterns and network connectivity during tasks or at rest
Amygdala hyperactivation; reduced medial prefrontal and anterior cingulate activity; disrupted executive and default-mode networks
Trauma alters functional brain organization, impairing executive control and emotion regulation
Hayes et al., 2012; Shin et al., 2006
Neuropsychological testing
Performance on standardized cognitive tasks (memory, attention, executive function)
Consistent deficits in working memory, attention, inhibition, and cognitive flexibility in trauma-exposed individuals
Trauma is associated with objectively measurable cognitive impairment
Scott et al., 2015; Op den Kelder et al., 2018
EEG / Event-related potentials (ERPs)
Millisecond-level neural processing during cognitive tasks
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.
“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.
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.
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), and recent federal research found significantly greater risk of premature death with just two drinks per day. 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.
A recent Gallup analysis of decades of data on top transformational leadership performers identified seven competencies that correlate with organizational success. Importantly, these aptitudes drive performance when they are openly modeled and visible. They are:
1. Build relationships. Establish connections with others to build trust, share ideas and accomplish work.
2. Develop people. Help others become more effective through strengths development, clear expectations, encouragement and coaching.
3. Lead change. Recognize that change is essential, set goals for change and lead purposeful efforts to adapt work that aligns with the stated vision.
4. Inspire others. Encourage others through positivity, vision, confidence, challenge and recognition.
5. Think critically. Seek information, critically evaluate the information, apply the knowledge gained and solve problems.
6. Communicate clearly. Listen, share information concisely and with purpose, and be open to hearing opinions.
7. Create accountability. Identify the consequences of actions and hold yourself and others responsible for performance.
Where are leaders the weakest?
According to Gallup, in every single domain, less than 40% of managers rated their own leaders as highly competent, with the weakest domain (30%) being accountability. In fact, less than half of leaders rated themselves as highly accountable.
Why does this matter? “The 30% of managers who say their leaders are exceptional or outstanding in holding everyone responsible for exceptional performance are three times as likely to be engaged in their work as those who say their leaders are not (51% vs. 17%).”
And… employee engagement is one of the most critical variables related to organizational performance and success—when leaders fail here, they fail big.
One very concerning theme across the entire analysis is that leaders consistently overrate their own abilities compared to how the managers who report to them rate their abilities.
Where are Leaders the Strongest?
From a relative perspective, managers rate their leaders highest on the competency of critical thinking and leaders also rate themselves highest on that domain as well. However, only 37% of managers believe that is a high-level aptitude in their leaders, while 66% of leaders rate themselves highly, i.e., they rate themselves twice as highly as their managers do!
Why might accountability be the weakest leadership link?
It is not surprising that accountability among leaders is the lowest rated of the seven key competencies by both leaders and the managers who report to them. Why? Because accountability requires clear, sometimes difficult communication and conversations, which require high quality relationships and people skills. Only one third of managers report that their leaders have high competence as communicators and people leaders, so the deficit in this key area is pretty clear.
Moreover, the delta between how leaders see themselves and how their managers see them in all areas is very problematic because leaders will engage their managers based on how they think they themselves are doing and what they’re good at, not based on what managers actually need from them!
How Leaders Can Improve Accountability (and other competencies)
Improving accountability is primarily about:
increasing clarity of expectations
improving communication
strengthening relationships
Regardless of a person’s role, knowing what they are expected to do and why it matters is essential to being accountable. Because some conversations are difficult, it is vital that relationships be strong enough to support direct communication that may be uncomfortable, both for setting expectations and evaluating whether or not they’ve been met. Avoidance is the enemy of clarity, and thus of accountability.
The Transformation Collaborative™ Leadership Discovery Program
At the TC, it became clear to us years ago that due to radical, destabilizing changes in operating environments, traditional notions of leadership are not only no longer viable, they often exacerbate organizational problems, particularly related to critical factors such as engagement, purpose, and resilience. The TC Leadership Discovery program was developed with a specific focus on high impact leadership traits and behaviors for the world we operate in now as well as on supporting personal discovery, i.e., not just what we can do, but who we are.
A Low-Effort, High-Impact Practice for Couples and other Relationships
Purpose Strong relationships are not built on grand gestures, but on consistent small moments of attention, warmth, and responsiveness. Keep in mind that connection grows from commitment, not perfection. This handout offers simple, inexpensive practices designed to increase enjoyment, emotional safety, and closeness while generating new patterns and ways of feeling about the relationship. These tools apply to both romantic partnerships and other relationships.
Why Small Moments Matter
Research consistently shows that connection grows through:
Brief but meaningful daily interactions
Expressions of appreciation
Shared rituals
Gentle reconnection after tension
Emotional responsiveness
Safe, no obligation touch
Small efforts done consistently are more powerful than occasional large efforts. Moreover, it is important to generate a large number of “positive” interactions, even if they are simple and brief.
Part I: Choose 3–5 Micro-Rituals
Select a few practices that feel realistic — not overwhelming.
Daily Connection Options
☐ 10-second hug when reuniting
☐ Brief smile with no words ☐ Share one “high” and one “low” from the day ☐ Phone-free coffee or tea together
☐ Brief touch in passing ☐ Sit next to each other (not across) while talking ☐ Express one specific appreciation you feel for your partner
☐ Your choice_______________________________
Weekly Connection Options
☐ Take a 10–15 minute walk together ☐ Cook a simple meal together ☐ Do a 10-minute tidy-up with music ☐ Have a 5–10 minute weekly check-in ☐ Share one hope or goal for the upcoming week
☐ Go to bed at the same time once per week
☐ Hide a small, warm note for your partner to find
☐ Your choice_______________________________
Our Selected Rituals:
Part II: Weekly Check-In Structure (5–10 Minutes)
Couples are encouraged to use this structure once per week. Schedule the check in as you would any other important activity.
1. This week I felt closest to you when… Partner A: ____________________________________ Partner B: ____________________________________
2. One thing that helped us this week:
3. One small adjustment that could help next week:
4. I felt appreciation/appreciated when: Partner A → Partner B: _________________________ Partner B → Partner A: _________________________
Part III: Light & Playful Connection Ideas
These activities are intentionally brief and low-pressure.
Tell a joke
Play a quick card or board game
Have a 5-minute kitchen dance party
Share a funny video
Try a new snack and rate it
Look at old photos together
Watch the sunset
Ask, “What made you smile today?”
Take a short drive/walk with no destination
The Role of Sex
For some people, within romantic relationships, sex can be “light and playful” and for others, it may require more emotional depth, planning, and relational “prerequisites.” Either way, it is often a source of meaningful connection, intimacy, and positive association with a partner and the relationship. If it is consensual and pleasurable, then it can play an important role in building connection. Of course, sexual touch is not appropriate in platonic relationships.
Part IV: Micro-Repair Practice
When tension happens, keep repair small and simple.
1. What happened?
2. What I felt:
3. What I needed:
4. One small repair step we can take now:
Examples of repair:
A brief apology
An extended hug
Simple amends
Taking a short break and returning with a commitment to do better
Summary
Relationships are more likely to be sustainable and enjoyable when they include frequent, relatively small overtures that build connection consistently over time. Also, because we tend to be more affected by negative experiences, it is important to provide a large number of positive experiences as a counterbalance. The specific activities we choose are less important than the fact that we commit to regularly engaging our partner in ways that feel close and connected.
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.
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)
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.
