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Why Therapy Works: The Science Behind Your Healing Journey

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Your Brain Is Always Changing — That’s the Good News

The foundation of why therapy works lies in a concept called neuroplasticity — your brain’s lifelong ability to form new neural connections and reorganize existing ones in response to experience. For a long time, scientists believed the brain was essentially “fixed” after childhood. We now know this is simply not true.

Every thought you think, every emotion you feel, every pattern of behavior you repeat — all of it shapes the physical structure of your brain. When painful experiences, trauma, or chronic stress have carved deep grooves into your neural pathways, those pathways don’t have to be permanent. Therapy creates the conditions for new pathways to form. Think of it like a forest: the old, worn paths don’t disappear overnight, but every time you take a new route, it becomes more defined, more accessible, more “normal.”

This is the foundation of everything we do together in session.

Trauma Lives in the Body, Not Just the Mind

One of the most important shifts in modern trauma research is the recognition that traumatic experiences are not stored only as memories in the thinking brain — they are held in the body and nervous system. When something overwhelming happens and our system can’t fully process it, the nervous system gets “stuck.” Fight, flight, freeze responses that were once protective can remain activated long after the danger has passed.

This is why purely cognitive approaches — thinking and talking through what happened — are sometimes not enough on their own. Research has shown that trauma treatment works most effectively when it includes the body. In our work together, somatic therapy addresses this directly. By bringing conscious awareness to body sensations, movement, and breath, we help your nervous system complete the responses that got frozen in time. Studies have linked somatic approaches to reductions in amygdala activation (your brain’s alarm center) and improvements in the body’s ability to regulate stress responses.

In practical terms, this might look like noticing tightness in your chest when we discuss something difficult, and gently staying with that sensation rather than pushing it away — allowing your nervous system to process what it’s been holding.

The Brain’s Alarm System — and How We Calm It

Your amygdala is the part of your brain that scans for danger. In people who have experienced trauma, chronic stress, or significant anxiety, the amygdala can become hypersensitive — sounding the alarm even in safe situations. At the same time, the prefrontal cortex (the rational, planning, decision-making part of your brain) can become less active, making it harder to think clearly, regulate emotions, or feel in control.

Research on trauma-focused psychotherapy has found that effective treatment can actually calm amygdala reactivity and increase activity in the prefrontal cortex — measurable, biological changes. The hippocampus, which helps process and contextualize memories, has also been shown to increase in volume following successful trauma treatment, helping people feel less controlled by the past.

In our sessions, this is why we take a measured, paced approach. Flooding the system doesn’t heal it. Working within your “window of tolerance” — enough activation to process, not so much that you’re overwhelmed — is what creates lasting change.

DBT: Skills That Rewire How You Respond

Dialectical Behavior Therapy (DBT) is one of the most extensively researched therapeutic approaches available. Its core skills — mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness — are not just coping strategies. They are neurological exercises.

Every time you practice a DBT skill in a moment of distress, you are creating an opportunity for your brain to respond differently than it has before. With repetition, these new responses become more automatic. The prefrontal cortex gets stronger at stepping in before the amygdala takes over. This is neuroplasticity in action — practiced consistently, skill by skill, session by session.

The mindfulness component of DBT is especially powerful from a neuroscience standpoint. Mindfulness practice has been associated with structural changes in the brain’s regions for attention, body awareness, and emotional regulation. It is not “just” relaxation — it is a form of brain training.

Chronic Pain and the Mind-Body Loop

For those of us working together around chronic pain — a deeply personal area of my clinical practice, shaped by my own experience with spinal cord injuries and rehabilitation — the neuroscience is particularly relevant.

Chronic pain is not “all in your head,” but the brain is absolutely involved. Pain signals are processed, amplified, or dampened by the nervous system, and prolonged pain can create sensitization — where the system becomes more reactive over time, not less. Emotional distress, trauma, and chronic stress can amplify pain perception, while nervous system regulation, somatic awareness, and targeted therapeutic work can begin to shift that sensitization.

This is why treating chronic pain often requires treating the whole person — not just the site of injury. When we work on nervous system regulation, process the emotional weight of living with pain, and build new relationships with body sensations, we are intervening at the neurological level. The mind and body are not separate systems. They are always in conversation.

The Therapeutic Relationship Is Part of the Medicine

No discussion of why therapy works would be complete without acknowledging what research consistently shows: the quality of the therapeutic relationship is one of the strongest predictors of positive outcomes — often more predictive than the specific technique used.

This makes neuroscientific sense. Humans are wired for co-regulation — our nervous systems respond to the presence of a calm, attuned other. When you feel genuinely safe, seen, and understood in a therapeutic relationship, your nervous system shifts into a state that is more open to change. The prefrontal cortex can engage. New learning can happen. Old patterns can be challenged without the brain going into pure survival mode.

This is why building trust in our work together is never “just” about rapport. It is therapeutic in itself.

