AUTHOR Deborah Farmer Kris

In the last decade, rates of anxiety-related disorders in teenagers have steadily risen, particularly in girls. Researchers and psychologists posit several hypotheses about why these rates are on the rise -- from digital hyperconnectivity to heightened external pressures to simply a greater awareness, and therefore diagnosis, of mental health concerns.
Whatever the causes, Dr. Lisa Damour has hopeful news for parents and teens: first, some degree of stress and anxiety is not only normal but essential for human growth. And if those levels become untenable, there are tested strategies for reining anxiety back in.

Reframing Anxiety

Damour, a psychologist and author of the new book "Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls," has spent decades working with adolescent girls and their families. In recent years, she has noticed a change in how society views stress. “Somehow a misunderstanding has grown up about stress and anxiety where our culture now sees both as pathological,” said Damour. “The upshot of that is that we have adults and young people who are stressed about being stressed and anxious about being anxious.”
Anxiety is a normal and healthy function, according to Damour, and much of the anxiety that teenagers express is a sign that they are aware of their surroundings, mindful of their growing responsibilities, and frightened of things that are, in fact, scary. Adults can make a difference simply by “reassuring them that, a great deal of time, stress is just operating as a friend and ally to them.”


Change and stress go hand in hand -- even if a change is positive. Teenagers' lives are filled with change: Their bodies and brains are transforming, they usually switch schools at least once between grades 5 and 12, their academic workload is increasing, and social relationships are constantly evolving. The anxiety that comes with stretching to face these and other challenges is part of how humans develop strength, said Damour.
When she talks with teenage girls, she uses the metaphor of exercise: To develop physical strength, you have to slowly push your levels of physical endurance, building up strength through resistance training. Similarly, said Damour, “you should see [a challenge] as an extraordinary weight training program for your mind. You are going to walk out of it tougher and stronger than you have ever been.”

Stress, Emotion and the Teenage Brain

Sometimes anxiety and stress reach levels that impede a girl’s ability to navigate life effectively. That said, Damour cautions that an emotional outburst -- in and of itself -- is not a reliable indicator of mental health. “If you are raising a normally developing teenage daughter, she will have meltdowns. And there’s nothing you can do to prevent that,” said Damour.
Of course, when it’s your daughter who is sobbing on the bathroom floor, it’s hard to keep this in perspective. “When it’s your kid, it’s terrifying,” Damour said. “A lot of parents are frightened and paralyzed in that moment. They wonder: Is this a sign that something is really wrong or that my kid is really out of control?”  
This is where a little neuroscience might be helpful, said Damour. “The adolescent brain is very gawky and vulnerable to emotion.” That gawkiness stems from the extraordinary brain development that happens in adolescence. “The brain is upgrading, but in the same order as it initially developed,” said Damour, from the more primitive regions that house emotions to the more sophisticated regions that regulate perspective and problem-solving.
The result? “When she’s calm, a teenage girl can outreason any adult. When she’s upset, her primitive regions can hijack the whole system and take it down.”  

When your daughter is emotionally overwhelmed, give her a little time. Damour said it’s easy to see a meltdown as a fire that’s about to turn into a conflagration. But a storm is a more accurate metaphor. “You can’t stop a storm,” she said. “You have to wait it out. But these storms do pass. The brain will reset itself. Don’t try to stop the storm or fix it in the moment.”  
Instead, sit with her, go on a walk together, watch a funny show, or offer her a cup of tea, advised Damour. After weathering a few storms successfully, “parents and teenagers get to discover that -- all by itself -- the storm will pass. At that point, either the problem completely evaporates and she moves on, or the girl can now look at the problem with clear eyes, assess it with her prefrontal lobe back online, and figure out what she wants to do.”

Responding Instead of Reacting

Teenage girls are particularly sensitive to the cues they receive from parents and teachers –  from words to facial expressions. How adults respond to teens’ emotional reactions matters a lot, said Damour. When adults become anxious in response to a teen’s anxiety, it exacerbates the situation.

Helping girls weather stress storms can be “excruciating for parents,” and Damour said she understands the almost primal desire to alleviate the pain, solve the problem for them or remove the stressor --  such as letting them stay home from school if they are anxious about a test. But avoidance feeds anxiety. Girls often feel stressed because they overestimate the difficulty of a situation and underestimate their ability to deal with it, said Damour. When they avoid a situation, they miss the opportunity to correct that perception and recognize their own strength.

Damour has found two words helpful in helping keep teens in the driver’s seat: “stinks” and “handle.”
“ ‘That really stinks’ is a very simple phrase that cuts right through it. It says, ‘I hear you and I’m just going to sit here for a moment and acknowledge that what you are up against isn’t that great,’ ” said Damour, “Empathy goes very, very far in helping them contain what is upsetting them.”

