Introduction — What Every Medicine Cabinet Is Missing
Just as you wouldn’t pitch a tent outside a family doctor’s waiting room at the first sign of a cough, you can’t run to a therapist every time a romantic prospect turns you down or a boss raises his voice. Yet while every household keeps a medicine cabinet stocked with bandages, ointments, and pain relievers for basic physical ailments, we have built no equivalent for the minor psychological injuries we sustain in daily life. Many of the diagnosable conditions for which people eventually seek professional treatment could have been prevented if emotional first aid had been applied to the wounds when they were first sustained — a ruminative tendency can quickly grow into anxiety and depression, and experiences of failure and rejection can erode self-esteem over time. Treating such injuries early not only accelerates their healing but helps prevent complications from developing and mitigates the severity of any that do arise. Of course, when a psychological injury is serious, emotional first aid should not replace seeing a mental health professional any more than a well-stocked medicine cabinet abolishes the need for physicians and hospitals. It is time we practiced mental health hygiene just as we do dental and physical hygiene.
Chapter 1 — Rejection
Of all the emotional wounds we sustain in daily life, rejection is perhaps the most common. By the time we reach middle school we have already been turned down for play dates, picked last for teams, not invited to birthday parties, dropped by old friends who joined new cliques, and teased or bullied by classmates — only to discover that adulthood brings an entirely new and more elaborate array. We get turned down by potential dates, refused by prospective employers, and snubbed by potential friends. Spouses rebuff our advances, neighbors give us the cold shoulder, and family members shut us out of their lives.
What sets rejection apart from nearly every other negative emotion is the magnitude of the pain it delivers. People regularly describe the sting of a significant rejection as analogous to being punched in the stomach or stabbed in the chest, and one reason that pain runs so deep is that reason, logic, and common sense are largely powerless against it. Rejection also floods us with anger and aggressive impulses — a powerful urge to lash out, especially at those who rejected us, and in a pinch, at innocent bystanders. Studies of school shootings, including the 1999 Columbine tragedy, found that thirteen of fifteen incidents involved perpetrators who had experienced significant interpersonal rejection and ostracism from schoolmates; many specifically targeted students who had bullied, teased, or rejected them in the past, often seeking them out first.
We compound the wound by becoming fiercely self-critical, kicking ourselves when we are already down and drawing sweeping conclusions about our shortcomings when the evidence rarely warrants them. The most frequent reasons people get rejected as romantic prospects or job applicants have nothing to do with fatal character flaws or critical missteps. Most often it is a matter of chemistry — either a spark exists or it doesn’t — and timing can be just as decisive. Similarly, getting rejected by a prospective employer usually has far more to do with internal hiring practices, a specific skill set or background they were always looking for, or a position that was required to be advertised but was always intended to go to an internal candidate. Rejection inflicts four distinct psychological wounds, each of which can require its own form of emotional first aid: lingering visceral pain, anger and aggressive urges, harm to self-esteem, and damage to the fundamental feeling that we belong.
The first form of treatment targets self-criticism, which rejection reliably and immediately triggers. The exercise is to list in writing any negative or self-critical thoughts the rejection has produced — and then to formulate a personalized counterargument for each one. When we feel the urge to berate ourselves over romantic rejection, we can remind ourselves that chemistry is not a reflection of our worth; it cannot be manufactured, and its absence says nothing reliable about us. When we blame ourselves after a job interview, we can remind ourselves that hiring decisions are driven by fit, timing, and internal politics as much as by the quality of the candidate. Whenever a self-critical thought surfaces, the practice is to articulate the relevant counterargument fully and clearly before moving on.
The second treatment rebuilds the self-worth that rejection erodes. The exercise is to write a list of five characteristics, attributes, or traits you genuinely value in yourself, keeping the list relevant to the domain in which the rejection occurred — if you were turned down romantically, qualities like being caring, loyal, a good listener, considerate, and emotionally available are apt examples. Rank those qualities in order of importance, choose two of the top three, and write a short essay about each: why this quality matters to you, how it influences your daily life, and why it belongs at the core of how you see yourself. The purpose is not to argue with the rejection but to reactivate a fuller sense of who you are beyond it.
The third wound rejection inflicts is damage to our feeling of social connection, and replenishing it requires deliberate effort. Social support mitigates stress of every kind, but the people closest to us often underestimate how much pain a rejection has caused, making their comfort feel thin. What helps most is recognizing that our need to belong has genuine substitutability — new relationships and memberships can psychologically replace those that have ended, especially when they provide a better fit for our personalities and interests. Painful as rejections are, they are always opportunities to evaluate whether the person, group, or employer who turned us away was actually a good fit for who we are. Sometimes spending time with any group we feel strongly connected to replenishes the feeling of belonging even without many words exchanged — shooting hoops with friends, watching a film together. Scientists have found that photographs of loved ones are among the most emotionally nutritious social snacks available after rejection; reading meaningful emails or letters, watching videos of loved ones, and handling mementos of those we feel most connected to all carry similar nourishment.
