Psychology and Stress

Welcome to 2026! I’m willing to bet that this year will be filled with news reports that have the potential to be very upsetting for many people. We’re off to a horrific start with the Minneapolis shooting, and a video that has the potential to haunt some folks for a long time. Can that video be so upsetting that it actually causes significant increases in your stress levels? In general, can you be negatively affected by saturation media coverage of real events? In addition to tragic events like Minneapolis, regularly we see, and read about, in-depth coverage of mass shootings, horrible scenes of combat carnage and destruction, and gut-wrenching interviews with survivors of trauma. This year, of course, will also include election issues that have the potential to be exceptionally stressful. At a time when statistics show an alarming increase in mental-health problems, the question arises: “Can frequent coverage of horrendous events traumatize you to the point that psychological problems develop?”

            In 2001, Propper was teaching a course on sleep and dreaming at a college in the Boston area. The course was already underway, and students had begun recording and documenting their dreams, when the events of 9/11 unfolded. Thus, Propper and her associates had an opportunity to assess trauma themes in dreams both before and after 9/11, and to relate them to amount of TV viewing of the 9/11 coverage.

            Analysis of students dreams before and after 9/11 demonstrated not only that post-9/11 dreams changed significantly compared to pre-9/11 dreams, but also that the dreams could be linked to amount of TV viewing of the horrific events. After 9/11, dreams contained more threat and danger themes and images, and more negative emotions expressed. These themes, images, and emotions tended to increase as the amount of time watching TV coverage increased. Thus, to the extent that dreaming can reflect efforts to process and resolve trauma and conflict, the authors concluded that extensive viewing of TV coverage of the 9/11 events served to increase trauma and conflict in viewers. It is also of particular interest to note that the students who spent more time talking with friends and relatives about the events of 9/11 did not show these threatening themes and negative emotions in their dreams. This finding is consistent with evidence from clinical psychology showing the therapeutic effects of talking with significant others following a personal trauma.

Propper believes the results show how media coverage of an event can negatively affect the emotional well-being of viewers. Reporting an event is one thing; saturating coverage with repeated replays over an extended period is quite another. Furthermore, if that coverage makes talking with friends and relatives less likely, then the negative effects of the saturation coverage are greatly compounded.

            You might ask, “Should I switch channels when coverage of horrific events is on?” No, at least not all the time. That would be avoidance of facing uncomfortable aspects of reality. Such avoidance on a regular basis would help make you unable to process and cope with troubling realities. Face those realities, but make sure you talk them over with others to help you manage your coping efforts.

            Avoiding troubling political news, of course, can be easy: Just limit yourself to media sources that reflect your beliefs. However, that selectivity would be an example of avoiding facing uncomfortable aspects of reality, and could be more psychologically damaging than simply avoiding all political news. Adhering only to media sources that support your opinions  will help you both avoid and degrade the unpleasant, and likely obstruct your ability to process, evaluate, and cope with troubling information. Do not be afraid, therefore, to familiarize yourself with positions that run counter to your opinions. Doing will help you accept reality and evaluate information logically and calmly.

However, you need not succumb to excessive anxiety from media exposure. You can arm yourself against emotional upheaval by exercising and living a fairly healthy lifestyle; by educating—not indoctrinating—yourself with verifiable facts; by having healthy, adult, rational interactions with others; by empathizing and understanding the needs of others; by serving those in need; by enjoying nature—hearing the birds chirp, smelling the vegetation, seeing the vast array of plant colors, and basking in the warmth of the sun. Psychological research documents the beneficial effects of these coping tools that are all around you, tools that we know can combat anxiety, depression, and other debilitating feelings. Use them.

Every January my wife notices that her gym is more crowded than usual with a lot of unfamiliar faces. “Resolutions people,” she tells me, “They’ll be gone by March.” Her prediction generally comes true for nearly all the newcomers. How come? Why don’t New Year’s resolutions last?