Often, there is no simple solution to a stressor, so “the next step may simply be acceptance –  acceptance of the situation and of their strength to persist through it. It’s the ability to say to yourself, ‘This stinks, but this is something I can handle.’ ”  
Damour said the word “handle” is empowering. Girls learn that “by enduring this, I’ll be able to endure more down the line. I’ll build up my capacity to handle unpleasant situations.”

Build in Recovery Time

In strength training, “you can’t just lift weights day after day after day,” said Damour. “In order to get the full benefits from the workout, your muscles need a chance to recover and repair.” The same holds true for the brain.
If teens accept that some level of stress is inevitable, they can spend less time worrying about stress and more time focusing on how they can build in recovery time.

“The good news is your mind recovers a lot faster than your muscles do. But you need to restore yourself so you can go right back in for another workout. Your job is to figure out how you like to recover. What’s the system that really works for you?”  For some teens, playing sports gives them the reboot they need to focus on academics. Another student might benefit from a watching a 22-minute episode of a sitcom, playing with a dog, going on a walk or listening to a favorite music playlist.

Having conversations with stressed-out teens about this type of downtime redirects the attention away from the stress and toward the recovery. Students can’t always control the stressors in their life, said Damour, but they can have a say over how they choose to restore themselves.

The Restorative Power of Sleep

Sleep deprivation is one of the simplest explanations for the rise in anxiety-related concerns, Damour said. “Sleep is the glue that holds human beings together.”

The research is unambiguous: When we are sleep-deprived, we are less emotionally resilient. According to Damour, the first question many clinicians ask teens who come in for anxiety is, “How much sleep are you getting?”

If they are consistently getting less than seven or eight hours, that’s the first line of intervention. “Teenagers need nine hours a night, middle-schoolers need 10, and elementary students need 11. Caffeine doesn’t make up for that.”
When it comes to sleep, she says, small changes can make a big difference, including completing as much homework as they can during the school day, making judicious choices about how much time they spend on any given assignment, and monitoring social media use in the evening.

“Technology is very hard on sleep,” said Damour. “I’m not anti-social media, but it makes a tremendous difference for teens to not have a phone and computer in the bedroom at night. Teenagers have texts waking them up.”

Because of the melatonin-suppressing effects of blue light emitted from smartphone screens and other devices, Damour encourages teens to turn off social media notifications well before going to sleep. But it’s not just the blue light. “Girls will often see something on social media that will keep them up at night -- and if you ask them, they’ll usually admit this.”   

Growing Up Brave

According to Damour, the most powerful force for good in a teenager’s life is a “caring, working relationship with at least one loving adult.” Within that context, adults can offer teenagers empathy, grounded perspective and a vote of confidence as they work through challenges --  helping them aim for courage, not avoidance.
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“Brave is a positive word --  it’s something we aspire to be,” said Damour. “Built into the word is the understanding that the person is scared and yet they are doing something anyway. Scared is here to stay. Anxiety is part of life. It’s not our job to vanquish these feelings. It’s our job to develop the resources we need to march forward anyway.”

https://www.kqed.org/mindshift/52994/how-to-help-teenage-girls-reframe-anxiety-and-strengthen-resilience?fbclid=IwAR0XztoDP0n-KnHTPBqYhFl4HZYqIS982nDNsyEYIjSN9txEi9Nykr8tmG0​

MATTHEW LOFTUS | NOVEMBER 23, 2016 Christianity Today, excerpt 

Is Addiction a Disease? Yes, and Much More. Understanding addiction as a disease does not mean that prayer and moral discipline are any less potent or important in recovery.

Many people see addiction . . . as a character flaw or a bad choice. They don’t recognize that addiction is in fact a chronic disease of the brain.” That statement by Vivek Murthy, surgeon general of the United States, reflects the current medical and scientific consensus about addiction. Murthy and others believe the language of moral choices only increases shame and decreases funding for more scientifically rigorous treatments. To make progress in saving lives, they argue, we need to change the way we think about addiction.