The fourth treatment addresses the accumulated sensitivity that makes each new rejection feel heavier than the last. The mechanism is desensitization. An actor who auditions rarely finds each rejection painful; those who audition several times a week learn to release each one far more easily, because repeated exposure diminishes the emotional charge any single instance carries. Once we accept that rejection will be a regular feature of whatever we are pursuing, the prospect of any one instance becomes more manageable. As one person discovered after committing to more frequent attempts: “Once I accepted that I’d be getting rejected a lot, it made the idea of any one woman rejecting me seem more manageable for some strange reason.” The essential element is concentrating the effort into a limited time frame, because spreading it across months dilutes the effect and renders desensitization ineffective. The goal is not numbness but proportion — to stop letting the inevitable friction of chemistry, timing, and fit feel like a verdict on who we are.
Chapter 2 — Loneliness
Despite this era of unprecedented global human connection, more people than ever suffer from severe loneliness. What determines loneliness is not the quantity of our relationships but their subjective quality — the extent to which we perceive ourselves to be socially or emotionally isolated. Two people can inhabit identically sized social worlds and one will feel profoundly alone while the other feels held.
Loneliness damages us through two main channels. First, it causes us to become overly critical of ourselves and those around us, judging our existing relationships too harshly, which poisons every interaction we attempt. Second, and more insidiously, loneliness drives us into self-defeating behaviors that reduce the quality and quantity of our social connections even further. The very fibers of our relationship muscles — our social and communication skills, our ability to see another person’s perspective, our capacity for empathy — weaken and function poorly precisely when we need them most. Scientists found that simply asking college students to recall a time in their lives when they felt lonely or socially isolated was sufficient to produce a more negative assessment of their current social support, boost their shyness, increase social anxiety, drop their mood and self-esteem, and impair their optimism. A memory alone was enough to set the spiral in motion.
Many journeys into loneliness begin during transitions. College freshmen often feel acutely lonely surrounded by unfamiliar faces, far from home, removed from the comfort of friendships they spent years building. Divorce, separation, and bereavement — especially when they arrive unexpectedly — leave people entirely unprepared for the palpable loneliness that follows such losses. When work and colleagues provide our primary social engagement, losing a job can mean losing the entire support system at the moment we most need it. Sometimes the grip extends far beyond any normal adjustment period. We become trapped, paralyzed by waves of emotional pain, defeated by feelings of worthlessness and hopelessness, overwhelmed by a devastating emptiness. This happens because loneliness drives us into cycles of self-protection and avoidance that create self-fulfilling prophecies, inadvertently pushing away the very people we hope to engage. When early attempts to re-enter social life falter, we rarely attribute the stumbles to rusty skills and weakened relationship muscles. Instead we take the rejection personally and assume it merely reflects our fundamental undesirability.
Recovery from loneliness moves through three stages: identifying and changing the misperceptions that lead to self-defeating behavior; strengthening our relationship muscles so that new connections become more possible; and minimizing the ongoing emotional distress loneliness causes, especially when the options for improvement are limited. The first treatment is to remove our negatively tinted glasses. Although pessimistic scenarios will elbow their way into our thinking, the best counter is to purposefully visualize scenarios of success that are both reasonable and realistic. It is just as plausible that people at a party will be friendly, welcoming, and happy to meet us as that they will be cold. Even if we do not meet new people, we might have a pleasant time catching up with one or two people we already know and make plans to see them again. By picturing successful outcomes we become more likely to recognize those opportunities when they arise and to take advantage of them. There are always concrete steps available to improve our situation — browsing websites like Meetup, which lists gatherings for people with mutual interests, hobbies, passions, or careers, to identify at least three activities or topics worth pursuing, whether book clubs, adult education classes, or hiking groups.
The second treatment is identifying the self-defeating behaviors we do not realize we are performing. Common examples include finding poor excuses to decline invitations, skipping spontaneous get-togethers because we feel emotionally unprepared, neglecting to send birthday messages or congratulations, taking friendly ribbing too personally, and using defensive body language — folding arms over the chest, standing with hands in pockets, exaggerated rummaging through a bag, or faking intense interest in nonexistent text messages. We might respond to conversation with monosyllabic sentences or overcorrect by hogging the conversation entirely. We might neglect to ask others about their lives and opinions, or confess our faults and insecurities to people we have only just met. Once we identify what we might be doing incorrectly, we need to be extremely mindful of avoiding such behaviors going forward.
The third treatment develops the relationship muscle of perspective-taking. Accurately reading another person’s point of view is foundational — it allows us to understand their priorities and motivations, anticipate their behavior, predict their reactions, negotiate and cooperate successfully, communicate effectively, and access our compassion and empathy. We should always ask how the other person’s point of view might differ from our own, give weight to what we know about their priorities and preferences, the history of the relationship, and the context of the current situation. Taking a few minutes to do this can prevent hours of repair work later. The best way to assess another person’s emotional experience is to visualize ourselves in their situation as immersively as possible — noting the surrounding environment, who else is present, the time of day, the person’s mood, any physical discomfort they might be carrying. Context is everything. And insight into another person’s feelings only matters if we can convey our understanding convincingly and compassionately. Knowing how someone feels but communicating it poorly is like buying them flowers and leaving them on the kitchen counter.