“Saturday, January 9^th, I’m joining a gym.” There’s a problem right out of the gate. If you tie your resolution to a specific date, you’re just focusing on a date; you’re not motivated; you’re procrastinating, just kicking the can down the road. Picking a date is artificial. “I’m going to work out more to make me lose weight and get in better shape.” We’ve got two problems here: (1) You’re putting the cart before the horse, using the resolution (“work out more”) to motivate you (“make me lose weight.”). Resolutions must be the result of motivation to do something, not the catalyst for generating motivation. “The boss invited me to join in a jog last week and I nearly died of exhaustion. That’s no way to get a promotion. I must get in better shape to keep up with him.” You want to improve your chance of getting a promotion now becomes the motivation for the resolution—running more to get in better shape. It always helps to connect your resolution to a specific motivator: “Warm weather will be here soon and I want to look good at the pool. I’ve got to join a gym”; “I’m in a wedding in three months and I want to fit into a smaller dress. I need to join a gym.” (2) The second problem is that the workout-more resolution is too vague. “I need to be in better shape, so I’m going to work out more.” Work out more? Get specific. Make a specific routine involving repetitions, muscle areas, and specific days. To have any chance of success, a resolution must involve specific doable actions: Lose weight? “I will eat a piece of fruit—an apple or a pear—for lunch instead of a sandwich”; “I will walk my neighborhood for 30 minutes every day.”

Resolutions are often unrealistic. You make grandiose, unattainable resolutions (“Be able to run a marathon by Spring”; “Lose 30 lbs. by February,”), and you also believe that you’re reinventing yourself, creating a new you. That’s unrealistic thinking. “I’m going to run two miles every morning before leaving for work so I can qualify for the local marathon in eight weeks.” That’s crazy. “I’m going to reinvent myself—create a new me. For starters I will lose 30 lbs. by February.” Once again, unrealistic thinking.

A good way to make sure that your resolutions are realistic is to connect them to your values. Specifically, you must engage in values-oriented thinking and make your actions consistent with that thinking. “I love being with my family [your value], but I put off spending more time with my kids and spouse” [an action]. “My job brings me little personal satisfaction [your value], but I put off looking for another one” [an action]. Can you see the disconnect between values and actions? When making a resolution, first identify your values, then devise a plan that will help you coordinate those values with compatible actions. “I value my health and the welfare of my family, my obesity is bad for both, so I must lose weight.” I knew a young man who was morbidly obese at nearly 400lbs. When his widowed mother became sick and had to be briefly hospitalized, he realized that if she became unable to care for herself, he would want to do so. He greatly valued his mother’s welfare “But,” he thought, “how can I care for mom if I can’t even tie my own shoelaces?” Over the next two years, he lost 220lbs.

Aaron is ready. He resolves that this year he is going to find a new job. Sure, it was the same resolution he made a year ago but this time he’s serious. Plus, he says the economy is looking better in his job market. Sorry, Aaron, but you are showing us how not to make a resolution, how notto attack a challenge: First, you have an excuse for last year’s failure—you weren’t serious last year, but this year you are; the excuse says you have not accepted the reality of your situation. If you did, you wouldn’t need to say you’re serious. Second, you focus on external factors like the economy, rather than on what you may have done wrong to fail in your job search last year. In other words, you haven’t taken accountability for your actions. You have a lousy strategy based on chance external factors, and you haven’t worked on a plan of action that corrects previous mistakes.

            The keys to being successful with New Year’s resolutions are no different than the keys for being successful when dealing with any stress in your life: (1) Accept your current situation and be accountable for evaluating your role in it; (2) make a plan of action that results from your motivation to change, not a plan designed to motivate you; (3) include realistic, attainable, and specific actions and goals in your plan; (4) connect your plan to your values; (5) begin now, not at some future date.

The holidays are a time when a lot of folks seem to focus on happiness. It’s Christmas! Let’s gather around the tree, sing carols, laugh, and have a happy time. Unfortunately, holiday happiness can be elusive because too often people tend to center their search around “me,” always asking, what do “I” need to do to make “myself” happier? If this sounds like you, the problem here is that you’re being self-serving and looking for answers that are defined by your needs, your frustrations, your anxieties, your difficulties. “But,” you ask, “how can I possibly find happiness without including myself?”    

