Neurocounseling And Its Relevance To Treating Complex-PTSD

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The term neurocounseling refers to a form of therapies that seek to take advantage of the relatively recent neuroscientific discovery that the human brain has far more NEUROPLASTICITY than was previously believed to be the case.

What Is Neuroplasticity?

The brain’s quality of neuroplasticity can be defined as its capacity to be physically changed, not only during childhood, but over the whole life-span ; it is only relatively recently that the extent to which the adult brain can be physically altered (both in terms of its structure and its pattern of neuro-pathways) has been discovered.

Why Is The Brain’s Neuroplasticity, And Therefore Neurocounseling, Relevant To The Treatment Of Complex-PTSD Resulting From Childhood Trauma?

Neurocounseling and the phenomenon of neuroplasticity have important implications for the treatment of post traumatic stress disorder (PTSD) and   complex-PTSD as sufferers of both types often have incurred damage to certain brain regions as a result of their traumatic experiences.

These brain injuries can include a shrunken hippocampus ( the hippocampus is a brain region involved in the processing of memories, including differentiation between past and present memories); increased activity in the amygadala ( a region of the brain involved in the processing of emotions and that is intimately related to the fear response); and a shrunken ventromedial prefrontal cortex (this region of the brain processes negative emotions that occur in response to exposure to specific stimuli).

Neurocounseling :

Neurocounseling is founded upon the premise that that symptoms of psychiatric conditions (both psychological and behavioral) are underpinned by maladaptive, neurological structures and functions and that these neurological structures and functions can be beneficial altered due to the quality of the brain known as neuroplasticity. It combines neuroscience with counseling techniques and, in this way, the individual receiving treatment is helped to learn new skills and new ways of thinking in an attempt to help correct the maladaptive physical development of the brain that has occurred in response to the person’s traumatic past experiences. Examples of neurocounseling techniques include :

  • incorporating biofeedback into the treatment plan ; this can help to treat emotional dysregulation – emotional dysregulation is a major symptom of PTSD and complex-PTSD and is linked to damage to the amygdala (see above)
  • incorporating neurofeedback into the treatment plan
  • mindfulness meditation training (one study found that this can alter the actual physical structure of the brain in just eight weeks)

Additionally, studies have shown that interpersonal psychotherapy and compassion focused therapy can lead to beneficial alterations to the brain.

Furthermore, research shows that neurocounseling can also be successfully employed to treat a range of addiction issues (including prevention of relapse and recovery management), sleep difficulties, ADHD, chronic fatigue syndrome and problems relating to aggression (all of which, potentially, can be linked to childhood trauma).

As understanding of the relationship between the way in which the physical brain operates and symptoms of psychological problems increases, it should be possible, in the future, to be apply neurocounseling more effectively to an expanding range of behavioral and psychological difficulties that have their roots in maladaptive brain biochemistry and physiology.

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Why Some Parents Can’t Love Their Children

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It is generally assumed that parents (in particular, mothers) have an innate, instinctive, natural and inborn capacity to love their children unconditionally. However, sadly, this is not the case. In this article, I will look at some of the most common factors that may inhibit a parent’s inclination to love his/her children :

 

Factors  That  May  Inhibit Parents’ Inclination To Love Their Children :