Creating new opportunities for social connection works best when we arrive with an additional purpose — documenting a creative project, training for a physical challenge, volunteering in a community cause. By having a larger goal, we come across not as someone who is lonely but as someone passionate about what they do, and the larger goal reduces self-consciousness because our attention is on the task rather than on ourselves. Online dating is now the second most common way couples meet, surpassed only by being introduced through mutual friends, having overtaken bars, clubs, and every other traditional venue. Volunteering is another powerful option: helping others reduces feelings of loneliness, increases feelings of self-worth, and makes us feel more socially desirable. By setting out to give rather than get, we can focus on the person in need instead of on ourselves, which in turn makes us feel less self-conscious, less insecure, and less vulnerable. For those with limited mobility, geographic isolation, or other barriers, adopting a pet — a dog in particular — is remarkably effective at soothing loneliness and, as a practical bonus, dogs are exceptional people magnets.
Chapter 3 — Loss and Trauma
Much like broken bones that need to be set correctly, how we go about putting the pieces of our lives back together after loss or trauma makes a huge difference in how fully we recover. Treating the psychological wounds that loss and trauma inflict can not only accelerate recovery but in some cases make it possible to emerge from such experiences with meaningful changes in our priorities, a deeper appreciation of existing relationships, an enhanced sense of purpose, and greater life satisfaction — a phenomenon researchers call post-traumatic growth. We have to reset our broken psychological bones, reassemble the pieces of our lives back into a well-integrated and fully functional whole.
Loss and trauma create four psychological wounds. They cause overwhelming emotional pain. They undermine our basic sense of identity and the roles we play in life. They destabilize our belief systems and our understanding of the world. And they challenge our ability to remain present and engaged in our most important relationships. The emotional distress in the first days following a loss or trauma can be utterly paralyzing — we may lose the ability to think straight or to perform even the most basic functions of self-care such as eating or bathing. Engulfed in pain, we experience every detail of life anew through a wrenching series of firsts: the first meal without the person we lost, the first night alone after violent crime, the first look in the mirror after events that altered the course of our lives.
We may have defined ourselves by our careers and lost our jobs, by our couplehood and lost our partners, by our athletic ability and lost our health, or by our parenthood and watched our last child leave home. In each of these situations we need to take time to rediscover who we are, to search within for things we find meaningful, and to find new ways of expressing aspects of ourselves that lay dormant. When we fail to do so we are left with a terrible void that only amplifies the extent of our loss, fragments our basic sense of self, and sets us adrift in stormy seas of self-doubt and self-loathing. One of our most compelling human drives is the need to make sense of our experiences. We each have our own framework of assumptions and beliefs about how the world works, and we filter most of our experiences through that lens. Loss and trauma can challenge those basic assumptions and cause significant additional distress. Our struggle to make sense of what happened often compounds the initial shock and sends us on a desperate quest to integrate new realities into a belief framework that no longer provides the security it once did. Crises of faith are common — floods of questions and doubts, a desperate search for answers. Yet the sooner we reconstruct our worldviews in ways that integrate the experience of the loss or trauma, the quicker the intensity and frequency of our ruminations will diminish, the better our psychological adjustment will be, and the less likely we will be to develop symptoms of post-traumatic stress disorder.
In time, most people begin to let go and move on, reengaging with people and activities from before or finding new ones in which to invest their energies. But some become stuck, maintaining vivid representations of the person they lost, clinging to the memory, and investing emotional resources in the dead instead of the living. Three treatments address the distinct wounds loss and trauma inflict.
The first is to soothe emotional pain in whatever way fits our nature. Although many people believe it is essential to talk about traumatic events in order to avoid psychological complications, a wave of recent research has demonstrated that many cherished notions about coping — including the five stages of grief (denial, anger, bargaining, depression, and acceptance) and the common wisdom about the importance of expressing feelings while avoiding bottling them up — are largely incorrect. We now understand much more about how traumatic memories form in the brain. The mere act of recalling an event changes our actual memory of it. When we revisit traumatic experiences while still flooded with intense emotion, we inadvertently cement the link between the memory and our intense emotional reactions to it, making it even more likely that the memory will continue to evoke intense emotions going forward — and increasing the risk of vivid flashbacks. That said, we should not repress such memories or refuse to discuss them. Most experts now believe there is no right way to cope with the aftermath of loss and trauma. The best any of us can do is deal with such experiences exactly as our proclivities, personality, and worldview dictate — if we feel the need to talk, we should; if we don’t, we should not push ourselves.
The second treatment, recovering lost aspects of the self, should be administered only once we have returned to normal functioning at home, at work, or in school. The exercise begins with listing qualities, characteristics, and abilities that we valued in ourselves or that others valued about us before the events occurred — aiming for at least ten items. From that list, we identify which feel most disconnected from our lives today, write a brief paragraph for each explaining why the disconnection occurred, and then write a paragraph describing the people, activities, or outlets that could allow us to express each quality more fully. We rank those options by what seems both doable and emotionally manageable and begin working through them, acknowledging that each step will likely cause some discomfort at first. By doing so we reconnect to meaningful aspects of ourselves and begin to move forward.