Here’s a thought, and an action that you can take year-round: Instead of putting yourself as the main ingredient in the recipe, take yourself out of the recipe. Consider the possibility that, whatever your difficulty, you can use the emotions it generates within you to increase your sensitivity to others who suffer—many times from conflicts similar to yours. This empathy will not only help others, but yourself as well. That’s right, taking yourself out of the formula will encourage you to reach out to others. The bonus? You will discover that reaching out will bring you ample helpings of personal satisfaction—call it happiness if you want, but it’s much more—and help you cope better with your problems. Many people feel that happiness is something that is acquired, like a trophy, a promotion, or winning the lottery. Psychology research shows, however, that happiness emerges from things you do, not from things you acquire. Reaching out to others, committing to a cause, working hard at a task, persisting in spite of frustration and adversity—these sorts of things seem more related to being “happy” than merely acquiring something.

Viewed from this perspective, one clear road to happiness involves empathy, a social responsiveness that does not involve a search for happiness, but a desire to help others because you understand their need. If you have been previously victimized or are presently dealing with emotional upheaval in similar ways as someone else, who can understand their plight better than you? Who is better equipped to relate to them than you? The true beauty of empathy and helping others, however, is that you reap the psychological benefits of contentment, satisfaction, and self-actualization. There is no more effective therapy than empathetic service to others. It’s not that empathy brings you happiness; it’s that empathy brings you a sense of being a competent and useful person.

Listen carefully to these clients in group therapy:

“Telling my story helped me face it as real. Then I knew others’ stories were real, too. I felt less alone. New people would show up. It was hard for me to listen to them because I was reliving my own experience. But I understood them, and knew they understood me. That was so cool.”

            “I discovered I could help others. Hell, if I could do that, I should be able to face myself. That brought me a lot of inner peace.”

            “I discovered I wasn’t the only one hurting. Others were there, too. Whenever I felt like I was drowning, I threw a lifeline to others in the group. We taught each other how to save ourselves.”

Whatever your plight, you are not alone in your difficulties. The best way to facilitate your ability to cope is to make sure that as you travel the road to discovering that you are useful you leave no one behind. Christmas is unique in offering you that pathway, but it can be traveled year-round. Take it. Doing so will help you will find yourself participating in—and enjoying the richness of—the human adventure.

The holidays can be a tough time if you lost a loved one during the previous year. Suddenly, someone who was a part of family celebrations and joy is not there. Grief is magnified by holiday family traditions. Grief often leads survivors “inward” to focus on their emotions, and dwell on how their loss has broken their emotional stability. This focus is understandable. Unfortunately, though, because holiday time is so strongly associated with happy times for most people, the inward spotlight can magnify sadness, despondency, frustration, guilt, anger—a literal flood of overwhelming negative emotions that can be devastating. That’s why an inward focus on grief—while OK in small doses—can ravage the coping process if the inward focus becomes a daily addiction. Sufferers then consider emotions “my problem,” but, in fact, they are not the problem; it is their reactions to the emotions that is the real problem. Fortunately, the holidays provide ample opportunities for an “outward” focus to help the aggrieved “live through” their grief. The grief-stricken—in a spirit of empathy—can reach out to others who have fallen on hard times, and discover that this outward focus gives them a way to move forward with their own grief, and honor their departed loved one.

I remember many years ago a friend of our family suffered a great loss when her son-in-law was killed in an accident several months before Christmas. Her daughter, Jill, now a young widow in her late 20s, came to live with her mom temporarily while they both sorted out their emotional lives. My mother invited them to join us for Christmas dinner. Before dinner, my mom handed each of them a wrapped present. Jill was dumbfounded. “But I have no present for you,” she said. “Yes, you do,” my mom replied. “Your presence is our gift.” I was in college at the time and thought that comment was pretty cool. Years later, however, I saw the comment in a new light.

