Lisa Find Love

Whether you believe you’re addicted to cannabis, or severely dependent on it, if you’re trying to reduce consumption and have been unable to do so with behavioral therapy alone, there may be some hopeful news. Researchers at the University of Sydney have found promising results from their study of a cannabinoid agonist medication that targets brain receptors in reducing cannabis relapse rates.

The study, which was published in the JAMA Internal Medicine noted that cannabis is the most widely-used psychoactive substance worldwide, with some 10% of Australians saying they’ve consumed it in the last year. About 10% of those individuals reported patterns of use that were dependent.

Yet, existing cannabis dependence treatments are ineffective, with relapse rates of about 80% within 6 months to a year of cannabis withdrawal or psychotherapy in the form of cognitive behavioral therapy (CBT). Therefore, there’s a great deal of interest in a cannabinoid agonist medication that may be combined with CBT to help improve treatment outcomes and reduce relapse rates.

To gain more insight into this research, I spoke with the study’s lead author, Conjoint Professor Nicholas Lintzeris, of the University of Sydney’s Faculty of Medicine and Health, and Director of Drug & Alcohol Services at the South East Sydney Local Health District.

Describe what led your team to study using nabiximols in connection with cannabis dependency?

Nicholas Lintzeris: There is a long history of studies looking at different medication approaches for cannabis dependence. Researchers have looked at a wide variety of different types of medications (e.g. antidepressants), although none have shown much promise across studies. In contrast, researchers over the past 10 years have been looking at cannabinoid medications, such as THC-based medications, and these have shown considerable promise. Nabiximols is particularly interesting, as it is a combination of THC and CBD extracted from cannabis plants. CBD dampens some of the side effects of THC (e.g. anxiety, paranoia) and may be considered a safer combination of cannabinoids than high-THC cannabis that predominates in illicit markets in countries such as Australia. Nabiximols also has the advantage of being an oral spray, avoiding the need for patients to smoke cannabis. Finally, nabiximols is licensed in many countries (for multiple sclerosis) and it is always easier to undertake research with a licensed pharmaceutical medication than unlicensed products. 

More broadly, the concept of replacement therapy, whereby we prescribe patients a safer form of the drug on which they are dependent, is common in addiction treatment. We use this approach widely in treating nicotine dependence (e.g. nicotine patches) and heroin dependence (e.g. methadone treatment). The rationale is that the medication enables patients to make the behavioral lifestyle changes necessary in stopping an addiction (e.g. routine patterns of behavior, links to certain social networks, etc.), while gradually reducing the medication over time, such that withdrawal and cravings are minimized. This approach is extremely effective in treating other drugs of addiction, and we were optimistic this would also work in treating cannabis dependence.      

What did you learn from that first study that helped shape the latest research you did on how using nabiximols can help cannabis users make long-term behavioral changes?

NL: The first study (Allsop et al., 2014) looked at a short course (5 days) of nabiximols compared to placebo in an inpatient withdrawal unit to see whether nabiximols could successfully reduce withdrawal severity, the doses we needed to use, and whether it would be tolerated by cannabis-dependent patients. While all the data indicated that [use of] nabiximols was very effective in managing cannabis withdrawal, when we followed up with patients a month after discharge, most had relapsed to heavy cannabis use. That did not discourage us, as this is the normal course following detox from any drug. Most people relapse if they do not engage in ongoing treatment. 

While the first study demonstrated that nabiximols was pharmacologically effective, we needed a more robust treatment model to help patients address their cannabis dependence on a longer-term basis. Hence, the recent study combined nabiximols with counseling and case management approaches over a 12-week period. 

What’s in the nabiximols spray, such as concentration/type of CBD and THC?

NL: Nabiximols is a combination of plant-extracted THC and CBD in approximately equal proportions. Each spray contains about 2.5 mg of THC and 2.5 mg CBD, and it is administered as a spray into the mouth to be absorbed across the mucosa (lining) in the mouth. This reduces the extent to which the liver breaks down the drugs before reaching the brain, and is a much more efficient way of administering THC and CBD. We were using on average 20 sprays a day, which is equivalent to about 50 mg THC and 50 mg CBD. This is much higher than when treating patients without regular cannabis use and reflects the phenomenon of tolerance. 

How, specifically, does the nabiximols spray work?

NL: In this context, patients were seeking to stop their use of illicit cannabis. The nabiximols alleviates withdrawal and cravings that they would normally experience when stopping cannabis use and allows them to start making the lifestyle and behavioral changes required to deal with addiction. This was supported through counseling approaches (cognitive behavioral therapy-based counseling) and case management that identified and started to address some of the other health and social concerns that patients may have.  

With time, patients can reduce the medication and cope with any minor withdrawal discomfort. This is a very similar approach to how we use nicotine replacement to assist patients to stop tobacco use. 

Is the nabiximols spray in any way addictive, or are there any potential or recorded negative or adverse effects to using this treatment?

NL: Perhaps surprisingly, we examined the effects of nabiximols in the patient group and identified no significant cognitive impairment or intoxication following routine dosing. The medication was enough to prevent withdrawal, has a slow onset of effect (compared to smoking a joint or a bong) and resulted in minimal intoxication. The nabiximols was well tolerated in these patients – even at such high doses. This suggests that the medication can be used for this indication and enable patients to continue to function in their routine daily activities. 

Nabiximols contains THC and, with long-term use, some patients will develop dependence to it. In our context, patients were already dependent on cannabis, and we were using the nabiximols spray a relatively short period (12 weeks), so long-term dependence was not a concern.   

How long before this product will be in the marketplace? 

NL: Nabiximols is already approved in Australia for multiple sclerosis. Technically, an Australian doctor can prescribe nabiximols today. However, because THC is a Schedule 8 medication in Australia (same scheduling as opioids), doctors need authorization from their local health department to prescribe nabiximols. Also, since nabiximols is not subsidized in Australia, the cost may be prohibitive for many patents. Furthermore, the medication is not licensed for treatment of cannabis dependence, so it would be considered “off label” prescribing. Off label prescribing is legitimate in medicine where a doctor has enough evidence of efficacy and safety, and where the patient understands that the medication is not licensed for the indication. We believe that the findings of this and previous studies are providing the evidence to support off-label prescribing of nabiximols for cannabis dependence. There are two randomized controlled trials now supporting the use of nabiximols for cannabis dependence, and a further pilot study from Canada is also consistent with our findings. A pharmaceutical company usually applies to the regulating body (in Australia, it’s called the TGA; in the U.S., it’s the FDA) to have a medication licensed for a particular indication.      