In fact, we need to recognize at least four dimensions in addiction: moral, social, biological, and spiritual. Addicts are moral agents, in community, with biology working against their spiritual goals. Biological science gives us insight into the particular ways an addict’s body makes a normal life that much harder to live. Public health can describe how a community and its institutions make recovery more accessible to people trapped in addiction. A moral framework helps us understand how addiction harms ourselves and the people we love, while also providing the basic routines of living free. Most importantly, spirituality helps us to understand God’s love for everyone (no matter how lost they are) and gives us the power to live healthy, whole lives.
Biology and the BrainOur brains were created with neurotransmitters to help us enjoy the physical pleasures of life, adapt to stressful situations, and direct us to do what is necessary to maintain our bodies’ physical and mental health. Addictive substances (and, to a lesser degree, other addictions like pornography or gambling) pervert all of these basic brain functions, breaking the biological systems we depend on to think and choose as we ought.
It is important to differentiate between dependence and addiction. Dependence refers to the basic physiological need that some drugs create in our bodies when used over time, leading to measurable physical symptoms when the drugs are withdrawn. Dependence is almost negligible for certain drugs, but it can make complete withdrawal fatal for others. Such physical dependence on heroin and prescription painkillers creates severe withdrawal symptoms when a user tries to stop. (Some people with severe chronic pain—from cancer, for example—can be physiologically dependent on opioids but not addicted.) Some medications available for treating addiction work primarily by preventing these withdrawal symptoms.
The biochemical effects of addiction, as Timothy King’s cover story for CT illustrates, tend to be more complex. The most obvious effect of many addictive substances is pleasure, but even that isn’t so simple: Drugs can overstimulate and alter the pathways that normally connect pleasure with healthy activities. Over time, the brain’s reward system becomes tied more exclusively to the drug of choice, decreasing an addict’s ability to experience natural pleasures while heightening the effect of the drug.
At the same time, the pleasure centers of the brain adapt so that using a drug is itself rarely euphoric anymore. Instead, the altered neurochemical reward pathways that once led to pleasure are instead fruitlessly stimulated over and over until other areas of the brain—such as systems linked to critical thinking and decision-making—are hijacked into supporting this never-ending cycle. Many drug addicts will describe the routine of using a needle as nearly as important as actually getting high, just as porn addicts will spend hours looking at pornography without masturbating. Both are fruitlessly reenacting the reward pathways that normally teach our brains to seek out good things, corrupting them so we merely anticipate and want instead of actually enjoy.

At the same time, drugs especially subject to abuse also tend to tamp down stress factors in the brain. When the drugs are no longer present, these neurochemicals are often released in greater volumes, heightening anxiety and creating another set of incentives to keep using. This makes the initial withdrawal that much harder, and makes addicts more likely to relapse in stressful situations.
Just like drinking nothing but soda will rot one’s teeth until one cannot even bite an apple, so using drugs will alter the physical and neurochemical structures of our brains until many of our personal resources for doing the right thing are impaired. Many of these biochemical alterations have been found to persist for months after an addict stops using. Addiction is not simply about “getting high.”
One of the most important (and controversial) treatments for opioid addiction is medication-assisted treatment—using methadone or buprenorphine (Suboxone) to prevent physical withdrawal symptoms while addicts learn how to manage their lives without abusing drugs. At first, it may seem counterintuitive to use one powerful drug to treat addiction to another. Many people stigmatize the use of methadone or Suboxone as “just another kind of addiction.” However, in cases of addiction (versus dependence), these medications can be very useful.
Medication-assisted treatment, when used in conjunction with a rigorous treatment program, has been shown by many studies to help people stop abusing drugs and live healthy, functional lives. That does not mean it makes recovery easy. When I was practicing medicine in Baltimore, my patients often described craving heroin even when they were on a strong dose of Suboxone. I had to explain again and again that the drug would not necessarily prevent cravings. They had to do the work of recovery to retrain their brains and bodies to manage without abusing drugs. Still, these drugs are a powerful adjunct in some people’s recovery. They are not the right choice for everyone, but to extend my earlier dental metaphor, they are like a set of false teeth that makes good nutrition more accessible.
Public Health and CommunityJohann Hari, author of Chasing the Scream, has said that “the opposite of addiction isn’t sobriety—it’s connection.” This is true, as long as we’re talking about a healthy community, not codependent connections with family and friends (some of whom may also be addicted). Connection and community are very important in overcoming addiction, but not always in the way that we might think.
An addict’s internal personal judgment and decision-making are corrupted, making other people necessary to reality-test the patterns of thought that would otherwise reinforce addiction. The church has an important opportunity here, not just in helping connect addicts in need with loving friendships but also in re-centering us in our basic human purpose of worship. Whether one walks in on Sunday morning five years sober or still a little intoxicated from Saturday night, our brains and bodies were created to worship God. It is by living in the typical patterns of life and worship that our bodies can be healed.
Recovering addicts always require this basic level of community support, but many also need a more intensive regimen. Many small groups and churches have implemented an explicitly Christian 12-step program like Celebrate Recovery (though there is no robust evidence that 12-step programs, as popular as they are, are superior to other treatment programs like cognitive-behavioral therapy).
What is important is ensuring that some sort of treatment is widely available. Waiting lists for treatment programs are often months long, meaning that someone who decides they want to get better has to wait to get the help they need—often still using and occasionally dying of an overdose before they get into treatment. We cannot expect our national addiction problem to get better until treatment is better funded and more accessible, including making sure medication-assisted treatment is available to anyone who wants it.
Morality and SpiritualityAddiction and recovery also have moral and spiritual components, and it is useful to distinguish them. As Eve Tushnet says, “Selfishness and idolatry are moral categories, in which . . . the proper hierarchy of our loves is disrupted. That’s different from addiction as a misdirected expression of a spiritual longing, an attempt to feed a spiritual hunger.” All people—addicts in particular—are called to start with the gospel that satisfies our hunger, trusting in God’s love for us and repenting of our sin. Many people recover without trusting in Christ, yes, but those who are grasped by the gospel have a significant head start in sorting out the “hierarchy of our loves” as they untangle the particular ways in which sin has created strongholds in their lives.
One of those strongholds, undoubtedly, is the perverted biochemistry of addiction. Our reward pathways and pleasure centers didn’t simply evolve to help us eat and reproduce; they were created to glorify God and enjoy him forever. Addiction cripples our brain’s ability to mediate the moral and spiritual ends we were intended for, which means that in recovery, we don’t just obey and worship but work to regain the capacity to obey and worship.
Understanding addiction as a disease does not mean that prayer and moral discipline are any less potent or important in recovery. But it does underscore the ways that medication and therapy can be helpful, and helps us to appreciate just how difficult and costly recovery can be. The process of an addict recognizing their need for help, finding a treatment program, and walking through the recovery process (including relapses, which are very common) will usually take more time, energy, and money than one person with a broken brain can bear. Not everyone will need all of these different elements, but our current crisis demands that kind of holistic response.
King’s CT essay reflects this complex interaction of body, mind, and soul. His doctors had to show him that the opioids were doing him more harm than good and acknowledge the role they had played in his addiction. They had to use their professional skills to develop a medical plan for dealing with his pain and his addiction that complemented the support from friends and family. But he also chose to get better, committed to the plan, and was willing to do the work necessary to confront the way that painkillers had changed his mind and body for the worse.
To help addicts heal, we have to bring all the forces available to us to bear—sometimes even to the extent of using medications like methadone and Suboxone. Loving people who have become trapped in biochemical bondage is not easy or cheap, but love never is. And when we use every possible resource God has given us to combat addiction, we also demonstrate the goodness and power of God, who seeks to transform us in every way—even the neurons in our brains.
Matthew Loftus, MD (MatthewandMaggie.org) teaches health workers and practices family medicine in South Sudan with his family.