  • Parents may resent the responsibility / burden placed on them by having children
  • A parent may resent character traits in their child that , consciously or unconsciously, remind them of aspects of their own personalities that they dislike or aspects of their partner’s / ex-partner’s (i.e. the child’s other biological parent) personality that they dislike
  • Parents may resent being made to feel inadequate by children ; for example, narcissistic parents may find the child’s challenges to his/her (i.e. the parent’s) impossible demands intolerable, especially if the child becomes, due to quite natural, normal and necessary survival mechanisms, rebellious in response to such impossible demands when s/he reaches puberty.
  • The parent may feel bitterly jealous of the child’s youth (e.g. a narcissistic mother may resent being reminded of her fading looks by her daughter’s youthful appearance)
  • A parent may have low self-esteem and a child’s success, or future prospects of success, may serve to make the parent feel inadequate or that s/he has, by comparison, wasted his/her life
  • Postpartum depression : biological changes that a woman undergoes when pregnant can lead to chemical changes in the brain that result in depression and impair  her ability to bond with her new born baby in the usual way.
  • A parent may have been emotionally neglected or abused during his/her own childhood, restricting his/her ability to express and feel love
  • A parent (most frequently, but not exclusively, the mother) may resent his/her child whom s/he perceives as having ‘got in the way’ of his/her career.
  • A parent may resent his/her child if that child does not share, or actively rebels against, his/her (i.e. the parent’s) strongly held beliefs (e.g. religious beliefs, especially in relation to sexuality)
  • Projection: parents who have a poor self-image, low self-esteem and, essentially, don’t like themselves, may off-load their negative feelings about themselves by projecting them onto their children (e.g. a parent who has latent homosexual inclinations and dislikes himself for it may project these feeling onto his son by using deprecating language in relation to his son’s (real or imagined) homosexuality, or, even, by disowning him (and thereby, on a symbolic level, disowning his own repressed, sexual feelings).

The Importance Of Showing Love :

Some parents may believe they love their children but the way in which they act towards these children does not reflect this ; in other words, despite the parents’ beliefs, their children do not perceive themselves as being loved – such parents may not be properly attuned to their children’s emotional needs ; this, too, can be very psychologically damaging to the child. Indeed, children who are not loved or perceive themselves not to be loved, especially in very early life (but at other stages, too) can incur damage to the physical development of their brains which, in turn, can lead to serious psychiatric problems.

You can go to the section of this site that contains articles on childhood trauma and brain development by clicking here.

 

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Retraumatization Caused By Psychiatric Care Institutions

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Retraumatization :

If the trauma we experienced as children was severe enough, we may, as adults, at one time or another, require residential psychiatric care (such as inpatient treatment on a psychiatric ward in a hospital, as was necessary in my own case on several occasions).

Obviously, the quality of the care we receive in psychiatric facilities can vary very considerably ; unfortunately, this means that, if we are unlucky, we may find ourselves in an environment that not only fails to be therapeutic, but is actively retraumatizing.

In What Ways Can A Psychiatric Facility Retraumatize Us?

According to Fallot and Harris (2001), the ways in which we can be retraumatized in psychiatric institutions can be divided into two main categories ; these are :

1) BY THE SYSTEM (policies, culture, procedures, rules etc). For example :

2) BY THE RELATIONSHIPS WE HAVE WITH THOSE ENTRUSTED WITH OUR CARE (e.g nurses, psychiatrists etc)

Let’s look at each of these in turn :

1)  RETRAUMATIZATION BY THE SYSTEM. Examples of how this may occur include :

– lack of choice regarding treatment ; for example, being prescribed medication when a form of psychotherapy may be more appropriate and more effective.

– not being given the opportunity to give feedback to the professionals caring for us about how we feel in relation to the treatment we are receiving

– being treated impersonally and not as an individual but, instead, according to how one has been ‘labelled’ by one’s diagnosis (two individuals with the same diagnosis may manifest very different symptom and have very different needs. In the case of those who have been diagnosed with borderline personality disorder, such individuals may experience the additional trauma as being regarded as ‘a trouble maker’ due to misinterpretation of the true causes of their behavior.

– constantly having to retell personal details relating to one’s psychological condition.

2)  RETRAUMATIZATION BY THOSE ENTRUSTED WITH OUR CARE.  Examples of how this may occur include :

– betrayal of trust

– feeling one is not being listened to and/or is being rushed when explaining one’s condition

– feeling one’s views are being dismissed /not taken seriously / invalidated

– being spoken to disrespectfully, insultingly or inappropriately

– being subjected to punitive ‘treatment’ methods (e.g. locked in isolation room without toilet or proper bedding)

– lack of communication / collaboration between patient and staff

My Own Experiences :

SECTIONING :  When my illness was at its worst, I was sectioned (despite my ardent protests) because it was felt I was a high suicide risk (which, in truty, I was) ; however, being sectioned accentuated feelings of powerlessness, humiliation and loss of autonomy