The third treatment is finding meaning in tragedy — and since Viktor Frankl wrote Man’s Search for Meaning, it has been widely accepted that this is essential to effective coping. Thousands of studies have confirmed it across every kind of loss and trauma studied, from those with spinal cord injuries to bereaved parents of young children, from victims of violence and abuse to frontline veterans of wars. The process includes two distinct phases. Sense making refers to our ability to fit the events into our existing framework of assumptions and beliefs so they become more comprehensible; we are usually able to begin making sense of tragic events within six months, though completing the process can take months or years. Benefit finding refers to our ability to wrest whatever silver linings we can from our experiences — greater appreciation of life, recognition of our own strength and resilience, realigned priorities, new purpose, new paths that have opened before us. Benefit finding occurs only in later stages of recovery; it is not something most of us can or should attempt while still in the grips of severe emotional pain. One of the most common ways people derive meaning is by taking action directly related to what they survived — though not every loss affords that option. Written reflection accelerates the process: how would life be different if the events had not happened? In what ways could the outcome have been even worse? What factors prevented those worse outcomes? Imagining ourselves ten years in the future, having achieved something meaningful, and working backward through the sentences — I never imagined such tragic events would lead me to this; my purpose, I came to realize, is — maps a route from devastation to significance. While identifying pathways for benefit matters, it is the real-world application of those benefits that does recovery the most good.
Chapter 4 — Guilt
While guilt can be heroic in small doses, in larger ones it becomes a psychological villain, poisoning both our peace of mind and our most cherished relationships. Unhealthy relational guilt manifests primarily in three forms. Unresolved guilt is the most common and often the most damaging; one of the main reasons it remains unresolved is that we are far less skilled at rendering effective apologies than we tend to realize. Survivor guilt is especially hard to purge because there are no actions for which we must atone, no relationship ruptures to mend, no outstanding apologies to render — the guilt serves no relational purpose and its warning signals constitute nothing more than a deafening false alarm. Separation guilt involves feeling guilty about moving forward and pursuing our own life when doing so means leaving others behind. And disloyalty guilt arises when we feel such binding ties of loyalty to family members or friends that pursuing our own goals or making choices that deviate from their norms and expectations makes us feel like a traitor.
The reason it is urgent to treat unresolved or excessive guilt is that such feelings often intensify and devolve into remorse and shame. Once that happens, we begin to condemn not just our actions but our entire selves, leading to self-loathing, low self-esteem, and depression. Things that used to bring pleasure, joy, or excitement lose their appeal — not because we no longer enjoy them, but because we no longer permit ourselves to do so. The ongoing toxicity of unresolved guilt can damage our relationships even more substantially than our original offense did. When we induce guilt in others to influence their behavior, we rarely consider that guilt trips have a boomerang effect: along with the guilt they produce, they also reliably produce resentment. In one survey, thirty-three percent of people felt resentful toward those who made them feel guilty, while only two percent of guilt inducers mentioned resentment as a potential consequence of their efforts.
The first treatment is learning to render an effective apology. Most of us conceive of apologies as including three basic ingredients: a statement of regret for what happened, a clear “I’m sorry,” and a request for forgiveness — all delivered with sincerity. Researchers have identified three additional components that play a vital role: validating the other person’s feelings, offering atonement, and acknowledging that we violated expectations. We generally find it hard to forgive people who hurt or disappointed us unless we believe they truly get how they made us feel. When an apology demonstrates a clear understanding of the emotional pain caused and takes full responsibility for it, the wronged person feels substantial relief and has a much easier time releasing resentment. To validate effectively, we put ourselves in the other person’s shoes and try to understand the specific consequences of our actions, how they were affected, and the feelings those actions produced. Conveying that we get it does not mean we intended for them to feel that way — it merely acknowledges that they felt wronged, regardless of our intentions. Emotional validation follows five steps: let the other person complete their full account of what happened; convey your understanding of what occurred from their perspective, whether or not you agree with it; convey your understanding of how they felt as a result; acknowledge that their feelings are reasonable given their perspective; and convey empathy and remorse for their emotional state. The more accurately we convey understanding of the wronged person’s feelings, the more relationship poison we remove. Making offers to compensate or atone, even if the other person declines them, communicates a deeper level of regret and a strong motivation to restore fairness. And clearly acknowledging that our actions violated certain expectations or social norms — while offering specific, concrete steps to prevent a recurrence — addresses the wronged person’s underlying uncertainty about whether we have changed.