BY CHRIS ZEIGLER DENDY, M.S.

Many children with ADHD, battered by daily criticisms and admonitions, have low self-esteem as early as second grade. As that child’s parent or teacher, make a powerful difference with these reframing strategies.


Children with attention deficit disorder (ADHD or ADD) who struggle in school get lots of negative feedback. As a result, their self-esteem is battered as early as second grade. Adding insult to injury, many parents may get caught up pushing their children to work harder to make top grades. This adds another layer of negativity at home.
I lost my perspective when my son was struggling in high school. At times, I found myself thinking that he was lazy and just didn’t care. I was focused on monitoring his homework, hoping he would make better grades. I met him at the front door every day when he came home from school and asked, “Did you bring home your books and assignments?” I never bothered to ask him how his day went.
When he started avoiding me at the front door, by going in through the basement, a light bulb went on. I had lost sight of my most important duties as a parent: loving my son and building his self-esteem.
We should all be investing in our children’s emotional bank account. Your job as a parent is to keep the most important things in mind: nurturing your child’s self-esteem and maintaining a strong relationship with him or her. Your loving relationship may one day save your child’s life.
Investing In and Nurturing Our ChildrenStephen Covey, author of The 7 Habits of Highly Effective People and other best-selling books, coined the phrase “emotional bank account,” and Russell Barkley, Ph.D., recently used it in one of his top 10 tips for grandparents of children with ADHD. Just as we make regular deposits into our savings account, so we have money when times get tough, adding to our children’s emotional bank account serves the same purpose. Are you making deposits, or emptying his account?
Offer lots of positive statements and fun activities. Catch your child being good. When you do, say, “Great job. You put all your dirty clothes in the hamper.” “You’re getting better at making up your bed.” “Thank you for taking out the garbage!” “You make me proud. You’ve been reading that book for a long time, and you didn’t give up when there were words you didn’t know!” Find joy again in spending time with your child. Enjoy a special meal, just the two of you, with no nagging. Attend a concert or sporting event together. Let your child teach you a video game.
Reframe negative thoughts about your child. When your child struggles, stop and look at her in a new light, focusing on her strengths and talents. Remember that your child’s traits, which may not be valued in school, may be useful in the work world. Here are a few examples of reframing: Bossiness may be an indication of potential leadership skills. Hyperactivity may mean that your child can approach workplace projects with high energy and the ability to work longer on more projects. A strong-willed child brings tenacity to his job and career. And who knows? Maybe an argumentative child will one day be a great lawyer.
Recruit others to help you. Parents alone can’t fill this bank account, so enlist willing siblings, grandparents, relatives, friends, co-workers, coaches, teachers, or members of your religious group. If parents are lucky, grandparents can be their strongest and most helpful allies. By calling weekly via “FaceTime,” grandparents can be active in the child’s life when distance separates them.
Believe in the goodness of your child, encourage her, and show affection. Hugs, pats on the back, or holding her on your lap gives the child a sense of self worth. Take photos of your child when she is engaged in happy activities, and hang them on the refrigerator.