American culture seems obsessed with dieting. According to the Centers for Disease Control, almost 70% of Americans over the age of 20 are overweight, including 35% that are considered obese. In kids and teens, it’s 17%. Meanwhile, the cultural ideal is to be fit, thin, and trim. The quest for body perfection has created a U.S. weight loss industry that was estimated to be worth $68.2 billion in 2017. In 2018, the fitness industry topped $30 billion.

While 45 million Americans go on a diet every year and 54 million Americans paid for gym memberships last year, the sad reality is that most diets fail and most people quit their gym within months. For those who want to be slimmer and more fit, it is very discouraging. It’s not surprising that according to the National Eating Disorder Association, in the USA up to 30 million people of all genders develop eating disorders. 

Social media and news articles have brought eating disorders, and specifically anorexia, bulimia, and binge eating, into public and professional awareness. But there are many ways that people engage in disordered eating. You may not be aware that your own eating habits and behaviors or those of someone you love fall into one of the following classifications. Do realize that, as is true of many classification systems, people don’t necessarily fit neatly into one disorder. Often symptoms of more than one overlap. Brief case examples are provided as illustrations.

Eating Disorders You May Never Have Heard Of:

Avoidant Restrictive Food Intake Disorder (ARFID): This is characterized by difficulty tolerating foods due to sensory issues (texture or smell or appearance) or past negative experiences with it.

Lidia was referred to me for her OCD, not for an eating disorder. But when asked specifically about symptoms, she admitted she would only eat seeds and raw fruits and vegetables. She said she couldn’t stand the texture of anything that is cooked.

Night Eating Syndrome is characterized by eating 25% or more of calories after the usual dinner time. According to the National Institute of Mental Health (NIMH), Night Eating Syndrome affects an estimated 1.5% of the population, It is unlike Binge Eating because the amount of food eaten may not be excessive and the person doesn’t necessarily feel out of control. Often there is shame and embarrassment that any progress made through self-denial during the day is undone at night.

Moderately overweight, Char says she has found that she can control her weight by not eating during the day. After a breakfast of coffee, she allows herself only a salad for dinner. But often she wakes up ravenous during the night and heads to the fridge. She says that this started when her parents were overconcerned about what she ate. She learned that she could look like she was following a diet but then eat secretly at night.

Orthorexia: People with orthorexia are intensely focused on eating only “pure” — or what they consider to be healthy — food. Often they would prefer to go without eating at all rather than eat anything they consider to be too processed, grown incorrectly, or dangerous to their health. They have come to the erroneous conclusion that their body is somehow “toxic.” They resist accepting the fact that the human body is designed to detoxify itself. They therefore go to extreme measures to get rid of perceived poisons in their systems.

Hal, age 40, said he had been dealing with being overweight his entire life. According to him, no diet works. Lately, he has settled on the idea that his problem is that his body is “toxic” and he therefore has to purify it. He is now “detoxing” with special shakes and only eating food he has decided is “pure”. He is perpetually hungry which gives him a sense of satisfaction.

Fussy eating: Yes, many kids go through a stage of being picky. But picky eating as an adult can become an obsession. Often foods of a particular flavor (salty, sweet) or texture are avoided. Sometimes there are rituals around the presentation or pace of eating.

Shirl is difficult to have as a lunch companion. Although she does eat a balanced diet, she has a long list of food items she won’t eat. She takes twice as long to eat because she pokes and prods the food to make sure it’s “okay” before taking a bite. She came to treatment because it was having a negative effect on her social life and she can’t take prospective clients out for lunch.

Muscle Dysmorphia: Although it is a subtype of body dysmorphic disorder, this is often described as an eating disorder due to the impact on diet and exercise. It is more usual in men who have an exaggerated belief that their body is too skinny or too lacking in muscle definition, even though in most cases it is well within the normal range. To fix his body, the person gets involved with a strict diet, nutritional supplements, and excessive and obsessive exercise routines. This is often difficult to diagnose because the individual may look fit, healthy, and buff. They generally come to treatment because their routines are interfering with social or occupational functioning and they are incurring debt due to the costs of supporting their supplements, gym memberships and coaching.

Mauri has a long history of being bullied throughout his teens for being skinny and weak. Body building is his answer. He eats concoctions his coach tells him will pack on muscles and will win him medals in competitions. He buys hundreds of dollars of supplements every month. Eating has become as much a “discipline” as going to the gym. He hates both but loves the results.

Food Aversion: When a person has a psychological intolerance to certain foods or ingredients that results in gagging or vomiting. (The same negative reaction doesn’t occur if the food is disguised.) In women, this sometimes starts during pregnancy. Morning sickness gets associated with certain foods. Food aversion may also start when a food(s) is associated with vomiting due to an illness or a medical procedure or due to an experience of choking. Sometimes food aversion is rooted in a food’s connection to a traumatic event.

Jack starts to gag if he smells baking chocolate chip cookies. He knows it started when he went to visit his mother and found her collapsed on the floor with cookies baking in the oven.

Eating disorders can be treated.

With treatment, 50 – 60% of people with eating disorders recover. Those numbers significantly improve (up to 80% depending on the disorder) if treatment starts within the first few 3 years of onset. It does take time, especially if the disorder has been long term. But recovery is possible.

Marijuana legalization is in motion: step by step, state by state. Counting Washington, where I live, twelve states have already passed recreational marijuana legislation. At least seven more states, including New York and Minnesota, both traditionally liberal states, are slated for similar legalization in 2019. 

While stopping the weed train is unlikely (there are profits to be made in this new frontier), ensuring that its brakes and safety protocols are in working order is imperative. Protections for our most vulnerable populations — adolescents, young adults, and people with mental illness issues — ought to be mandatory.