AGGRESSIVE/THREATENING PATIENTS : Unfortunately, some patients one is exposed to in psychiatric wards can be aggressive and intimidating, leading to feelings of being unsafe and constantly under threat

UNPROFESSIONAL STAFF : Sadly, occasionally one comes across staff who are not above behaving unprofessionally ; this can exacerbate feelings of mistrust

ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) : Because I was so ill – utterly unable to function and, indeed, almost catatonic at times, as well as a very high suicide risk, I was ‘strongly encouraged’ to undergo ECT treatment ‘voluntarily’ on several occasions ; in fact, though, there was no genuine choice as I was told that, if I did not undergo it ‘voluntarily,’ I would be sectioned and the act of sectioning me would, in turn, give the hospital the legal right to administer the treatment even without my consent. Due to the controversial nature of ECT treatment, this was an intimidating, degrading and, quite arguably, dehumanizing position in which to be placed. (To read my article about my experience of ECT, click here.)

COMPULSION TO ABSCOND :  Indeed, I often found the conditions to which I was confined so intolerable that, on three occasions, I absconded (each time with the intention of committing suicide – to read about one such incident, see my article On Being Suicidal (Or, Why I Carried A Rope In A Bag Around London For Three Months ).

Obviously, vulnerable patients who find themselves compelled to abscond, as I did, potentially expose themselves to a high level of risk in a multitude of ways.

The Trauma-Informed Environment :

Tailor and Harris (2001) state, based on the main ways in which retraumatization may occur, therapeutic environments that cater for the traumatized (e.g. those suffering from PTSD or complex-PTSD) should be trauma-informed. Trauma-informed environments should :

1) Be calm and comfortable

2) Provide the patient with choice

3) Empower the patient

4) Recognize the strengths and abilities of the patient

5) Involve the patient, as far as possible, in all decision-making processes.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Trauma Triggers : Definition And Examples

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Anger May Operate To Soothe Emotional Pain

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We have seen from other articles published on this site that many forms of childhood abuse/trauma can put as at an increased risk of developing problems controlling our anger as adults, particularly if the abuse/trauma that we have suffered has been serious enough to result in us developing a serious psychological condition such as borderline personality disorder or complex posttraumatic stress disorder.

Steven Stosny, author of the excellent book Treating Attachment Disorder, proposes that the act of getting angry may function, at times, to reduce the level of psychological pain we are feeling (it is known that borderline personality disorder can cause intense mental suffering, even agony).

How Can Anger Alleviate Mental Suffering?

According to Stosny, anger may lessen mental suffering by the chemical changes it produces in the brain, in particular by increasing levels of the neurotransmitter called norepinephrine.

‘Core Hurts’

Stosny further states that the mental pain our anger may help to soothe is pain that is linked to our core hurts‘ ; these are the painful feelings that we carry around with us that are linked to our childhood trauma / abuse and may include those of :

   – rejection

   – worthlessness

   – powerlessness

   – guilt

   – shame

   – being ‘unlovable

   – being an ‘outcast’

Anger As A Kind Of Addictive Drug :

If, then, as Stosny suggests, the act of getting angry, by producing chemical changes in the brain that serve as a psychological analgesic (i.e. pain-killer / self-soothing agent), it is possible that, just as we can become addicted to other pain-killing drugs such as morphine, that some of us may become addicted to anger as a means of coping with unbearable mental anguish.

Any Benefit Of Anger Likely To Be Short-Term :

However, the possible analgesic effect of anger are likely to be ephemeral. This is because, after the initial boost of norepinephrine, we are likely to regret, and feel guilty about, our behavior and find that, in the longer termm it has merely served to compound our already not  inconsiderable problems.

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BPD And Hallucinations

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What Are Hallucinations?

Hallucinations are PERCEPTIONS that people experience but which are NOT caused by external stimuli/ input. However, to the person experiencing hallucinations, these perceptions feel AS IF THEY ARE REAL and that they are being generated by stimuli/ input outside of themselves (in fact, of course, the perceptions are being INTERNALLY GENERATED by the brain of the person who is experiencing the hallucination).