How to Invest In Your Child’s “Emotional Bank Account”Many children with ADHD, battered by daily criticisms and admonitions, have low self-esteem as early as second grade. As that child’s parent or teacher, make a powerful difference with these reframing strategies.
BY CHRIS ZEIGLER DENDY, M.S.
ADHD or ADD) who struggle in school get lots of negative feedback. As a result, their self-esteem is battered as early as second grade. Adding insult to injury, many parents may get caught up pushing their children to work harder to make top grades. This adds another layer of negativity at home.I lost my perspective when my son was struggling in high school. At times, I found myself thinking that he was lazy and just didn’t care. I was focused on monitoring his homework, hoping he would make better grades. I met him at the front door every day when he came home from school and asked, “Did you bring home your books and assignments?” I never bothered to ask him how his day went.
When he started avoiding me at the front door, by going in through the basement, a light bulb went on. I had lost sight of my most important duties as a parent: loving my son and building his self-esteem.
We should all be investing in our children’s emotional bank account. Your job as a parent is to keep the most important things in mind: nurturing your child’s self-esteem and maintaining a strong relationship with him or her. Your loving relationship may one day save your child’s life.
Investing In and Nurturing Our ChildrenStephen Covey, author of The 7 Habits of Highly Effective People and other best-selling books, coined the phrase “emotional bank account,” and Russell Barkley, Ph.D., recently used it in one of his top 10 tips for grandparents of children with ADHD. Just as we make regular deposits into our savings account, so we have money when times get tough, adding to our children’s emotional bank account serves the same purpose. Are you making deposits, or emptying his account?
[Your Free Guide to Parent Training Programs]
Offer lots of positive statements and fun activities. Catch your child being good. When you do, say, “Great job. You put all your dirty clothes in the hamper.” “You’re getting better at making up your bed.” “Thank you for taking out the garbage!” “You make me proud. You’ve been reading that book for a long time, and you didn’t give up when there were words you didn’t know!” Find joy again in spending time with your child. Enjoy a special meal, just the two of you, with no nagging. Attend a concert or sporting event together. Let your child teach you a video game.
Reframe negative thoughts about your child. When your child struggles, stop and look at her in a new light, focusing on her strengths and talents. Remember that your child’s traits, which may not be valued in school, may be useful in the work world. Here are a few examples of reframing: Bossiness may be an indication of potential leadership skills. Hyperactivity may mean that your child can approach workplace projects with high energy and the ability to work longer on more projects. A strong-willed child brings tenacity to his job and career. And who knows? Maybe an argumentative child will one day be a great lawyer.
Recruit others to help you. Parents alone can’t fill this bank account, so enlist willing siblings, grandparents, relatives, friends, co-workers, coaches, teachers, or members of your religious group. If parents are lucky, grandparents can be their strongest and most helpful allies. By calling weekly via “FaceTime,” grandparents can be active in the child’s life when distance separates them.
Believe in the goodness of your child, encourage her, and show affection. Hugs, pats on the back, or holding her on your lap gives the child a sense of self worth. Take photos of your child when she is engaged in happy activities, and hang them on the refrigerator.
[Free Resource: What Not to Say to a Child with ADHD]
Identify and facilitate your child’s interests and talents. If your son is interested in sports, music, dance, drama, or debate, make certain he has a chance to participate in those joyful activities. The successes he will achieve doing something he loves put deposits in his emotional bank account.
Ensure your child’s school success. If your child is struggling and stressed by school, be a persistent detective and advocate. Work with the school to figure out what is causing the struggles. Up to 50 percent of our children with ADHD also have learning disabilities that are overlooked.
How Teachers Can Make DepositsGreet each student by name as he or she comes into class.
Set the child up for success in the classroom. Talk to the student privately and have him answer the question that will be asked in class the next day. When students know the answer, they feel good about themselves.
Address and accommodate academic and executive function deficits.
Post the names of five students you’ve caught working hard or being kind on the board. Rotate names so everyone gets on the board.
Use “encouraging” words more than praise. Examples include: “Wow! You figured out how to do that.” “You did it. Tell me how you did it.” “This is hard for you, but you are sticking with it.” “Super progress.”
Create a booklet of students’ best work. Print and send the booklet home to parents during the holidays.
Visualize your child’s emotional bank account right now. Is it full or nearly empty? Your goal as parent, grandparent, or teacher is to make regular deposits in the child’s account. And if it gets low, you now know what to do.