Change Is Possible — Because Your Brain Is Built for It

The most important thing I want you to take away from this is simple: healing is not a matter of willpower or positive thinking. It is a biological process, and therapy provides the structured, intentional conditions for that process to unfold.

Your brain is not broken. It adapted to what it experienced. And it can adapt again — toward regulation, resilience, and a life that feels more like yours.

If you have questions about your own treatment process, or if you’d like to talk about how our specific work together connects to what’s described here, please bring it into session. Transparency is part of how I practice — and curiosity about your own healing is always welcome.

With warmth,

Justine Framularo, MA, LMHC, HMIP

Heartfelt Healing Institute, LLC

Warwick, RI • heartfelthealing.us • 401-584-2837

Breaking the Pain Loop: How Your Nervous System Gets Stuck in Chronic Pain and How Cognitive Behavioral Therapy Can Help You Heal 

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Understanding Chronic Pain: More Than “Just” Tissue Damage 

Acute pain—the kind you feel when you stub your toe or burn your hand—serves an important protective function. It’s your body’s alarm system, alerting you that something is wrong so you can respond. In a healthy pain cycle, once the injury heals, the alarm turns off and the pain resolves. 

Chronic pain is fundamentally different. While acute pain is a response to active tissue damage, chronic pain can persist long after tissues have healed—or in some cases, without any identifiable structural cause at all. Research published in the Cleveland Clinic Journal of Medicine describes how the central nervous system can undergo structural, functional, and chemical changes that make it more sensitive to stimuli, a process called central sensitization. In this state, the nervous system amplifies pain signals—essentially turning the volume up on pain even when the original cause has resolved. 

According to data reported in the Cleveland Clinic Journal of Medicine, roughly one in five Americans lives with chronic pain that significantly impacts their daily life. Chronic pain is now recognized as a leading cause of disability globally, according to research published in The Lancet Rheumatology. These aren’t just statistics—they represent real people who are suffering, often without understanding why their pain persists. 

The Brain’s Pain Feedback Loops: How the Alarm Gets Stuck 

Here’s what neuroscience is teaching us: chronic pain is not simply a signal traveling from an injury site to the brain. It involves complex feedback loops between multiple brain regions, the spinal cord, and the peripheral nervous system. Over time, these loops can become self-reinforcing—meaning the brain continues to produce pain even in the absence of ongoing tissue damage. 

The Pain-Emotion-Cognition Loop 

Research in neural circuits and pain processing has identified that activity in corticostriatal and corticolimbic circuits plays a central role in whether acute pain transitions to chronic pain. In simpler terms: the brain regions responsible for emotions, memory, and decision-making become deeply intertwined with pain processing. This means that fear, stress, depression, and catastrophic thinking aren’t just consequences of chronic pain—they actively contribute to maintaining it. 

A 2024 study published in Communications Biology describes this as a vicious cycle: chronic pain triggers negative emotional reactions, and those negative emotions further amplify the person’s pain perception, creating a repeating loop of pain–negative emotion–pain. The amygdala—the brain’s emotional processing center—and the prefrontal cortex—responsible for higher-order thinking and regulation—are both key players in this cycle. 

Central Sensitization: When the Nervous System Turns Up the Volume 

Central sensitization occurs when neurons in the central nervous system become hyperexcitable, responding more intensely to stimuli than they normally would. This can lead to allodynia (pain from stimuli that shouldn’t be painful, like light touch) and hyperalgesia (an exaggerated pain response to mildly painful stimuli). Research shows that the central nervous system can essentially “learn” pain through long-term plasticity changes. Persistent stimulation from an initial injury can cause pain-related brain regions to remain in a heightened state of excitability, creating what researchers describe as long-term potentiation of cortical synapses. Think of it like a well-worn path through the woods—the more the pain signal travels that route, the more established and automatic it becomes. 

The Trauma Connection 

There’s another layer to this story that is especially important in my practice: trauma. Research from a study of over 900 chronic pain patients found that 54% reported traumatic life events, and those with higher trauma severity showed greater pain widespreadness, sleep impairment, and emotional distress. Trauma and chronic pain share overlapping neural pathways, and unresolved trauma can keep the nervous system locked in a state of heightened arousal—making it much harder for the pain alarm to turn off. 

How CBT Rewires the Brain’s Pain Response 

Integrating CBT with Nervous System Regulation 

At Heartfelt Healing Institute, I believe that the most effective approach to chronic pain combines the cognitive tools of CBT with somatic, body-based strategies that directly address the nervous system. While CBT works from the top down—changing thoughts to change feelings and physical responses—somatic approaches like biofeedback, breathwork, and nervous system regulation techniques work from the bottom up, helping the body learn to shift out of fight-or-flight and into a state of safety and regulation. 

Research supports this integrated approach. A Frontiers in Molecular Neuroscience review notes that interdisciplinary approaches combining neuromodulation techniques with CBT show promise for disrupting the pain-emotion feedback loops that keep chronic pain entrenched. And neuroimaging research consistently shows that multi-modal treatment—pairing pain education with CBT—produces better long-term outcomes than either approach alone. 