Different Types Of Hallucination :

There are several different types of hallucination and I summarize these below :

  • VISUAL HALLUCINATIONS – these involve ‘seeing’ something that in reality does not exist or ‘seeing’ something that does exist in a DISTORTED / ALTERED form.
  • AUDITORY HALLUCINATIONS – these, most often, involve ‘hearing’ voices that have no external reality (though other ‘sounds’ may be hallucinated, too).
  • TACTILE HALLUCINATIONS – these occur when an individual feels as if s/he is being touched when, in fact, s/he isn’t (for example, feeling the sensation of insects crawling over one’s skin).
  • GUSTATORY HALLUCINATIONS – these occur when a person perceives a ‘taste’ in his/her mouth in the absence of any external to the person causing the taste.
  • OLFACTORY HALLUCINATION – this type of hallucination is sometimes also referred to as phantosmia and involves perceiving a smell which isn’t actually present.

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BPD And Hallucinations :

Mild hallucinations are actually not uncommon even amongst people with no mental illness (e.g. believing one has heard the doorbell ring when it hasn’t).

At the other end of the scale, however, are fully-blown hallucinations that involve the person who is experiencing them being psychotically detached from reality; for example, someone experiencing a psychotic episode might hear, very clearly and distinctly, voices that s/he fully believes are coming from an external source (such as ‘the devil’ or a dead relative). A person suffering from such hallucinations cannot in any way be convinced that the ‘voices’ are being generated within his/her own head/brain.

It is uncommon for people suffering from borderline personality disorder (BPD) to suffer from the most serious types of hallucinations (as described above); however, under acute stress (and those with BPD are, of course, far more likely to experience acute stress than the average person), the BPD sufferer may experience hallucinations that fall somewhere between the mild and severe types.

For example, if s/he (the BPD sufferer) was constantly belittled and humiliated by a parent when growing up, s/he may, when experiencing severe stress, ‘hear’ the ‘parent in their head’ saying such things as ‘you’re useless’ or ‘you’re worthless.’

However, unlike the person suffering unambiguously from psychosis, when this occurs s/he is not completely detached from reality but is aware the ‘voices’ are being generated within his/her own mind and are imaginary as opposed to real.

Severe hallucinations may be indicative of schizophrenia but can also have other causes which include : delirium tremens (linked to alcohol abuse), narcotics (e.g. LSD) and sensory deprivation.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Healthy Narcissism Versus Unhealthy Narcissism (Kohut’s Theory).

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‘Healthy’ Versus ‘Unhealthy’ Narcissism :

We have seen from other articles that I have published on this site that being brought up by a parent or primary caregiver who suffers from narcissistic personality disorder (NPD) can result in us developing serious psychological difficulties in later life ; indeed, this includes increasing the risk of developing narcissistic personality disorder (NPD) ourselves.

Whilst extreme, destructive narcissistic personality traits are clearly undesirable, the psychotherapist Heinz Kohut (1913-1981) suggested that there is also such a phenomenon as ‘healthy narcissism.’ I briefly explain what he meant by this below :

‘Healthy’ Narcissism :

Kohut was of the view that we have primary need to develop a strong, solid and stable sense of self if we are to live a contented and fulfilling life.

He also believed that, in the case of young children, it was particularly important that their parents made them feel special and gave them a sense of being admired (and, therefore, as being admirable) and that this would lead such children to develop a healthy sense of self and general, emotional resilience.

Kohut also believed that as these children got older, and assuming their parents were psychologically healthy role-models, they would learn that nobody’s perfect, that this is OK and that it was not necessary to constantly ‘outshine’ others in every aspect of life.

As such, Kohut suggested, such children would, as adults, develop what he termed ‘healthy narcissism.’