The second treatment, self-forgiveness, applies when circumstances prevent a direct apology or when the relationship cannot be repaired. Self-forgiveness is a process, not a decision — though it begins with one. We first have to recognize that we have beaten ourselves up enough and that our excessive guilt serves no productive purpose, and then make the emotional effort required to work through it. The process demands taking full responsibility for our actions and giving ourselves an honest, accurate accounting of the events. We describe the actions or inactions that caused harm, strip out any qualifiers or excuses, and summarize the harm the other person sustained — tangibly and emotionally — as accurately and realistically as possible. Then we consider extenuating circumstances: did we intend for events to unfold as they did, and if not, what were our original intentions? The goal is not to excuse our actions but to understand the context so that self-forgiveness can ultimately be authentic. Once we have minimized the likelihood of repeating the transgression, we purge remaining guilt by identifying significant tasks, contributions, or commitments that would make self-forgiveness feel well earned — and by creating a short ritual to mark the completion of that atonement, signaling to ourselves that penance is complete.
The third treatment addresses survivor guilt, separation guilt, and disloyalty guilt — situations where there is nothing for which we actually need to forgive ourselves. The best way to move past such guilt is to gather the rationales that make reengaging in life both possible and necessary. Those who have lost loved ones often realize, as Morris did at seventy-two after losing his wife of fifty-one years to a heart attack, that it was unfair to mourn for so long because she would have wanted him to enjoy the life he had left. Sylvia, a breast cancer survivor who lost her best friend to the same disease, concluded that not living her life to the fullest would make her another victim of the cancer. Joey, a father of three who lost his wife in a car accident while she was running an errand he was supposed to do himself, spent many months feeling dead inside before recognizing that if he did not recover, his children would feel they had lost both parents. Jeremiah, the only member of his high school football team to receive a full scholarship to a top university, felt guilty about it for months until his pastor helped him see that it would be ungrateful to deny the gifts and chances he had been given — the best way to show gratitude was to take full advantage of them. Shandra, the sole member of her department to survive a brutal round of layoffs, decided she would excel and advance to a position of authority where she could make sure good employees were not fired.
Separation guilt yields to a different set of recognitions. Billy, father of a severely disabled child, realized that when he made time for satisfaction and even joy, he had far more to give as a caregiver. Wanda, who looks after an elderly parent, keeps the airplane safety demonstration in mind — in an emergency, put on your own oxygen mask first, because you cannot care for others if you don’t care for yourself. Marsha’s severely depressed husband would break down whenever she went out with friends, keeping her home for months; she eventually realized that by going out and enjoying life she was not projecting callousness but modeling optimism. Cam and Bev felt guilty about leaving their twin toddlers with a babysitter until they recognized that the more they coddled their children, the less resilient and independent those children would become. For disloyalty guilt, Levi — an orthodox Jew who fell in love with and married a non-Jewish woman, leaving his entire family feeling betrayed — came to see that if he let his father dictate how he lived, his father would be leading two lives while he led none, and that was not fair. Juan, whose Catholic father refused to accept his homosexuality, recalled how he had supported his father when the man was fired from his job even though Juan was just a child; that memory helped him realize he deserved the same support in return, and instead of apologizing, he began asking for respect. Lucas, who enrolled his daughter in a private school after coming from a long line of home-schooled children, accepted that he was not willing to sacrifice doing what he knew was right for his child because it might hurt someone’s feelings.
Chapter 5 — Rumination
When we encounter painful experiences we typically reflect on them, hoping to reach the kinds of insights and epiphanies that reduce our distress and allow us to move on. Yet for many of us who engage in this process, things go awry. Instead of attaining emotional release, we get caught in a vicious cycle of replaying the same distressing scenes, memories, and feelings over and over again, feeling worse every time we do. We become like hamsters trapped in a wheel of emotional pain, running endlessly but going nowhere. What makes rumination a psychological injury is that it provides no new understandings that could heal our wounds — it serves only to pick at our scabs and infect them anew. Rumination increases the likelihood of becoming depressed and prolongs depressive episodes when we have them; it is associated with greater risk of alcohol abuse and eating disorders; it fosters negative thinking and impaired problem solving; and it raises our psychological and physiological stress responses, putting us at greater risk for cardiovascular disease. Even revisiting the same feelings with a therapist, when we have strongly ruminative tendencies, only increases the drive to ruminate and makes matters worse.
Rumination scratches at our emotional scabs and causes four primary wounds: it intensifies our sadness and allows it to persist far longer than it might have otherwise; it likewise intensifies and prolongs our anger; it hogs substantial amounts of emotional and intellectual resources, inhibiting motivation, initiative, and our ability to focus and think productively; and our need to discuss the same events or feelings for weeks, months, and sometimes years taxes the patience and compassion of our social support systems and puts our relationships at risk. Rumination causes us to stew in negative feelings until we become so consumed that we see our entire lives, histories, and futures more bleakly. That negative outlook makes problems seem less manageable, produces fewer solutions, and compels us to give up or stop trying. Intense ruminations can make us so focused on our own emotional needs that we become blind to those of the people around us, and relationships suffer as a result.