Giving vs. receiving—we generally separate these actions as distinct, but they’re not. When Jill accepted the gift from my mom, she also gave my mom something very special in return: the blessing of fulfillment and satisfaction resulting from giving. It sounds corny but I think my mom received a gift of feeling part of the family of humanity; mom discovered that a simple gesture to someone in distress—“Yes, Jill, you are saddened and in pain, but life endures through the pain.”—offered mom the special gift of receiving through the act of giving. So, looking at Jill and my mom, who gave and who received?

For me, the lesson here is straightforward: Are you in emotional pain—depressed, saddened, hurt, upset, guilty, angry? No matter what time of year, focus on what’s “out there” and how you can be a part of it. After all, it’s life out there. Accept and receive from others, and in doing so, you will discover that you are also giving, and bringing honor to the memory of your loved one. Give your service and help to those who, like you, need support, and you will be blessed with the contentment of receiving in the act of giving.

Do you let trivial things add to your stress? For instance, when greeting someone do you worry about offending them if you say, “Merry Christmas,” as opposed to “Happy holidays”? Or, if you’re Jewish, are you offended if someone says “Merry Christmas” to you? Complaints about so-called politically-correct (PC) greetings increase around holiday time. Those who whine about this issue seem to forget that PC language boils down to courtesy, respect, and empathy for others who have a perspective different from theirs. The strength of this self-serving bias varies from person to person, and even within ourselves at different times. Any way you look at it, however, the bias is there and it has the potential to make certain language distasteful to those who refuse to accept that there’s a world out there beyond their personal space; and that bias adds stress.

            Here’s a coping thought: acknowledge the importance of others. Ask yourself, “What determines how others remember me?” The answer is, “People remember how you make them feel.” With that thought in mind, what sort of daily legacy do you want to leave? Do you want people to remember you as someone who made them feel undervalued and inferior to you earlier that day? Or, do you want them to remember you as someone who made them feel good because you understand and respect their perspective?

            Why not adopt a little humility, and decide that life is not all about you? Why not take the time to make others feel worthy of your respect? Doing so will remove concern from your mind about frivolous, nonsensical things like PC language. You will feel more empowered and independent; you will feel more productive; and those feelings will bring you more personal satisfaction. Most important, you will have more pleasant interactions with others.

            I knew a colleague who was one of those guys who greeted life each day with a smile. He was always ready to lend a helping hand and believed in teamwork. He never took himself too seriously, and loved to defuse conflict with a joke or light-hearted comment. I remember a time during the Christmas holiday when he was exiting the building and passed an employee he didn’t know. He said with a big smile, “Happy Hanukkah, Kwanzaa, Christmas, or bah humbug. Choose your preference!” We all laughed heartily and the employee said, “Right back at you!” And we all went our way with a smile.

            But what if things go a little differently? There’s never a guarantee that any social interaction will be pleasant. What if the employee says something like, “I don’t think that’s funny at all. You know some people don’t like to be reminded about holidays.” How do you handle situations like this? Well, remember that you have no control over how others will react. Maybe they associate Christmas with personal loss; maybe they harbor unresolved anger; maybe they want to be left alone. There are a host of possible reasons for a negative reaction. What can you do? How about a quick apology—“Sorry, didn’t mean to offend.”—and move on. It’s a trivial matter and not worth adding to your stress levels.

Here’s a piece that Dr. Carlea Dries wrote on December 12, 2016, words I like to repeat every year at this time:

It’s the most wonderful time of the year… except when it’s not. The holidays usually mean the coming together of family members. Ordinarily this is a welcome time of festive gatherings, exchanging of presents, and special memories made near a roaring fireplace. For some, however, this Norman Rockwell image is drastically different from reality, particularly when recent loss of a loved one is involved. Let’s note that “loss” is not limited to the death; it can also include divorce, hospitalization, incarceration, active duty without a holiday leave, or a family member who moved away. 