Qualities Of The ‘Healthy’ Narcissist :

Kohut suggested that qualities of the ‘healthy’ narcissist included the following :

  • the ability to accept the admiration of others
  • the ability to admire others
  • a solid sense of self-worth / self-esteem
  • a healthy sense of pride
  • an appreciation of the needs of others
  • the ability to empathize with others
  • the capacity to feel self-love as a means of self-protection / obtaining emotional resilience
  • the ability to connect to our ‘authentic selves’
  • the confidence and self-belief to have hopes, dreams and ambitions (and the capacity to cope with, and to accept, failure to achieve them)
  • the ability to approve of ourselves and to withstand the disapproval of others

Unhealthy Narcissism :

Kohut contrasted children who were brought up in such a way that they were able to develop ‘healthy’ narcissism with children who are brought up by parents who were abusive and /or neglectful ; these abused/neglected children are at risk of developing unhealthy narcissism.

The unhealthy narcissist feels, deep inside, a profound and pervasive sense of inadequacy, inferiority, worthlessness, emptiness and vulnerability (as a result of his/her parents’ deeply psychologically damaging treatment of him/her when s/he was growing up) and, as a form of psychological defense (manifesting as overcompensation), develops a dysfunctional personality marked by intense hostility towards others, extreme arrogance, a condescending attitude and an insatiable need to feel superior to others at all times.

Furthermore, the unhealthy narcissist does not view others with empathy but views them as ‘servants’ and ‘playthings’ to feed his/her own ego.

On an unconscious level, the unhealthy narcissist strongly needs to avoid meaningful, emotional connection with others lest s/he becomes dependent upon such a connection which would make him/her vulnerable to being hurt emotionally in the way s/he was hurt by his/her parents as a child. As such, the unhealthy narcissist’s subconscious reasoning goes, a mutually loving bond with others is to be avoided at all costs; by desperately trying to convince him/herself that s/he is better than, ‘above’ and superior to others, s/he is simultaneously, frantically attempting to convince him/herself that s/he is emotionally self-sufficient and, therefore, emotionally invulnerable.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Trauma Release Exercises

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THE MIND-BODY CONNECTION :

We have seen how the experience of significant and protracted childhood trauma increases our risk of developing both serious psychological and physical problems as adults – e.g. see the Adverse Childhood Experiences (ACE) Study.

Therefore, therapies for those who, as adults, are suffering the effects of childhood trauma – in the most serious cases in the form of  cPTSD (complex posttraumatic stress disorder) – include not only treatments for the mind, but also ones for the body. (And, because the mind and body are interconnnected, treatments for the body will also, to varying degrees) benefit the mind.

THE FIGHT/FLIGHT/FREEZE STATE :

If we have grown up in an environment in which we were frequently made to feel afraid or threatened (physically, psychologically or both) it is possible the early physical development of our brain has been disrupted in such a way that now, as adults, we find ourselves perpetually, tense, anxious and hypervigilant, or, in other words, continuously in the fight/flight/freeze state.

One result of this is that it can cause us to store up a vast amount of physical and muscular tension.

EXCESSIVE AND CHRONIC TENSION IN THE PSOAS (‘Fight or Flight’) MUSCLE :

A main location in the body where muscular tension accumulates is called the PSOAS muscle (sometimes also referred to as the ‘fight or flightmuscle ; it connects the lumber spine to the legs.

It is sometimes called the fight/flight muscle because when we feel threatened, anxious or fearful, or in response to significant loss, it becomes energized in preparation to assist us with the actions of running away or fighting.

And, if, during childhood, we have frequently been in the fight/flight state this muscle may have become perpetually tensed up to the extent we have habituated to this feeling of tension to such a degree that we no longer register it as abnormal; notwithstanding this, it is an indication that we are still being adversely affected by painful emotions linked to our traumatic childhood (if only on an unconscious level).

TRAUMA RELEASE EXERCISES  (TRE) :

Bercelli, PhD, devised six trauma release exercises designed to alleviate this stored muscular tension. The idea is that the tension is released by a ‘muscular shaking process’ known as ‘neurogenic tremors’ and its purpose is rid us of our deep-seated, chronic, early life trauma-related bodily tension.

 

To read my related article : ‘YOGA FOR COMPLEX PTSD’, please click here.

 

RESOURCE : You can learn much more about TRE by visiting Dr Bercelli’s website – click here.

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Do Only Good People Get Depressed?