I work in an outpatient mental health program adjacent to an acute psychiatric hospital. A major portion of our patient population wrangles with substance use issues. Patients tend to use marijuana to relax, to dampen the pain of loss, or to escape from emotional intensity entirely. There are patients who use marijuana to sleep, and patients who use it for adventure or relief from boredom. Some patients have made recent suicide attempts or serious self-harm gestures. Other patients have intrusive negative thoughts that make life seem untenable. 

Marijuana can worsen these symptoms. Marijuana with high THC content, for example, can exacerbate suicidal ideation or psychosis in people who have bipolar disorder. I worry about the vulnerability of these patients when it comes to marijuana. I worry about teenagers using it without understanding the impact it has on their brain development and future mental health. I want to steer vulnerable patients toward a cautionary approach to marijuana or towards avoiding it entirely. 

While I’m an advocate for caution around marijuana use, I do not believe that legalization will produce the catastrophic results portrayed by Alex Berenson in Tell Your Children: The Truth About Marijuana, Mental Health and Violence. Berenson is a mystery writer who has in this case written his second nonfiction book in fifteen years — and it shows. 

In it, he portrays people with mental illness, particularly those diagnosed with schizophrenia, as violent and dangerous — even more so with legal access to marijuana. To do this, he relies on media portrayals that engender fear and amplify stigmatization of mental illness with all the subtlety of an evangelical pamphlet illustrated with images of marijuana-crazed schizophrenic zombies.

The public’s primitive fear of madness — which likely protects us from getting too close to our own vulnerability — is fueled by negative associations fed by negative media stereotypes. Portrayals of people with mental health challenges as being “other,” that is, outside the shelter of society, are destructive. This “othering” induces shame, remorse, and hopelessness in people who are already tasked with the difficulty of establishing a new version of a self.

In Tell Your Children, Berenson focuses only on the behavioral extremes of schizophrenia mixed with marijuana, skewing his statistics in order to make his argument against legalization stronger. He sometimes includes other forms of psychosis (in addition to schizophrenia) in his numbers without explaining crucial differences, randomly adding bipolar patients and patients with other mental health  issues to his numbers. Often, such patients are more at risk of doing damage to themselves — exhausting their primary relationships, destabilizing their own financial well-being, engaging in various forms of self-harm — than to others. 

As well, Berenson tends to leave out anything that weakens his case, such as the unfair incarceration of black men for marijuana possession crimes.  

I’m angry about Berenson’s choice to link violence, marijuana, and mental illness because it discourages productive public discourse about real human struggles. The patients I meet have a tough enough time coming out to family, friends, workplace acquaintances, and supervisors about their mental health struggles for fear of rejection, judgment, and the possibility of losing their jobs.

Among the patients enrolled in our program are people who were recently hospitalized for psychosis. They are people diagnosed with a variety of conditions: bipolar, depression, PTSD, anxiety, or schizophrenia. Often their symptoms have been exacerbated by marijuana use. Some patients have lingering symptoms of psychosis, both what we call positive symptoms (i.e., hearing voices, seeing things others don’t see, paranoia, uncertainty about what is real) and negative symptoms (i.e., mood issues, disorganized thoughts, difficulty putting thoughts and emotions into words). 

I work with a psychiatrist and a psychiatric ARNP who prescribe medication to these patients on an individual basis. These providers are always fine-tuning and titrating doses until they find what works best for a patient. They also know that what works now doesn’t always keep working. They adjust accordingly. Marijuana is not a medication they prescribe; on the contrary, they caution against it.

Historically, funding and federal approval for marijuana research has been limited due to restrictions on access to federally approved research-grade pot. Now these restrictions are lifting, and researchers are increasingly able to collect data about marijuana. If all goes as it should, we may gradually begin to get a reasoned understanding of the plant’s dangers and benefits.

Down the road twenty years from now — maybe less — marijuana may be among the medications that providers are prescribing, fine-tuning, and titrating for patients with schizophrenia. 

But that moment hasn’t yet arrived. 

There are human scale questions to consider in the grand marijuana legalization debate. I worry that we are missing the opportunity to help people understand what we know and what we don’t know about marijuana at this point, so they can make educated choices. We need to offer more adequate warnings and protections, and more straightforward conversations, to help vulnerable populations. We also need to better educate the general public going forward.

That includes acknowledging the complex layers of background issues that inform mental health conditions. By background issues I mean race, socioeconomic status, gender, sexuality, domicile status, individual and family history, and environmental issues including the impact of living in an increasingly toxic, unpredictable, and polarized world in which violence is granted more than ample media airtime. 

I‘ve never been a big fan of marijuana. It’s not something I’ve turned to, even when experiencing side effects from chemotherapy. At the same time, I respect that marijuana has been of great benefit to many people in cancer treatments and with various chronic illnesses such as IBS or Parkinson’s Disease. Marijuana may prove to be a substance that has multiple benefits, and, in the right dosages, may be able to help moderate some of the mental health conditions it can exacerbate.

We ask our patients at orientation to avoid using marijuana entirely for the three weeks they’re enrolled in the program, and even longer if they’re vulnerable to marijuana’s negative effects. At this turning point in marijuana legalization, at least in the business I’m in, caution is essential. 

In the meantime, better public education — particularly for young people and vulnerable populations — and more balanced representations of marijuana in media would be helpful, as would explicit and broad warning labels. In solving the mysteries of marijuana, our best course is slow and steady, keeping our focus on funding the research and re-thinking that will keep this train on track.

References:

Berenson, A. (2019). Tell your children: The truth about marijuana, mental illness, and violence. New York, NY: Free Press.

DeAngelo, S. (2015). The cannabis manifesto: A new paradigm for wellness.  Berkeley, CA: North Atlantic Books.

It can be hard to find stories about women who are single and don’t have children. There are now so many more people delaying marriage and family, but it can be hard to find them. It might be tempting to think that they don’t exist. Glynnis MacNicol’s wonderful book No One Tells You This is one such story. It’s an exploration of life when MacNicol turns 40, a year which holds highs and lows of family illness and loss, friendship, professional successes and challenges. Regardless of your relationship status, this is a must-read.