Recently, I attended the funeral for my great aunt. Though Marge was 93 and in failing health, her death hit our family rather hard, especially her daughters and sister (my grandmother, who is now the only one left of the original 11 siblings). The sermon during the church service (paraphrased herein) highlighted how this first holiday is going to be different: “You’ll notice the quiet. You’ll notice the missing [specialty food]. You’ll notice the missing chair at the table.” 

While I was at the repast, a good friend of mine texted to say that her parents are getting divorced after more than thirty years of marriage. This news was unexpected and rendered her numb. She just kept asking how it could be real and why, if it had to happen, it had to come so close to Hanukkah. This was supposed to be the first time she would be hosting her family, and now everything was changing. 

How do you cope with the first holiday season in the “next normal” or “new normal”? How do you hold on to a sense of control when things are clearly out of your control?

The most important thing to do, discussed in other blog posts, is to recognize what is in your circle of power. My grandmother can’t bring her sister back. My friend can’t convince her parents to stay together. So, they must try to do what they can: accept what it is and move forward from that point. Yes, that’s easier typed than done.

Some feel consoled by leaving a place at the table for the absent person, but many others find that much more discomforting because it is a visual reminder of the vacancy. You may, therefore, choose to remember the person in a smaller way. I have made ornaments with pictures of departed relatives, reminding me of times we spent together. Every year for Thanksgiving, my mother makes her aunt’s stuffing (though Aunt Petronella called it “dressing”). My mother-in-law uses a picture of her mother as the angel for her crèche. A friend video-chats with her husband who is stationed overseas. For the past 14 years, my father brings homemade goodies to the staff at the nursing home where his parents finished their earthly stories. A colleague mentioned that she has a “moment of reflection” during which everyone present shares a memory, story, or image of those who cannot be with them—one even sings a favorite song!

These simple gestures become meaningful traditions that do not overwhelm us with intense feelings of loss. Rather, they celebrate the lives and connections we had to those who are absent. 

Other coping suggestions include planning a totally new activity that literally takes you away from the familiar reminders of the absent one. Go on a mini-vacation. Celebrate with a different group of people. Volunteer at a soup kitchen or shelter. Service to others is probably the most effective way of coping with personal loss. Keep your mind and body distracted, not to the point where you are ignoring, denying, or detaching from the loss, but to keep you focused on something productive instead of painful. 

No matter what options you are comfortable choosing, you must give yourself permission to feel. There will be moments when you want to do nothing but sit in silence. Other times you will want to do nothing but scream. You might even find yourself smiling or laughing and then feel guilty because how dare you be happy when you are missing someone?! Have “the big, snotty cry” if that is what you want to do. Let yourself feel. Take the time you need. It’s okay to say “no” to invitations; just be sure you don’t let your mourning stop you from living.  

There was also a message of comfort in the sermon for my Aunt (again paraphrased): Marge lives on in your hearts and memories. If you listen in the quiet, you can hear her. If you feel in the still, you can sense her. Remembering means no one ever leaves.

You might not feel better today. You might not feel better tomorrow. But at some point, you will feel that you have moved to the next normal and that will be the next best thing.

We’re at that time of year when millions of children have Santa Clause on their mind. But then someone comes along and tells parents that encouraging the Santa myth will cause their children to mistrust mom and dad. The argument goes that when kids realize there is no jolly guy flying around the world in a sleigh pulled by reindeer, they conclude, “My parents have been lying to me all this time. I’ll never trust them again.” If that’s not bad enough, these “bah humbugers” say that a belief in Santa makes kids vulnerable to peer ridicule and embarrassment: “You believe in Santa? I suppose you also believe in the tooth fairy and the Easter bunny!” There are also those who argue that focusing children on Santa encourages them to overlook the true meaning of Christmas—the birth of Jesus. What’s a parent to do? Talk about stress!