Teachers: Avoid Making “Withdrawals!”
Avoid sarcasm or criticizing a student in front of the class; drawing “frowny faces” or highlighting mistakes on papers with lots of red ink; making negative facial expressions or gestures; punishing a child for behaviors caused by his disability—inattention, forgetfulness, slow writing and reading, losing papers, and other executive function deficits.
Never withhold recess as punishment. Our children need downtime and outside activity to re-energize their brains. Having recess increases brain activity, resulting in better grades and behavior. The CDC is strongly against withholding recess for any reason.
Chris A. Zeigler Dendy, M.S., a member of ADDitude’s ADHD Specialist Panel, is a former educator and school psychologist. She is the author of Teenagers with ADD & ADHD: A Guide for Parents. You can reach her at chris@chrisdendy.com.

The waiter appeared at our table again, this time offering a basket full of bread rolls just pulled from the oven. I picked out my third piece of the night, and carved out a heap of cultured butter, flecked with sea salt.  

“What have you been up to at work?” I asked my boyfriend Scott. 

This was last June. We were at a corner table at a Michelin-star restaurant in New York. We’d been dating for three years, and living together in San Francisco for a little over a year. I’d temporarily moved to New York to participate in the four-month TED Residency. He’d surprised me with this dinner to celebrate the end of the program.

It was a grand gesture, and one I appreciated, because we were not doing well. 

Our relationship had been shaky since January, turned upside down by several big changes in my life. After almost a decade in the corporate world, I’d quit my job to pursue my passion. I’d gone from earning a tech salary to earning no salary, and from working in an office with thousands of people to working alone at home.

We’d had several long, difficult conversations over the past few months. I told him what I needed from him and the relationship. I stated my values that I felt weren’t being met (community, friends, travel) and asked him if he could meet me halfway. We even went to a terrible couples therapist. He quoted his own Facebook posts to us and suggested that we, neurotic Jews, should start doing extreme sports together to reconnect. Ironically, we bonded over our mutual dislike of him. 
During one of those difficult conversations, Scott mentioned that I never seemed to listen to him when he talked about work.
“You think what I do is boring,” he said. “It’s not. We’re trying to help save women’s lives by improving breast cancer screening.”

He was right. I never really understood what he did. I worked in tech but I’m not a particularly technical person. I could barely work my DSLR camera. When people asked me about my boyfriend’s job in artificial intelligence at Google, I replied with a word salad of “machine learning,” “computer vision,” and “medical imaging,” until they nodded sympathetically and the conversation moved on. 

Finally the four months of long distance were over. Scott had flown across the country to see my TED talk, which focused on romantic relationships. I work as a dating coach and researcher, studying ways we can make better decisions in our love lives. The irony wasn’t lost on me that I was helping others create lasting love while my own relationship faltered. There, at that corner table at that fancy restaurant, I finally decided to learn what my boyfriend did for a living. 

He provided the basics of his job—what he does and why it’s different from traditional radiology. When I asked more questions, he explained that mammograms consist of four pictures—one of each breast from above and from the side. Radiologists usually look all four images together to look for cancer, but Scott’s artificial intelligence team only looked at the two images from each breast, not the pair. 

I began to ask him what the radiologists gained from looking at the four together, which the machine learning algorithms were missing out on.
“Sometimes a pattern appears in both breasts in the same place, which makes it less likely to be malignant,” he said.

“Oh,” I said. “So why don’t you train the model to take one set of images and compare it to the other to see if it’s symmetrical? Then you can rule out cancer if it is.”

“How would you do that?”

“Take one set, flip it, and put it on top of the other.”

He put down his forkful of “foraged seaweed” and stared at me in disbelief.

“What?” I said. 

“Wow, I’m just so impressed. That exact idea was used by one of the most competitive entries in a recent machine learning competition.”

I sat there, proudly listening to him explain the intricacies of his role on the mammography team. I felt connected to him, wondering why I’d never cared to ask him about his work before. I felt he too was seeing me in a new light, pleased with my newfound interest in his job. 

I realized how much I’d asked him to change for our relationship, without being willing to put in the work myself. 

And I knew this was the work. The paying attention, the asking questions, the listening. I knew this because of innovative research conducted by John Gottman, one of my relationship science heroes. Earlier that spring, I made a video with The Gottman Institute about “bids,” which are attempts a person makes to connect with their partner. 

Gottman’s groundbreaking ideas about bids were born from his 40-year-long quest to answer one question: What separates the relationship masters from the relationship disasters?

He conducted this research with his colleague Robert Levenson at the University of Washington. He brought couples into an observation facility, dubbed the Love Lab by the media, and recorded them discussing their relationship. He asked them to share the story of how they met and then to recount a recent fight. He even had some couples spend a week in an apartment decked out with cameras (with their permission) to see how they interacted during everyday moments.

Six years later, the researchers followed up with the couples and divided them into two camps: the masters, couples who were still happily married, and disasters, couples who had either broken up or remained together but were unhappy. 
When he studied the tapes of these two types of couples, he looked for differences in the content of their conversations. What did the masters discuss that the disasters didn’t?