To break the self-reinforcing cycle, we must interrupt it once it gets triggered, weaken the urge to ruminate by diminishing the intensity of the feelings that fuel it, and monitor our relationships to ease the burden we may be placing on those who support us. The first treatment changes our visual perspective. When scientists began investigating what distinguishes adaptive self-reflection from its maladaptive counterpart, one factor emerged as hugely significant. When researchers asked people to analyze a painful experience from a self-distanced perspective — a third-person view in which they actually saw themselves within the scene from the standpoint of an outside observer — something quite remarkable happened. Instead of merely recounting events and how they felt about them, people tended to reconstruct their understanding of the experience and reinterpret it in ways that promoted new insights and feelings of closure. This result was amplified when they were asked to reflect not on how things happened but on why. Subjects who used a self-distanced perspective experienced significantly less emotional pain than those using self-immersive perspectives; their blood pressure was also less reactive, rising less and returning to baseline more quickly, indicating that the approach lowers stress responses and causes less cardiovascular activation. These findings held for both depressive and anger ruminations. The practice is to close our eyes, recall the opening snapshot of the scene, zoom out until we see ourselves within it, and then zoom out further still — watching the scene unfold from a distance, as a stranger passing by might observe it. We use this same perspective every time we find ourselves returning to the events in question.
The second treatment is distraction. The main reason we indulge the urge to ruminate even after recognizing how damaging it is, is that we usually catch ourselves only once our emotions are already churning. Trying to simply suppress ruminative thoughts is not only difficult but inadvisable — decades of research on thought suppression demonstrate that nothing compels us to think of something more reliably than trying desperately not to think of it. What works instead is engaging in tasks that are absorbing or demand concentration: moderate to intense cardiovascular activity, socializing, puzzles, computer games. Distraction also restores the quality of our thinking and our problem-solving abilities, because once we cease ruminating, we recover our intellectual skills rather quickly. Brief, less labor-intensive distractions can also be effective. The practical exercise is to list the places and situations in which we tend to ruminate most often, and for each one, compile as many distractions as possible — both short ones, like a game of Sudoku or mentally walking through the layout of a familiar supermarket, and longer ones, like a cardiovascular workout or watching a film.
The third treatment reframes the anger that ruminations frequently produce. Venting anger by assaulting benign objects only reinforces our aggressive urges. The most effective strategy for regulating anger involves reframing the event so that its meaning shifts to something less infuriating. Four approaches are broadly useful: finding the positive intention behind the other person’s actions; identifying any opportunities the situation might be creating; embracing the learning the moment contains; and viewing the person who wronged us not as deserving our anger but as someone in need of help — deserving, if anything, our compassion. The fourth treatment monitors the relationships we rely on for support. We should regularly ask ourselves how much time has passed since the event, how many times we have already discussed it with this person, whether this person feels comfortable bringing up their own issues in return, and what percentage of our communications with them is dominated by the subject of our ruminations. Social support is not a renewable resource in unlimited supply, and protecting it is part of treating the wound.
Chapter 6 — Failure
Trying, failing, and trying again is one of the main ways toddlers learn. Fortunately, toddlers are generally persistent and determined — otherwise we would never learn to walk, talk, or do much of anything. But failure inflicts three specific psychological wounds. It damages our self-esteem by inducing us to draw conclusions about our skills, abilities, and capacities that are highly inaccurate and distorted. It saps our confidence, motivation, and optimism, making us feel helpless and trapped. And it can trigger unconscious stresses and fears that lead us to inadvertently sabotage future efforts. When a failure is especially significant, leaving it untreated puts us at risk for complications such as shame, crippling helplessness, and clinical depression.
Failure not only makes the goal seem to loom larger — it makes us feel smaller. Failing can induce us to feel less intelligent, less attractive, less capable, less skillful, and less competent. If our six-year-old failed a spelling test and announced, “I’m a stupid loser who can’t do anything right,” most of us would swoop in immediately, refute every word, and forbid him to speak about himself that way. We would have no doubt that such thoughts would make him feel worse and make future success harder. Yet we frequently fail to apply the very same logic and wisdom to our own situations. Criticizing our attributes so globally makes us hypersensitive to future failures, can lead to deep feelings of shame, and threatens our entire well-being — and it prevents us from accurately assessing the actual causes of failure. If we blame our shortcomings on character deficits, we will never identify and correct the errors in planning and strategic goal setting that are far more likely responsible.
Every New Year, people list resolutions with hopes of improving their lives, only to abandon them entirely by February — and often by January second. Instead of self-esteem being strengthened by accomplishments, we end up weakened by failure and telling ourselves, “I guess I don’t want to change,” or “I’m just too lazy.” What makes such conclusions inaccurate is that the primary reason so few resolutions survive is the failure to think through how to achieve them. Without a carefully crafted plan, resolutions are unlikely to make it out of the starting gate no matter how motivated or capable we are. Another common error is goal bingeing — taking on multiple goals without prioritizing them by urgency or attainability, failing to break long-term goals into smaller and more realistic subgoals, and neglecting to develop action plans for dealing with the obstacles and setbacks that will arise along the way.