I caught up with MacNicol to talk about the way things have changed for single people, friendships, and what she loves about her life.

Tell me about your book?

I’ve come to think of it as a coming-of-age story about turning 40, being single, not having children, and trying to find your way in a world that really doesn’t recognize you as a vital part of it. I think a lot of why I wrote the book was that I was struggling to find a blueprint for myself for what the next phase of my life would, could, and should look like. You really have narrow narratives around women’s lives that almost exclusively adhere to the marriage plot or the motherhood plot. I wanted to create a different narrative.
I was seeing not just myself, but so many women in my life, living fulfilling, exciting and complicated lives as women outside marriage and motherhood. Women in marriage and motherhood live full and difficult lives outside of both of those roles, but I couldn’t find any version of that in the culture. I was both incredibly angry about its absence and felt suffocated by it, as I think anyone who finds themselves living outside the norm. How do you measure the value of your life? How do you measure the progression? How do you know your place in the world when you are not seen? That’s what the book is trying to accomplish.

One of the reasons I was able to write this book is because so much happened to me when I turned 40, which is a very loaded age for people, but women in particular—because it coincides with our idea of the end days of fertility. The book is about what it means to be a woman outside these cultural norms. But it’s also very much about my relationship with my mother and the generation my mother came from and the relationships I have with many of my friends.

In many ways, your book is about the extremes of single life. Would you talk about how you found being single to be similar/different from our cultural stereotypes?

I found it to be both. I’ve observed that single women, particularly single women past a certain age are found to be either very spoiled or objects of pity. Some people will read this and think I’m very spoiled. Let me emphasize the self-made nature of my life. Most people are so comfortable attributing self-made-ness to men and so uncomfortable attributing it to women. I have been living on my own since I was a teenager, and, financially, I’m my only support system. We really don’t have any way to understand women as both self-sufficient and as outside the direct support system of being a mother. I am in a supporting role in so many people’s lives, as a caretaker or support system, or whatever it is, that the idea I was selfish and spoiled was pretty much upended. At the same time, the freedom that coincided with some shred of financial independence, on my part, in terms of being able to travel, made me sort of an object of envy in ways that no one had ever prepared me for. No one prepares a single woman, aged 40, to be the object of envy of anybody. You’re just ready to be the forever alone person.

I was living both those stereotypes, but sort of at the opposite ends of them and I felt that as the title suggests, no one had told me either of these things were going to be possible.

“No One Tells You This”

Your story makes it clear that while you don’t have a partner, your life is full of love, both in the friends you’ve chosen, and the family you belong to. How have these relationships enriched your life and how do you think they would be different if you were in a couple?

I don’t like to speak broadly for everyone because everyone’s experiences are different, and I want to emphasize how much I was in New York City. I love New York, but I think living in New York and living in major urban areas as a single person is a different experience culturally then living in the suburbs. If I owned a house, as a single woman in the suburbs, and had to drive places, my social interactions would be far fewer than they are right now.

I always like to say I think it’s a fallacy that women in my position wouldn’t be overwhelmed with relationships. I appreciate that that’s not true for everyone, and I have lived in the same place for two decades and I am still friends with many people I’ve known since my early twenties. Maintaining friendships over two decades is complicated and difficult and requires determination and compromise, much the same as marriage. So I like to emphasize that too, because some people have come up to me and said ‘How do I get friendships like yours?’ and I’m like, ‘It looks perfect now, but you know, we’ve been through the deep end of difficulty over the years like any long-term relationship.’ But we have this assumption of like lonely, poor you. Even my editor said to me at one point ‘Do you want to talk about how difficult it is around the holidays, you’re not married, and you don’t have a place to go?’ and I was like, ‘I don’t know what other people’s experiences are, but people are trying to book me up for their holidays months in advance.’ I have so many holiday invitations and I think I’m very fortunate. How would that be different if I were married or if I were in a partnership? I don’t know, so it’s hard for me to say.

When all of your friends start getting married and having children, your life shifts fundamentally and you have no control. It’s really painful. My experience is that everyone comes back to you once they get through those early years of their lives shifting, but what happens is that people have less time. There’s a number of years where everyone’s main focus is their children.

So dating and relationships of all kinds change so much as we get older, what are some of the differences you’ve seen both in dating and building other relationships throughout your different decades?

Making friends in your 20s is so easy because you’re all unformed and have high tolerance levels. You’re also, and this goes for dating too, constantly in social situations, surrounded by people your own age, largely with your own ideas about how life should go. I say that as somebody who very clearly left where I was raised and found a place where I felt comfortable and was surrounded by people who shared my idea of what the world should look like. I’ve kept my friends since my early twenties and then also have made a different set of friends with each decade that goes by. The older you get the more you understand the people you want in your life and the people you don’t want in your life.

With regards to dating, people tend to think of dating as a job. There’s some truth to that since you don’t find yourself in circumstances that naturally create the environment where you are meeting new people. You have to go out of your way to create these circumstances. If you are a person that wants to be in a relationship, and if you are a person that wants to be married with children, which is a completely valid goal to have, you have to work at creating those opportunities. Those circumstances just don’t happen naturally they happen even less naturally in a world that’s dominated by social media. So, if dating is a priority for you, you have to make time in your schedule.

That changes again when you hit your 60s and people’s kids are out of the house. We see people coming more back into a social arena where you’re surrounded more by people your own age. What do you see as the greatest gifts of being single?

That’s a big question, because women having the opportunity to remain outside of marriage for their entire adult life and financially be able to support themselves is an incredibly new development in history. I raise this point every time I talk about this subject: in the United States women couldn’t have credit cards or bank accounts in their own name until 1974. They had to have a husband or a father co-sign. When we talk about what is the greatest thing about remaining single, just the fact I can is the greatest thing.

I encourage every single woman to remind themselves of that, because, culturally, we really like to attach shame to any aspect of a woman’s life where she’s doing something on her own. You’re traveling alone? What’s wrong with you? You’re eating alone? That’s something to be ashamed of, or you are up to nefarious things. What’s the matter with you? That’s a cultural decision we’ve made. I encourage women to think, if they’re feeling bad about being alone, who benefits from you feeling bad about it? The greatest thing about this development is that I even have the ability to be single and successful in every aspect of my life.