I remember a conversation I had with a former student about this issue. She told me a story that one time, a few days before Christmas, she and her 7-year-old daughter were wrapping presents. She told her daughter they could make one from Santa. “But mom, I know Santa’s not real.” When I asked mom how she handled that, paraphrasing, here’s what she said:

“Well, you know I teach elementary school, and I was ready for it. I admitted there was not a bearded old man in a sleigh. But I brought up some of our family traditions and talked about them with her—things we did, special decorations, meals, all the fun times we had at Christmas. And I asked her, ‘Has Santa been a part of all those fun times? How is Santa in this house? Could it be that we’re all Santa? You, me, your dad, your little brother? And what is it that makes us Santa?’ My daughter nailed this one and said, ‘We give each other presents!’ Building on that insight I went into some comments about giving and receiving, that both are blessings because they bring us together as a family. I said, ‘That’s who Santa is. All of us, and it’s one of the things that shows each of us that we love each other.’ She looked a little puzzled, but I could tell she was soaking it all in like a sponge.”

The stuff about seeding mistrust in children by lying to them about Santa is nonsense. An isolated deception about a real Santa is not going to sow mistrust of parents in an overall warm, supportive family filled with love and positive guidance. Furthermore, as Swiss psychologist Jean Piaget showed us, children’s understanding about their world progresses through stages, and the first stage is very primitive and concrete. Try to explain to a 3-year-old that Santa is symbolic of the gifts of giving and receiving, and other things that define a family and love. Good luck. But, believe it or not, the vision of a jolly, smiling guy being towed through the sky by a bunch of flying reindeer is preparing the child’s mind for understanding greater mysteries about giving and receiving, love and forgiveness, to be grappled with at a later age with a more physically-matured brain. The fact is, the early belief in the real Santa is not at all incompatible with appreciating at a later age the significance of what’s really going on in that Bethlehem stable.

There’s a coping lesson here: Put more Santa into your life throughout the year. The reality of Santa embodies the principles of effective coping with stress: Get outside yourself and give service and support to others; likewise, receive what others bring you, which allows you to give to another the special blessing of giving. Keeping Santa’s Ho-Ho-Ho in your heart will help you establish a psychologically healthy daily legacy that is based on making others—and yourself— feel good.

The young man had the rapt attention of his college classmates when he spoke:

“I was 8 years old, a long way from puberty. I was watching an episode of the old Star Trek TV show from the ‘60s. There was a scene when Captain Kirk had no shirt on, and I couldn’t take my eyes off him. I didn’t feel any sexual attraction, but I just wanted to wrap myself around that chest. Years later as I moved past puberty and into my teens, I realized that I was sexually attracted to guys, not girls. I remember thinking back to my Captain Kirk episode and being surprised; I guess my brain realized I was gay before my body did.”

For two reasons, this classroom comment was not as surprising as you might think. First, the student was well-known on campus as gay, and he made no attempt to hide his orientation. Second, in class that day we were discussing the psychology of sexual attraction, and had begun talking about whether our attractions were based on conscious choice or an inborn nature present at birth. The question I had posed to the class was simple: “Do you think a therapist could use psychological persuasion techniques to change your sexual orientation?”

After telling his Kirk story, the young man answered my question: “Absolutely not. I did not choose to be gay. It’s who I was at 8 and it’s who I am now. No therapist could possibly change that.” A conversion therapist would disagree with that last sentence. Conversion therapies for homosexual attraction began in the 1960s, and were designed for those who were bothered by their sexual preference and wanted to change to conform better to larger society. The therapy model was based on fundamental conditioning principles: For a homosexual male, combine images of attractive men with pain, and images of attractive women with pleasure. One version of this therapy was called “Playboy Therapy.” A homosexual man would sit in front of a screen. At times, a photo of a naked attractive man would appear on the screen, and be accompanied by a very painful shock to the client. The shock would end when a new picture, a relief stimulus, appeared, a naked Playboy centerfold. The idea was to condition the client to consider the naked male disgusting and the naked female pleasing. Variations of conversion therapies were widespread in the ‘60s and ‘70s and were, at best, “behaviorism gone wild.” Plus, and most importantly, they not only did not work in changing one’s sexual preference, but they also often resulted in significant psychological harm to the client.