Failure can also be very persuasive, and very misleading. Failing to win the national lottery rarely sends anyone into depression — context determines how much psychological damage any particular failure inflicts. The prospect of failing can be so intimidating that we make unconscious efforts to lower expectations for our success, and the way we go about doing so can result in unwittingly sabotaging ourselves and bringing about the very outcome we fear. Studies show that parents who suffer from fear of failure often transmit such fears to their children; children pick up on their parents’ withdrawal, which triggers their own feelings of shame and teaches them that failures should both be feared and avoided. Choking under pressure tends to happen because the stress of high-stakes situations makes us overthink tasks and draws attention away from the part of our brain that executes them automatically and fluidly.
The most effective treatment is to find the positive lessons in what happened rather than to seek only emotional support. Receiving concern and sympathy when we are still reeling from a failure can actually validate our misperceptions about the deficits in our character and abilities, and studies have repeatedly found that support alone often makes people who experienced a significant failure feel worse. Thomas Edison failed thousands of times before he invented the lightbulb, and he viewed each failure as a learning experience: “I haven’t failed once. I’ve learned ten thousand things that don’t work.” Failure always tells us something about what we need to change in our preparation or execution of the task. Failure also provides new opportunities. Henry Ford’s first two car companies failed; had they succeeded, he might never have attempted a third, which was precisely when he hit upon the idea of assembly line manufacturing and became one of the richest men of his time. The question worth sitting with after a failure is not only what went wrong but also in what ways the failure might make us stronger, and whether the difficulty overcome will make eventual success more meaningful.
The second treatment is regaining a sense of control. In one study, scientists taught sedentary seniors to attribute their inactivity not to age but to factors entirely within their control, such as how much they walked on a daily basis. One month later, this simple intervention led to those seniors increasing their walking by two and a half miles per week — a significant change — while reporting equal improvements in stamina and mental health. The best way to regain control over the circumstances that led to failure is to reexamine both preparation and performance to identify elements that felt outside our control but could be within it if we approached them differently. This means defining goals in realistic and specific terms; setting intermediate milestones that are challenging but not daunting, starting easier and ramping up; assigning concrete time frames to both the overall goal and each subgoal; and listing the potential detours, setbacks, and temptations likely to arise, along with specific plans for addressing each one. Subgoals should focus on variables within our control — what we eat and how much we exercise — rather than outcomes we cannot force, like how much weight we lose per week.
The final treatment addresses the performance pressure that previous failures create when the next high-stakes moment arrives. When stress and anxiety threaten to steal our attention, we need to steal it right back. Studies have demonstrated that whistling can prevent us from overthinking the kinds of automatic tasks we have performed many times before — whistling requires just enough additional attention to leave nothing over for the overthinking that causes choking. Anxiety also tends to cause shallow breathing, limiting oxygen intake and increasing the sense of panic; focusing on breathing for a single minute, inhaling and exhaling to a count of three, is sufficient to stabilize the body and take the edge off. Once breathing is restored, vocalizing the questions or reasoning steps required by the task aloud uses just enough attentional resources to deprive the part of the brain that wants to catastrophize about the outcome. And the best medicine against the irrelevant worries a previous failure can stir up is to affirm our self-worth beforehand — taking a few minutes before the test or performance to write a short essay about an aspect of our character we value highly and feel genuinely confident about. It requires little time, and it can render us noticeably more resilient to the anxieties that past failures tend to trigger.
Chapter 7 — Low Self-Esteem
Studies indicate that most of us are of two minds when it comes to self-esteem: we feel inadequate as individuals on one hand, yet believe we are better than average on the other. How we feel about ourselves in the specific domains we consider personally meaningful has a large impact on our general self-worth. Low self-esteem inflicts three types of psychological wounds: it makes us more vulnerable to the emotional and psychological injuries we sustain in daily life; it makes us less able to absorb positive feedback and other emotional nutrients when they come our way; and it leaves us feeling insecure, ineffective, unconfident, and disempowered.
Measurements of cortisol have demonstrated that people with low self-esteem generally respond to stress more poorly and maintain higher cortisol levels than people with high self-esteem. High cortisol is associated with high blood pressure, poor immune system functioning, suppressed thyroid gland function, reduced muscle and bone density, and poor cognitive performance. Stress can also substantially weaken willpower and self-control, causing us to revert to automatic old habits without realizing it — a stressful day might make a dieter drive all the way home before snapping out of a daze and realizing that instead of a salad he has purchased a large bucket of fried chicken. When our self-esteem is low, we are far less likely to attribute such slips to mental and emotional fatigue, which is the more likely culprit, and far more likely to assume they reflect fundamental character deficits. In one striking study, people with low self-esteem agreed that watching a funny video would improve their mood — and then declined to do so anyway. That is how low self-esteem leads to the rejection of the very nutrients that could help.