In his book The Relationship Cure, Gottman writes, “But after many months of watching these tapes with my students, it dawned on me. Maybe it’s not the depth of intimacy in conversations that matters. Maybe it doesn’t even matter whether couples agree or disagree. Maybe the important thing is how these people pay attention to each other, no matter what they’re talking about or doing.”

Simply put, successful couples are attentive. They listen, and they put their phones down when the other person wants to chat. 

This research led Gottman to develop one of the core tenets of his philosophy for building successful relationships: healthy couples constantly make and accept bids to connect.

What’s a bid?Gottman refers to bids as “the fundamental unit of emotional communication.” Bids can can be small or big, verbal or nonverbal. They’re requests to connect. They might take the form of an expression, question, or physical outreach. They can be funny, serious, or sexual in nature. 

For example, your partner might say, “Hey, whatever happened with that situation at work with your manager?” or, “Do you want to talk about our plans this weekend?” or simply, “Can you pass the water?”

They could also give you a loving squeeze, pat you affectionately on the head, or tease you with a wink. 
Bids are often purposely subtle because people are afraid to be vulnerable and put themselves out there. It’s scary to say, “Hey! I want to connect! Pay attention to me!” so instead, we ask a question or tell a story or offer our hand for connection. We hope we’ll receive connection in return, but if not, it’s less scary than pleading, “Connect with me, please!”
How should I respond to a bid?There are three ways you can respond to a bid:

1. Turning towards (acknowledging the bid)
2. Turning away (ignoring or missing the bid)
3. Turning against (rejecting the bid in an argumentative or belligerent way)

When your partner reads their email and sighs audibly, they’re making a bid. You could turn towards them and ask, “What’s wrong?”

Now imagine you’re tidying up the kitchen and your partner asks you how your day was. You could pause, look up from what you’re doing and respond with details about the challenging phone call you had that day. That’s turning towards. You’re telling your partner you see and value them. 

Turning away from your partner, in the same situation, would be ignoring them or just grunting and continuing what you were doing. 

Turning against them takes the form of an attack, such as replying, “Why are you always interrupting me when I’m trying to get things done?”

Why do bids matter?A tendency to turn towards your partner forms the basis of trust, emotional connection, passion, and a satisfying sex life. 

Gottman found a critical difference in how masters and disasters respond to bids for connection. In the Love Lab, masters turned towards each other 86% of the time. Disasters turned towards each other only 33% of the time. 

None of us are perfect at accepting all of our partner’s bids, but the masters are better at it than the disasters. 

Some people think they can put their relationship on ice and then thaw it out with the occasional romantic date night. But relationships are built and maintained with daily attention, not grand gestures. 

It was the bids we made and received at dinner in New York, not the fancy dinner itself, that saved my relationship with my boyfriend.

How often should I make bids?Bid often. Master the art of the tiny moment. Reach out to show you care. Send a good luck message before a meeting. Leave an encouraging note on the fridge. Kiss your partner when they walk in the door—Gottman recommends a kiss that lasts at least six seconds. 

Bids can be super short and simple, but they hold great power. The key is to make many bids per day to show your partner you want to connect.

In fact, happy couples bid all the time. Gottman found that at the dinner table, masters bid as many as one hundred times in a ten minute period, while disasters engaged each other only sixty-five times.

What happens when bids are ignored?When our partner denies our bids, we internalize the experience. Our brains subconsciously keep track of how many bids are accepted or rejected by our partners. When our partner constantly turns away or against our bids, we begin to feel frustrated. We are more inclined to criticize our partners, which pushes them to be defensive and may result in an argument.

Gottman found when couples break up, it’s usually not because of issues like big fights or infidelity. More often, it’s a result of the resentment and distance that builds up over time when partners continually turn away from bids for connection.
The lesson here is to make many small bids every day. Pay attention and turn towards your partner’s bids. Listen for their sighs and look out for their winks. Make eye contact when they ask you a question. Engage with them when they point something out.

The power of bids

Prior to that dinner, I was guilty of the critique in that old saying, “The shoemaker’s children go barefoot.” In my attempt to help others with their relationships, I’d forsaken my own. 

That night in New York I made a bid to connect with my boyfriend about his job. He turned towards me and we had one of the best conversations of our relationship.

I see that dinner as the turning point in our relationship, the moment when I realized I’d been taking him for granted and prioritizing my work, emails, and dating coaching clients over him. 

Our entire relationship is different now. We are, as couples therapist Esther Perel would say, “on our second relationship” with each other. We are happier than we’ve ever been. 
​
I take the time to make more bids. But more importantly, I pay attention to his bids. I put down my phone. And I listen.