Conversion Therapy in 2025 has expanded beyond the conditioning model of 60 years ago, and challenges clients in core personality areas of self-esteem and self-understanding with potentially devastating messages: You are confused over who you are and who you should be; you are sick, broken, pathological, disordered, and need to be repaired; you have lost your decency; you cannot trust yourself and should feel shame, guilt, and self-hatred. Most psychologists believe that such attacks on a client’s personality dynamics run counter to the foundation, goals, and ethics of psychotherapy, and can pose a risk to the psychological stability of the client. How do they advise clients who feel out of the mainstream when it comes to sexual attraction, and who feel anxiety, identity problems, or other emotional difficulties? Many advise such clients to confront their reactions to their homosexual inclinations, not the inclinations themselves. They caution that denying and trying to change those inclinations through counseling might cause more problems in the long run. Clients may be better off going into counseling not to change who attracts them, but to adjust their thinking about who they are; to realize that it’s OK to be who they are, and to use therapy to help them move toward acceptance of that reality. (This description, of course, is a simplified analysis of what can be very complex therapy)

Conversion Therapy is still with us in 2025, even though 27 states and D.C., Puerto Rico, and more than 100 municipalities have instituted bans on the therapy. However, a case—Chiles vs Salazar—is presently before the Supreme Court, challenging Colorado’s Minor Conversion Therapy Law, which bans the therapy for minors by licensed mental health professionals. The plaintiff claims the law restricts first amendment rights, and therapists should be free to engage in conversion therapy with willing clients.

Do you have a friend or family member who has little interest in the rights and feelings of others; has no obvious values, standards, or moral compass that guide actions; regularly manipulates, deceives, and takes advantage of others for personal gain; feels no remorse when actions bring discomfort to others; is impulsive and reckless with minimal regard for the consequences of unlawful behavior; is prone to substance abuse and addiction. This profile is typical of those with Antisocial Personality Disorder. They are the “black sheep” in the family. They can be very charming and witty, but also quite skillful at manipulating others to satisfy their own needs and goals, usually at the expense of someone else’s welfare. Not surprisingly, they are not very good at maintaining stable relationships. Others are simply there to be used and then tossed aside. In everyday conversation we often refer to these people as “sociopaths” or “psychopaths,” and, in fact, these conditions would be included in a formal definition of the antisocial personality.

Antisocial tendencies can appear in childhood. The path to this personality disorder results in kids who are mostly unresponsive to threats of punishment, and don’t seem to be bothered much by typical childhood stressors, such as peer pressure, bullies, or rules at home and school. The deception, disregard for others, and failure to conform to social rules seen in adult antisocial disorder is already present when they are children. Children who manifest the antisocial patterns are at the opposite end of the anxiety scale from children who are shy, inhibited, fearful, reactive to stressors, and motivated to follow rules. These anxiety-dominated kids are “marinated in guilt,” whereas the antisocial kids are largely immune from remorse and conscience.

Can the antisocial personality be helped? The challenges here are daunting. Counseling—talk therapy—methods are generally based on helping clients deal with their stress, anxiety, and avoidance tendencies. For the most part, these are not concerns for antisocial people; they do not suffer from stress and anxiety, are not afflicted with guilt issues, and have a “who cares” attitude when actions (robbing a store) are likely to result in punishment (jail). In short, there is little for a counselor to work with.

There is evidence showing a genetic basis to the antisocial personality disorder, a basis that manifests its effects on the prefrontal cortex of the brain. This area has been called the executive center of the brain, and is what gives us humans higher-level cognitive characteristics like judgment and morality. Genetics may also be expressed in the reactivity of the nervous system. For instance, if you’re born with an over-reactive nervous system—highly sensitive to pain and threats of pain—you will likely be prone to anxiety and seek to avoid stressful situations and obey rules. If, however, you have a highly under-reactive nervous system, you are at risk for antisocial personality disorder because you don’t feel much pain and need to find extreme activities to generate interest. At Halloween, the former kid will get a rush by going trick-or-treating; the latter kid will only get a rush by vandalizing porches and stealing from other kids while trick-or-treating.