Why do positive affirmations leave so many people feeling worse? Persuasion studies have long established that messages falling within the boundaries of our existing beliefs are persuasive, while those that differ too substantially from those beliefs are rejected outright. If we believe we are unattractive, we are far more likely to accept a compliment like “You look very nice today” than “Your beauty is breathtaking.” When people with low self-esteem are exposed to positive affirmations that differ too widely from their existing self-concept, the affirmation is perceived as untrue, rejected in its entirety, and actually strengthens their belief that the opposite is true. Most of us also only put in as much effort as a situation requires; if we can get away with being less considerate or less reciprocal, many of us will — not because we are evil, but simply because we can. When our self-esteem is low and we expect very little of others, we are likely to get very little from them as well.
The first treatment is adopting self-compassion and silencing the critical voices in our heads. Imagine witnessing an emotionally abusive parent berating a child for a poor report card — mocking, belittling, without a shred of empathy — while the child’s face registers utter devastation. Most of us would find that scene extremely distressing and vow never to treat our own children that way. Yet when our self-esteem is low, that is exactly how we treat ourselves. We call ourselves losers and idiots, give ourselves stern lectures, and replay scenes of failure while ruminating on our inadequacies. We treat ourselves even worse than an emotionally abusive parent would. Purging these voices and adopting kinder, more supportive ones is an absolute imperative. The exercise to do this takes three days. Each day we choose a different failure, embarrassment, humiliation, or rejection that made us feel self-critical, detail what happened and how we felt, then imagine the same event happening to a dear friend — describing how that person would experience it and feel. We write that friend a letter with the explicit purpose of making them feel better, expressing kindness, understanding, and concern, and reminding them why they are worthy of compassion and support. Then we return to our own experience and describe it again — this time as objectively and as generously as we can manage, without judgment, without negativity.
The second treatment is identifying our genuine strengths and affirming them — not through positive affirmations, which backfire when they fall outside the boundary of what we already believe about ourselves, but through self-affirmations, which identify and affirm valuable aspects of ourselves we already know to be true, such as trustworthiness, loyalty, or work ethic. Reminding ourselves that we have significant worth regardless of our perceived shortcomings provides an immediate boost to self-esteem and renders us less vulnerable to rejection or failure. The exercise is to make a list of important attributes, qualities, and meaningful achievements — aiming for at least ten items, preferably many more. If negative thoughts arise during brainstorming, those go on a second sheet. We choose one especially meaningful item from the first list and write at least one paragraph about why it is meaningful and what role we hope it will play in our lives. Then we take the second sheet — the negative one — crumple it into a ball, and throw it in the garbage where it belongs. On subsequent days we choose other items from the positive list and write about them, until the list is complete.
The third treatment increases our tolerance for compliments by building what researchers call relationship self-esteem. Studies have found that by affirming aspects of ourselves related to our worth as relationship partners, we can make incoming compliments from our partners less discrepant from our current self-views, which makes us less likely to reject or rebuff them. The exercise is to recall a time a partner, family member, or friend conveyed appreciation for something about us — a personal quality or something we did — describe the incident and what made that person feel positively, and then consider what benefits having that attribute brings to our relationships and what other meaningful functions it might serve in our life. The fourth treatment, increasing personal empowerment, requires that feelings of empowerment be supported by evidence of actual influence in the various spheres of our lives. The process involves identifying situations that make us feel frustrated across community, work, family, social, and consumer life, ranking those situations by their likelihood of success and by the manageability of consequences if we fail, and then using that list as a master plan for practicing assertive action. The fifth treatment improves self-control, which functions not as a stable character trait but as a muscle — subject to fatigue, capable of strengthening with practice. One essential fuel this muscle requires is glucose. In one study, participants whose glucose was depleted through effortful mental exercises were given lemonade: half received it sweetened with real sugar, half with an artificial sweetener that tastes identical but contains no glucose. After fifteen minutes, those who received real sugar had recovered their willpower significantly while those who received the artificial sweetener had not. Exercising willpower in small, insignificant areas also strengthens the muscle for larger and more meaningful ones. Habits always have triggers, and changing a habit requires first avoiding the trigger. And when cravings threaten to overwhelm self-control, mindfulness offers a way through — becoming an anthropologist in our own minds, observing the strength of our emotions and the sensations they create in the body without dwelling on them, visualizing their intensity as a seismographic readout, and focusing on breathing until the quake passes without acting on the urge.
Conclusion — Opening the Cabinet
The treatments in this book represent a psychological medicine cabinet starter kit — a set of emotional balms, ointments, bandages, and painkillers that can be applied to emotional and psychological injuries when we first sustain them. They are drawn from current research by experts in the field, and they address the injuries that most commonly go untreated: rejection’s sting, loneliness’s self-defeating cycles, the shattered identity of loss and trauma, the corrosive spread of guilt, the exhausting hamster wheel of rumination, failure’s distorted verdict on our capacity, and the immune deficiency of chronically low self-esteem. Being a good self-practitioner means developing our own individualized set of mental-health-hygiene guidelines, and whenever possible we should personalize the medicine cabinet these treatments provide. The goal, simply put, is to treat our psychological injuries with the same matter-of-fact care we give our physical ones. Anyone who wishes to lead an emotionally healthier and happier life need only open their psychological medicine cabinet and reach for the treatments within.