If you could go back and communicate with your younger self, what would you say and what advice would you offer our single readers?

If I went back to my younger self and I said: ‘You’re living in New York City in your own apartment and you’re making a full-time living as a writer,’ my eight-year-old self, would just be like: ‘Awesome.’ I don’t think my eight-year-old self would have asked: ‘Are you married?’

My advice to women who are single: you have nothing to be ashamed about. Congratulations on being able to live a life that hasn’t been possible for women before this era. Marriage is not a solution. We look at single women as a problem in need of a solution, but you are not a problem. Do not feel ashamed.

What were your hopes for your readers as you wrote this book and sent it into the world?

I really wanted just to open the door. I didn’t want this book to be prescriptive. This book is not: how to be single and great, or self-help or anything. I thought of it like a dispatch. I am out here in what feels a bit like no man’s land. I fully appreciate that there’s long history of women outside of marriage and motherhood, but the fact that we have so few stories about them tells you something about who’s writing the stories.

I want to tell you what it’s like so that maybe it will be less overwhelming, or frightening, or shame-filled, or anxiety-inducing for you as you contemplate it. I just wanted to map my small place in this wide experience and send that back. I wanted to provide an alternate version of what a woman’s life could look like.

Cara Strickland writes about food and drink, mental health, faith and being single from her home in the Pacific Northwest. She enjoys hot tea, good wine, and deep conversations. She will always want to play with your dog. Connect with her on Twitter @anxiouscook.

The post No One Tells You This: Being Single with Author Glynnis MacNicol appeared first on eharmony Advice.

Often the walls used for protection are the same walls that hinder the development of intimacy. You may genuinely want to find a loving relationship, but your fear gets in the way. This trouble occurs if your fear leads you to date with your guard up. This is why learning to be vulnerable despite your fears, insecurities and natural imperfections is one of the most important aspects of skilled dating.

Being vulnerable involves being open, present, and authentic. It is the opposite of playing games or dating with a façade. The harsh truth is that when you share something about yourself and put yourself out there, you are not in control of how others respond. This can be especially painful when others don’t respond with the compassion, acceptance and understanding you had hoped for. Not being received in the way you had hoped can make the experience of sharing even more anxiety-provoking, and when faced with rejection, you may question yourself and enter into a shame spiral.

However, taking the risk to let people in is the recipe for a true romantic partnership and love, so breaking through your walls is a must. You can learn a lot by being vulnerable and witnessing other’s responses. If you are not met with openness and acceptance by your date, this information is significant in evaluating compatibility.

Here are six ways to increase vulnerability as you date:

1. Recognize the purpose of being vulnerable.

Healthy sharing is the path toward true intimacy and connection. Vulnerability is the means to really get each other, build a genuine bond and hopefully fall in love or determine you aren’t a good fit. If you don’t share about yourself, you may be protected from rejection, but you also won’t know if you’re a match. If you can view being vulnerable as a healthy and normal aspect of dating, maybe it will feel more and more worth it despite the attached fears.

2. Change your perception of vulnerability.

Unfortunately, our culture sometimes mistakes vulnerability for weakness, especially when it comes to men and what it means to be masculine. Vulnerability equals strength. Vulnerability shows your date that you are emotionally available, in touch with your thoughts and feelings, and that you care. Vulnerability makes you relatable as another imperfect human. Even though it may feel uncomfortable, vulnerability is a form of confidence and self-acceptance.

3. Understand vulnerability may look and feel different at different stages of dating.

For example, healthy sharing and vulnerability on a first date looks and feels vastly different from healthy sharing and vulnerability on a sixth date because it takes time to build trust. The progression of sharing paired with healthy boundaries will allow you to get to know each other more deeply. Maybe this means that you share your passions and interests early on, but you withhold your relationship history until you know each other a bit better. It can mean later in dating when you know you want to be exclusive; you openly communicate that you’d like to define the relationship. Please know that being vulnerable is an evolving process that takes time and emotional investment.

4. Take baby steps toward being open and sharing more about yourself.

Your walls will not come down overnight. This is natural, so go easy on yourself as you try new ways of thinking and behaving. Changing the way you relate to others takes time and practice. Focus on going slow and ensuring that sharing isn’t one-sided. Build a connection by taking turns with sharing, listening and asking questions.

5. View yourself as worthy.

You have value and a lot to offer to others even if you get rejected. Denying your worth will make it nearly impossible to put yourself out there and show the world who you are. In the dating context, if you don’t feel worthy, you will walk around feeling insecure about what potential matches think of you. You will put up walls for protection, disown parts of yourself, and maybe even self-sabotage to ensure others don’t get too close to you and can’t reject you. Accepting that rejection is a natural part of dating will aid you in taking it less personally.

6. Take care of yourself when you are feeling vulnerable or over-exposed.

For example, maybe you shared that you have a child on a first date, which is a topic that feels very vulnerable to you. Just because you feel uncomfortable, doesn’t mean the choice to share was wrong. Breathe through it and be gentle with yourself. Understand that being uncomfortable is part of the process of allowing yourself to be more vulnerable. Also, be aware of the stories you make up about yourself if your date doesn’t respond with empathy or understanding. Don’t take it personally if someone rejects you because you disclosed you are a parent and your date perceives this as a deal breaker. Embrace who you are and own it.

I’ll leave you with one of my favorite quotes on vulnerability by Brene Brown:

“Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy—the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.”

Consider how you can apply the above to dating, and I believe you can transform your love life.

About the Author:

Rachel Dack is a Licensed Clinical Professional Counselor (LCPC), Nationally Certified Counselor and relationship coach, specializing in psychotherapy for individuals and couples via her private practice in Bethesda, Maryland. Rachel’s areas of expertise include relationships, self-esteem, dating, mindfulness, anxiety, depression and stress management. Rachel is a co-author to Sexy Secrets to a Juicy Love Life, an International Bestseller, written to support single women in decreasing frustration about single-hood, leaving the past behind, cultivating self-love and forming and maintaining loving relationships. Rachel also serves as a Relationship Expert for http://www.datingadvice.com/ and other dating and relationship advice websites. Follow her on Twitter for more daily wisdom!