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If, when we are growing up, our parent/s make us feel constantly inadequate and that we were never ‘good enough’ due to their constant criticisms and general, perpetual air of  disapproval, we are put at risk of developing a serious depressive illness later on in life which produces feelings in us which echo what we were made to feel in childhood – that we are somehow deficient, unacceptable and, in short, not good enough.

However, Dorothy Rowe, a world renowned clinical psychologist and author, has, in fact, stated that it is her belief that only good people get depressed. After all, if an individual were a very bad, wholly amoral person without a conscience, s/he would hardly be concerned about not being good, let alone about not being good enough; such an individual couldn’t care less. In other words, only essentially good people worry about the possibility that they are not good enough. And, as, according to Rowe, a sense of ‘not being good enough’ lies at the heart of depression, it follows, as Rowe sees it, that it is only good people get depressed.

As well as good people being more prone to guilt, self-blame and self-hatred for (in their minds) ‘not being good enough’, Rowe also suggests that those who believe the world is ‘fundamentally just’ are also at greater risk of suffering from depression.

This is because their ‘just world’ belief entails the (erroneous) idea that ‘the good will always be rewarded and the bad will always be punished.’

Therefore, when something (randomly) happens to such people that is bad (like contracting an illness), then, based on their erroneous ‘just world’ theory, they may make the irrational inference that they somehow ‘deserve’ to be ill and are ‘being punished.’ And it is this mistaken view that adds another (unnecessary) layer of suffering which, in turn, makes it more likely that they will succumb to depression.

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How To Stop Taking Things Personally

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Taking Things Personally And Low Self-Esteem :

If we suffered significant childhood trauma, we are at greater risk as adults of suffering from psychological difficulties, including low self-esteem. And, if we have low self-esteem, we are particularly vulnerable to being hurt by others who criticize us and negatively evaluate us ; to put it in colloquial terms, we may be ‘thin-skinned’ and prone to ‘taking things personally’. (To read my article on the link between childhood trauma and low self-esteem in adulthood, click here.)

So what can we do to stop taking things personally? Below you’ll find several suggestions :

Methods We Can Use To Help Us To Stop Taking Things Personally :

  • understand that, often, those who criticize and negatively evaluate others do so because of their own problems – they may be inadequate, unhappy, frustrated, angry etc and displace (take out) these feelings on you or project their own shortcomings onto you (displacement and projection are defense mechanisms – click here to read my article relating to these).
  • if a person criticizes you and you feel s/he might have a point, try not to be defensive, but, instead, see if it’s possible to learn from what’s been said and then, if necessary, make changes rather than waste energy feeling bad
  • related to the above is the fact we are complex and, often, contradictory beings who make mistakes and that the mistakes that we make are just one aspect of us that does not define who we are
  • remember that even the most popular people will always be criticized and disapproved of by some – nobody  garners universal admiration, respect and approval
  • remember that not everyone has to approve of you all the time for you to live a contented life ; self-esteem is based upon what one thinks of oneself, irrespective of what others think. Allowing others to control how one feels about oneself is to give away power to them that need not be relinquished
  • real progress in society is very frequently made by those who are prepared to go against the grain irrespective of making themselves unpopular ; this is a virtue, not a fault and demonstrates strength of mind, character and possession of the courage of one’s convictions
  • ask yourself if you may have misinterpreted the situation. For example, if someone seems uninterested in what you’re saying, it may be that they’re preoccupied with their own concerns and not a sign you are boring them. Or if someone you know passes you in the street and seems to ‘blank’ you, could it be they simply didn’t see you?
  • realise it won’t benefit you (quite the opposite, in fact) if you ruminate on the perceived insult/slight/criticism etc. -to read my article on controlling rumination, click here
  • realize that whilst you cannot control what others think, you CAN control how you react to what they think
  • if you have done something wrong remember that, even if you have not been able to stop thinking about it, this does not mean others are thinking a lot about it too – they have myriad other things to worry about and what you do is unlikely to be central to their concerns and thought processes
  • develop self-confidence

 

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HIGHLY SENSITIVE PEOPLE (HSPs)

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