Family and friends face considerable hurdles when trying to help the antisocial personality, whether a child or an adult. One thing for sure: reasoning with them, appealing to their sense of fair play, threatening them with punishment, and reminding them that you are always there for them…these strategies that work so well with those who have feelings and empathy for others, are unlikely to be successful with antisocial personalities. In fact, they are likely to see you as weak and vulnerable to manipulation, and be encouraged to distract you with their charm.

A common dilemma for many seeking counseling: should I take medication? Tim is a client in psychotherapy. He sought help because, “I don’t have the feelings like most people. Nice things don’t make me feel happy. If my kids do good, that’s nice but…[and he shrugs his shoulders]. My wife and I might out, and later she says, ‘That was fun.’ Me? Nothing. I have a great wife, healthy kids, and a good home and family life. But nothing seems to make me happy like other people. I’m just blah, all flat.”

Tim had already seen a number of doctors over an extended period to time, but he never received a full psychological assessment. Not surprisingly, he received many different medications on a trial-and-error, “Let’s see if this helps,” basis. The list of medications is familiar: Effexor, Zoloft, Prozac, Lamictal, Cymbalta, Lexapro, Strattera, Risperdal, Xanax, and Wellbutrin. When Tim came to his current therapy with a psychologist, he was frustrated that the cocktail of prescription drugs was not working. The psychologist gave him a full range of psychological testing to get an objective sense of his psychological functioning. The test data indicated a schizoid personality disorder.

Schizoids are introverts who do not receive much positive emotion in their social interactions. They like and love other people more intellectually than emotionally. They are emotionally flat and “colorless.” They show a narrow range of emotions, but seldom express them in any animated or spontaneous way. They show a definite preference for solitary activities. In a sense, schizoids are like unfeeling robots who go through life efficiently, but emotionless.

Tim’s diagnosis explained why his previous treatment regimens were so unsuccessful: personality disorders do not respond to anti-depressant, anti-anxiety, and anti-psychotic medications. Tim’s problem was that he viewed himself as flawed and frustrated with his emotionless reactions to life; he had difficulty accepting himself. His problem was with his thinking and his behavior, problems that needed to be changed and controlled by Tim, not by medication. Cognitive psychotherapy with Tim targeted his biased views of himself to get him to face his difficulties from a different perspective. He had always put himself down as being weird and inferior. He needed to consider the fact, however, that being different from others does not equal being weird and inferior. Also, he needed to consider some advantages that resulted from his emotionless tendencies. Many people are overwhelmed by emotionally-driven stressors and problems; Tim’s relative lack of emotion, on the other hand, protected him from such difficulties. His presumed “problem” could be recast in his mind from a glass-half-full perspective rather than a glass-half-empty one. Tim slowly began to accept himself more and improve his self-concept. Most importantly, he realized it was futile and self-defeating to reject his personality style. He began to understand that schizoid personality characteristics are relatively stable ones during adulthood; it was unrealistic for him to think these characteristics would change substantially, even with long-term (and expensive) therapy. It was better, therefore, to be more accepting of his schizoid characteristics, and to put those characteristics to work for him in more positive ways. As Tim came to accept his schizoid characteristics more, his confidence and assertiveness grew, and he evaluated himself in more realistic fashion. He stopped fighting and rejecting himself like he had for so many years. He moved forward, facing himself and making what he had thought was a weakness work for him, not against him.

We describe Tim’s case to argue for the importance of diagnostic psychological assessment before designing a treatment plan; we do not describe his case to argue against the use of psychiatric medication in treating psychological issues. In fact, it is important to remember that both medication and psychotherapy play appropriate roles in treating many problems, and many studies find that a combination of drugs and therapy works better than either one alone. It is also safe to say that each approach can be appropriate at different points in the treatment regimen. That is, medications can provide quick early relief from intense suffering, while psychotherapy can give wider and more lasting relief.