The post 6 Strategies to Increase Vulnerability While Dating appeared first on eharmony Advice.

Codependency robs us of a self and self-love. We’ve learned to conceal who we really are because we grew up pleasing, rebelling against, or withdrawing from dysfunctional parents. That sets us up for trauma. As adults, even if we’re successful in some areas, our emotional life isn’t easy. Looking for security and love, most of us struggle to get into or out of relationships. We may remain in unhappy or abusive relationships or try to make painful ones work. Many of us would be content just to find a reprieve from ongoing anxiety or depression.

After the Breakup

However, ending a relationship isn’t the end of our problems. After initially rejoicing and reveling in newfound freedom, there’s often grief, regret, and sometimes guilt. We might still love the very person whom we’re grateful we left. We may no longer speak to estranged friends or relatives, even our children, who we still love or worry about. These are unexpected losses to be embraced.

Going “no contact’ doesn’t necessarily end the pain either. The trauma of abuse isn’t over. Our self-esteem has surely suffered. We may lack confidence or feel unattractive. Abuse may continue in a new relationship or in family relations. You may suffer abuse from an ex with whom you co-parent or through children who have been damaged or weaponized. 

As hard as it was to breakup an abusive relationship, it may still haunt us (sometimes even after the abuser is dead). One day, often decades later, we learn we have post-traumatic stress disorder (PTSD) — scars from the abuse we thought we’d left behind. We might be haunted by nightmares and become risk-averse or hesitant to love again. It’s not easy to “leave” for good. 

Fearful of re-experiencing abuse, abandonment, or loss of our autonomy, many codependents become counter-dependent. Yet, our inability to be alone and/or our low self-esteem can cause us to again make poor choices. Out of fear we may settle for someone “safe,” who isn’t right for us and whom we’d never commit to. But despite our intentions, we nevertheless reattach and find it difficult to leave. We don’t trust ourselves and ponder whether the problem lies with us or our partner. And although we’ve vowed to never again let anyone abuse us, some of us may once more be betrayed, abandoned, or mistreated in ways we hadn’t anticipated. We have to let go all over again.

This cycle of abandonment can make us fearful of intimacy. If we opt for being alone, our needs for love and closeness go unmet. Loneliness can trigger toxic shame from childhood, when we felt alone and unloved or unlovable. It may seem like there’s no hope or escape from our misfortune.

The Core of Codependency

We didn’t expect that after coming out of denial, courageously setting boundaries, and leaving unhealthy or abusive relationships, we would then have to face the core of codependency. Our codependent symptoms have been coping mechanisms that masked our basic challenge: How fill our emptiness and loneliness with self-love.

In part, this reflects the human condition, but for codependents these feelings are connected to trauma. Our insecurity, self-alienation, and self-love and self-nurturing skills fuel addictive relationships and habits that cause us recurring emotional pain.

Real Recovery

Just as addicts turn to an addiction to avoid unpleasant feelings, codependents also distract and lose themselves by focusing on others or a relationship as the source of their well-being. If we stop doing that — often not by choice, but due to isolation or rejection — we may uncover depression and feelings of loneliness and emptiness that we’ve been avoiding all along. We keep recycling our codependency until we address our deepest pain.

Healing requires we turn our attention inward and learn to become our own best friend because our relationship with ourselves is the template for all our relationships. 

With some insight, we discover that we’re actually quite self-critical and haven’t been treating ourselves kindly with self-compassion. In fact, we’ve been abusing ourselves all along. This is actually a positive revelation. Our mission is clear: learning to relate to ourselves in a healthier way. Our tasks are to:

1. Revitalize our connection to our internal cues — our guidance system — to trust ourselves.
2. Identify and honor our needs and feelings.
3. Nurture and comfort ourselves. Practice these tips. Listen to this Self-Love Mediation.
4. Meet our needs.
5. Heal our shame and affirm our authentic self. 
6. Take responsibility for our pain, safety, and pleasure.

Attend Codependents Anonymous (CoDA meetings), and work the Twelve Steps. PTSD and trauma don’t resolve on their own. Seek trauma counseling.

©Darlene Lancer 2019

Ghosting, a term that came into popularity in the last decade, is a perfect term. When someone you were matched with suddenly disappears, that individual suddenly seems like a real-life ghost. You may have any of the following thoughts when you experience a ghosting: Did we have an actual connection or did I imagine it? Was the ghoster lying to my face or did they actually care? How can a person simply disappear? If you’ve been ghosted, I am sorry and I have empathy for you. It’s not fair or just that another person treats you so callously. Keep reading to discover a plan to help you deal with this hurtful experience.

First, get clear about which feelings come up for you as a result of being ghosted

When ghosted, you may feel a tornado of feelings. Some of the most common post-ghosting feelings are confusion, sadness and anger. These negative feelings are natural in response to such poor treatment, and your reaction to the treatment is a healthy sign that you are healthy and expect mature treatment in your relationships.

Resist the urge to blame or doubt yourself

The cruelest symptom of ghosting is that the person who gets ghosted often ends up blaming or second-guessing themselves. You might wonder if you did something to turn your match off; you might fear that he or she decided that you aren’t interesting or attractive enough to merit even one more text, phone call or date. But please, don’t take another person’s selfish behavior personally.

What ghosting says about the ghoster

Yes, life is complicated and unpredictable, which means that people sometimes experience events or circumstances in their lives that cause them to act in ways they typically would not. For instance, a person could experience a limitless number of life emergencies: a loved one dies or has a serious accident; a person’s house burns down; or a person loses their job. If catastrophes like these occur, it’s fair to expect that this individual is in life-emergency mode and may be suddenly not able to communicate in a dating relationship. In these cases, the sad reality for anyone they were talking to is that this individual is simply too overwhelmed to engage romantically.