Logan Ury is a writer, researcher, and dating coach who applies insights from behavioral science to help people have more meaningful relationships. She’s currently conducting research for her forthcoming Simon & Schuster book on how to make better decisions in romantic relationships. She was a 2018 TED Resident and formerly ran the Irrational Lab, Google’s behavioral economics team, alongside Dan Ariely, author of Predictably Irrational. Her interview series Talks at Google: Modern Romance, where she speaks with world-renowned dating and relationship experts, earned 1M+ YouTube views. ​

C-PTSD: From Stigma to Healing​
Traumatized people often suffer from anxiety and depression, among other symptoms. Others might accuse them of being rude or hypersensitive. After hearing such comments, traumatized people feel worse about themselves. This stigma makes it difficult to heal.
However, life doesn’t have to be that way, and first impressions are not necessarily accurate. In order to understand why traumatized people might come off as rude or hypersensitive when they didn’t intend to, it is necessary to examine what’s going on inside them.
What Is C-PTSD?Most people think of trauma as something primarily war veterans experience. We’ve all heard of PTSD (post-traumatic stress disorder), which is limited to single traumatic incidents. But did you know that repeated trauma over time during childhood results in C-PTSD?
Another factor to consider is that everyone processes trauma differently and is at a different stage of the healing process. One person being able to handle their trauma seemingly easier than someone else with a similar trauma does not mean that it was not harmful to them. Sometimes, the phrase “What doesn’t kill me, makes me stronger” doesn’t apply. And it’s okay to admit a lack of strength in dealing with trauma. That’s where a professional diagnosis comes in.
ComorbidityC-PTSD can be misdiagnosed as Borderline Personality Disorder. Dr. Bessel van der Kolk has theorized that BPD and C-PTSD are one and the same. C-PTSD can also be misdiagnosed as ADD or ADHD. Regardless, many trauma victims have more than one issue at once. This is known as comorbidity.
Brain DevelopmentAfter a traumatic incident, the brain can remember it or blackout the memories. A blackout occurs when the body reacts against the harm of trauma by forcing the victim to forget what happened. This is also known as psychogenic, dissociative or functional amnesia. It is a disorder that affects one’s identity, memory, consciousness, and perception. As a result, trauma victims are often disbelieved because they often remember sensations over specific personal or circumstantial details, such as time. The after-effects of trauma are not limited to the specific incident or incidents in question and can continue for years — even for the rest of one’s life.
Dr. Bessel van der Kolk once explained it this way:
“…their problems primarily have to do with attention; being able to focus in on something and engage with something in a very steady, consistent way. So they get thrown off, they have a hard time focusing on things, concentrating on things, filtering irrelevant stuff out, so they get hijacked. That’s one very big issue that deserves its own special series of treatments.”
Children experience developmental issues from C-PTSD, such as a lack of socialization, but it does not mean they are lacking in intelligence any less than other people. In fact, they can have a high IQ. It’s just not very important for the whole picture: Emotional intelligence also matters, and it is emotional intelligence which therapists address. It is difficult for trauma victims to regulate their emotions.
According to Dr. Bessel van der Kolk:
“The second thing is the core issue of affect regulation. That is, we have our emotions in order to tell us what to do or where to go, to orient our bodies and minds to the reality around us. Traumatized people’s emotions become too large, too extreme, or they become too quiet.”
Because they experienced repeated traumatic incidents and did not have the support necessary to process that trauma, people with C-PTSD do not activate the same areas of the brain non-traumatized people do; namely, the amygdala, which governs the emotions. They also have an increase of the hormones cortisol and norepinephrine.
Brain scans show a decrease in the function of the areas governing the autonomic nervous system, memory, emotion, impulse control, empathy, decision-making, planning, social moderation, self-expression, and cognition. That is why cognitive and awareness exercises such as mindfulness are so helpful.
TriggersAn incident, word, or anything else that reminds the victim of their trauma is a trigger. A trigger activates their traumatic stress response in various ways:

• Flashbacks: Memories of the trauma or traumas.
• Dissociation: The sensation of being detached from what’s going on and not being present mentally, or observing from a distance.
• Depersonalization: Feeling like one is outside of their body, is unreal or unrecognizable to themselves. Some people describe it as a “glass wall” sensation where they cannot connect with what’s happening around them.
• Anxiety, depression, anger, and other overwhelming emotions
• The 4 Fs: According to Pete Walker, our survival instincts are Fight, Flight (or Flee), Freeze and Fawn.
• Negative thought cycle: Many mental health professionals acknowledge that abuse victims internalize their abusers’ words towards them or are so affected by trauma that they engage in harsh self-criticism, which lowers their self-esteem and causes the cycle to repeat itself.

Therapeutic MethodsCurrent therapies for C-PTSD include, but are not limited to:

• Somatic Experiencing
• Mindfulness practices
• Meditation
• Bodywork that integrates yoga, exercise, etc.
• Accelerated Resolution Therapy

Nobody should have to dwell on their pain. Accelerated Resolution Therapy can put you on the fast track to healing.