Given these freak exceptions, most ghostings are not the result of such tragic emergencies. Most ghosters ghost because they aren’t mature enough to have a real relationship. We expect this behavior from a first-grader, but not from actual adults! Ghosters ghost because they cannot tolerate the feelings that would come up for them if they were to tell their date the truth about what’s going on. Even though telling someone the truth is what you owe them – by definition – in dating them, ghosters don’t have the integrity to set aside their own feelings and focus on the feelings of the other person.

Label the ghoster’s behavior and focus on the overall lessons

Define the ghoster’s behavior. Say to yourself “No matter the specifics, not communicating to a match any further is selfish, immature and incredibly insensitive behavior.” Next, say something like this to yourself: “I am super sad and bummed, but I also know I would not want to be in a couple with someone who acts like such a #$@! anyhow. I did nothing to deserve that kind of treatment.” Notice that the statements I suggest to say to yourself draw more from anger (when you feel empowered) than sadness (when you internalize self-blame or feel hopeless). Connect with your anger and make a mental note to give an extra chance to anyone you date who calls when they say they’ll call, and shows up when they say they will.

Good quotes to remember when you’re ghosted:

• “If someone chooses to behave in an insensitive way, they have effectively reminded me why I would never want them as life partner.”
• “A person’s behavior is a reflection on them, not me.” “People show their character not through words but through their actions.”
• “If I am going to have a partner, it’s going to be someone who knows how to act like a decent adult.”
• “I don’t overthink things that make me feel bad.”

The post What to Do When You’re Ghosted: A One-Week Plan appeared first on eharmony Advice.

We’ve all heard the saying that “you can’t love another if you don’t love yourself.” While this sounds logical, few of us have any idea of how or why we fell out of love with ourselves in the first place. 

The complexities of our families and unavoidable traumas big and small often destabilize our self-love, and, sadly, few of us have been given the tools to help reestablish it. The good news is that these tools exist, and I’ll share several of them below. 

 As you fall back in love with yourself, you’ll notice that you become a magnet that attracts healthier and healthier partnerships.

The Importance of Secure Attachment

Let’s start with a little background on “attachment theory.” The term was first coined by psychiatrist John Bowlby, MD, in the 1950s. He proposed that healthy personal development and growth begins with a “secure attachment” between a child and primary caregiver. 

The ingredients of secure attachment include providing a child with appropriate boundaries, structure, consistency, safe physical touch, support to express emotions, and unconditional love. These lead to the development of confidence, curiosity, and self-exploration — all of which are the foundation of a cohesive relationship with self and an accurate assessment of the world.

When childhood attachments are successful between a parent and child, the child will mature into an adult with a resilient nervous system and the skills to manage life’s stressors with a sense of mastery. Haven’t we all met someone who seems to navigate the world with a sense of ease and flow no matter what life throws in their path? Chances are, their primary caregiver was able to provide them with a secure attachment. 

But what happens when a child senses that they are not safe with their primary caregiver? For example, If a child cries when they are upset and the primary caregiver reprimands the child for crying, the child will suppress their feelings to avoid crying. The message the child receives is “it is not okay to be you.” With a caregiver who is unpredictable in their reactions and unreliable in their actions, the child will begin to detach from herself as a means of survival, and the relationship with the primary caregiver will take priority over the relationship she is developing internally.

Experiences like these leave an imprint on the developing brain and body, stifling our ability to express ourselves and to evolve our personality and character in ways that lead us to greater fulfillment. 

If our attachment issues remain unresolved, they can lead to significant health problems over our lifespan. The Adverse Childhood Experiences questionnaire (ACE) was the largest study of its kind (with 17,000 participants) to examine adverse childhood experiences. It found that the higher a person scored on adverse childhood experiences, the greater the negative impact on emotional and mental health later in life. 

Luckily, as humans we have an innate capacity to heal. When we can access our essence and connect with our inner voice and desires, we shift our energy. And when we have deep and safe connection internally we gain more capacity to be engaged and present with others and the world around us. I’ve witnessed this rebirth in many of my clients — and myself — and I know that you can experience it, as well. 

Find the Words

Because breaches in attachment force us to abandon our own experiences, the first step to healing is to learn how to put words to our experiences and find words for the body’s non-verbal experience. 

Have you ever felt challenged in this area? Maybe someone has asked you to describe an experience and you could not find the words? This likely has much to do with how you were forced to abandon your own early experiences. 

A good place to begin learning how to do this is by using a feeling list, such as this one on my website. I invite you to carry this list with you and use it twice a day to put words to two different interactions. By creating a vocabulary for your feelings and non-verbal experiences, you will begin to acquaint yourself with… yourself. Think of this task as dating yourself, as though you are slowly getting to know the person you really are. Creating this vocabulary gives you more capacity to connect to your feelings and communicate your needs and wants to others.

Practice Non-Judgmental Observation

Observe, observe, and observe. I cannot overemphasize the importance of this. Paying attention to your experiences is the first step in learning how to be present. This increases our capacity to contain negative emotions without fear and positive emotions without overstimulation. This also assists in changing our internal dialogue from why we are experiencing something to what we are experiencing. 

Begin by noticing your experience. For example, rather than asking yourself why you are sad today, see what it is like to notice and simply be with your sadness. Maybe you notice that you want to judge yourself for feeling this way? Maybe you notice that you would rather distract yourself? 

Resist the temptation to tell yourself how you “should” be feeling. Whatever shows up, simply try to lean into the discomfort and observe your actions and thoughts. Notice the internal dialogue you are having with yourself. For example, let’s say I’m working with a client, Jane, who often tells herself that it is not okay to feel angry, even though she can feel the rage in her body.  I would invite Jane to allow herself to simply notice that she feels angry and give her permission to express the anger even though it feels uncomfortable. 

Create Safe Connection

If you did not experience safe connection as a child, developing safe connection as an adult can be a challenge. I often hear clients say that they find people draining and that they prefer their own company. Believe it or not, safe connection is as vital to human development as oxygen is to breathing. Safe connection is one of the greatest ways to nurture a positive sense of self and also encourages new neurological pathways for social, emotional, and cognitive development. 

I encourage you to step up your game and actively create more safe connection by reaching out to friends and family who support who you are and allow you to express yourself freely. One of the qualifications in selecting these individuals is that you feel accepted and loved by them. I understand that this may be a challenge, but it’s worth it. I invite you to notice how you feel after interacting with them. I am almost certain you will feel more positive and energized. The more safe connection you can consciously add to your life, the more you will begin to attract it without any effort. 

When we can attend to ourselves and attune to our inner being the world around us looks different. Each positive experience trains our body to build more resilience and changes our body chemistry. Positive experiences and connections build a sense of competence and well-being. They reassures us that we are capable of having more of these feel good experiences. These help our bodies produce more of the “feel good” hormone oxytocin and less stress hormones such as cortisol and adrenaline. 

As we continue to move through challenges with a sense-of well-being, we build a sense of mastery over our lives. This mastery gives us a sense of pride, satisfaction and/or gratitude, raising our self-esteem and our hopes for our future.  

Healing is possible. You can take charge of your relationship with yourself by gently and slowly getting to know yourself. Be patient; think of this as you would think of meeting and dating someone who you hoped to have a long and loving relationship with. Think of the excitement and curiosity you experience when getting to know a new and important person in your life. Pretty soon, as you have more and more good experiences with yourself and build self-trust, you may find yourself falling in love…with you. 

Reference

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (2019). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 56(6), 774-786. 

“Write down your goals, make plans to achieve them, and work on your plans every single day.” – Brian Tracy

Do your goals seem too lofty and far-off to reasonably achieve? Do you sometimes feel stymied by lack of discernible progress? Does this dearth of accomplishment make you lose interest and diminish momentum toward doing what’s necessary to get to the next level? It isn’t your goals that may need attention, but how you go about reaching them. Here are some thought-starters on how to make progress without struggle.

1. Review your list of goals to ensure they’re ones you really want.

“It’s better to be at the bottom of the ladder you want to climb than at the top of the one you don’t.” – Stephen Kellogg

Compiling a long list of goals you have no real desire to achieve is a worthless endeavor. Not only will you toss the list in a deep drawer never to revisit it, you’ll likely feel a twinge of guilt that you did so. Why? When everyone seems to want to talk about how much they want to do in life, how long their goal or bucket list is, you know that you’ve given short shrift to what you really want out of life. You have nothing to talk about, let alone motivate you to go beyond what you now know.

The simplest way to get around this is to dig out that list of goals and go through it, weeding out each one that hasn’t a remote chance of ever getting done and retaining those that may spark your interest, if only slightly. There’ll be time to flesh them out later. For now, you need to pare that unwieldy list to one that’s more manageable. In fact, if you wind up with a handful of life goals that you may be able to rework into some that will energize you, that’s making progress right away.

2. Single out a goal you want to achieve above all others. This is the one to focus on.

“This one step – choosing a goal and sticking to it – changes everything.” – Scott Reed

You must begin somewhere, and that starts when you identify one goal on your pared-down list that you most want to achieve. There’s no sense diluting your energy by trying to go after too many goals at once. By zeroing in on a single goal, the right goal, you’re honing your focus to a laser sharp concentration. 

Note that you may need to sleep on this goal in order to allow your subconscious to link threads of possibilities for you to review upon waking. Why is this important? What may be a natural progression of steps might not be readily apparent when you first think about what approach to take with this goal. You may, for example, be tempted to jot down easy-to-do steps that may look like you’ll be making progress when, in fact, they’re more busywork than anything else. What you want is a coherent plan, something that makes sense while it also spurs you to action. This may seem like an impossible outcome, yet you’ll be surprised what your subconscious can come up with. Let it go to work for you.

3. Fan the fire within.

“When your desires are strong enough, you will appear to possess superhuman powers to achieve.” – Napoleon Hill

When you can’t wait to get started working on your goal, you know this is something you really want in your life. It will not matter how arduous the path or how many times you stumble along the way, the vision you have of success is firmly imprinted in your mind and nothing will deter you. What’s so beautiful about having this fire within is that obstacles that might otherwise stall momentum have little chance. Instead, novel solutions may appear, seemingly out of nowhere. 

Granted, there will be twists and turns as you work towards the goal. That’s to be expected and is nothing to worry about. If you find that you’re making phenomenal strides with little effort and no problems, it may mean that your plan was so well-crafted and executed that nothing could stand in the way. On the other hand, it could also mean that the goal you chose was not lofty enough.

It is good to have minor goals, ones that you can work on and accomplish so you have a track record of success. Just be sure you always put in time on the highest-value and most-desirable goal as well.

4. All goals are possible – even those that seem impossible.

“What the mind can conceive and believe, and the heart desire, you can achieve.” – Norman Vincent Peale

If there was no challenge, there would be no satisfaction in success. The journey to achieving a heartfelt goal is perhaps as important as the realization of accomplishment. Goals that rank as highly impossible, as compared with just impossible, a comment generally used to dismiss difficult, time-consuming or seemingly improbable goals out of hand, may very well be the ones that others will talk about for years to come. After all, didn’t the world’s great inventors put their energy into solving riddles that confounded, perplexed, and for which no answer seemed possible?

They didn’t give up. They did persist, with enthusiasm, determination and follow-through. As a study from the American Psychological Association points out, monitoring the progress made toward goals helps promote goal achievement, especially when such progress is recorded or written down.

5. Add variety to your action plan.

“The best way to keep good acts in memory is to refresh them with new.” – Cato the Elder

Researchers at the University of Sussex found that pond snails learned and remembered more when learning two totally unrelated tasks. How does this relate to making progress reaching your goals? By adding variety to the action plan you’ve put together for achieving the goal, you’re more likely to learn faster what works and remember it than if you keep doing the same step (or one that’s very similar) over and over.

6. Recognize that where you live is now.

“Small daily improvements over time lead to stunning results.” – Robin Sharma

Attaining that all-important goal may take some time, yet you do make progress on the end result with action you take today. This is, after all, where you live: in the here and now. Put your best work into making little improvements today. Do the same tomorrow. You’re bound to make progress – and it won’t even seem like a struggle. Research shows that immediate rewards today can help with long-term goal achievement.