When we pair cognitive tools with body awareness and nervous system regulation, we address chronic pain at every level: the thoughts that fuel it, the emotions that amplify it, and the physiological patterns that sustain it. 

Signs Your Nervous System May Be Stuck in a Pain Loop 

If you’re wondering whether your chronic pain involves nervous system dysregulation or a brain-based feedback loop, here are some signs to look for: your pain persists long after an injury has healed, your pain seems to move around or spread to different areas of the body, light touch or mild stimuli cause significant pain, stress or emotional upset reliably worsens your pain, you experience fatigue, sleep disturbance, or brain fog alongside your pain, medical tests have come back “normal” but the pain is very real, and you notice a strong connection between your emotional state and your pain levels. 

If any of this resonates, know that your pain is not “all in your head”—but your brain and nervous system are deeply involved in maintaining it. And that’s actually good news, because it means we have powerful tools to intervene. 

Taking the First Step Toward Healing

Chronic pain doesn’t have to be a life sentence. Understanding the neuroscience behind your pain—the feedback loops, the central sensitization, the emotional amplification—is the first step toward reclaiming your life. CBT, especially when combined with somatic and nervous system–focused approaches, offers a path forward that addresses the whole person: mind, brain, and body. 

If you’re living with chronic pain and feel stuck, I invite you to reach out. At Heartfelt Healing Institute, we take a compassionate, science-informed approach to healing that 

honors both the physical reality of your pain and the nervous system patterns that may be maintaining it. You deserve more than just managing your pain—you deserve to understand it, and to have real tools to change it. 

Heartfelt Healing Institute 

Justine Framularo | MA, LMHC, HMIP 

Specializing in Psychotherapy, Biofeedback, Somatic Therapy, & Trauma Treatment 

401-584-2837 -215 Toll Gate Road, Suite 309 #13, Warwick, RI 

Disclaimer: This blog post is for educational and informational purposes only and is not a substitute for professional medical or psychological treatment. If you are experiencing chronic pain, please consult with a qualified healthcare provider. 

Works Cited 

Baliki, M. N., & Apkarian, A. V. (2015). Nociception, pain, negative moods, and behavior selection. Neuron, 87(3), 474–491. 

Dydyk, A. M., Chiebuka, E., Stretanski, M. F., & Givler, A. (2025). Central pain syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553027/ 

Jensen, K. B., Kosek, E., Wicksell, R., Kemani, M., Olsson, G., Merle, J. V., Kadetoff, D., & Ingvar, M. (2012). Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain, 153(7), 1495–1503. https://doi.org/10.1016/j.pain.2012.04.010 

Kuner, R., & Kuner, T. (2021). Cellular circuits in the brain and their modulation in acute and chronic pain. Physiological Reviews, 101(2), 619–718. https://doi.org/10.1152/physrev.00040.2019 

Nijs, J., George, S. Z., Clauw, D. J., Fernandez-de-las-Penas, C., Kosek, E., Ickmans, K., Fernandez-Carnero, J., Polli, A., Kapreli, E., Huysmans, E., Cuesta-Vargas, A. I., et al. (2021). Central sensitisation in chronic pain conditions: Latest discoveries and their potential for precision medicine. The Lancet Rheumatology, 3(5), e383–e392. https://doi.org/10.1016/S2665-9913(21)00032-1 

Rathod, S. S., Zhang, J., & Zhuo, M. (2025). Decoding pain chronification: Mechanisms of the acute-to-chronic transition. Frontiers in Molecular Neuroscience, 18, 1596367. https://doi.org/10.3389/fnmol.2025.1596367 

Thorn, B. E. (2020). Putting the brain to work in cognitive-behavioral therapy for chronic pain. Pain, 161(Suppl 1), S66–S74. https://doi.org/10.1097/j.pain.0000000000001839 

Volcheck, M. M., Graham, S. M., Fleming, K. C., Mohabbat, A. B., & Luedtke, C. A. (2023). Central sensitization, chronic pain, and other symptoms: Better understanding, better management. Cleveland Clinic Journal of Medicine, 90(4), 245–254. https://doi.org/10.3949/ccjm.90a.22019 

Wiesenfeld-Hallin, Z., Xu, Q., & Zhuo, M. (2025). Cortical potentiation in chronic neuropathic pain and the future treatment. Pharmaceuticals, 18(3), 363. https://doi.org/10.3390/ph18030363 

Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030 

Zhuo, M. (2025). Chronic pain and comorbid emotional disorders: Neural circuitry and neuroimmunity pathways. International Journal of Molecular Sciences, 26(2), 436. https://doi.org/10.3390/ijms26020436 

Bridging Mind and Body: How Biofeedback and Somatic Regulation Transform Trauma and Chronic Pain Recovery

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Understanding the Trauma-Pain Connection

Trauma and chronic pain share more than coincidental timing in many people’s lives. Both conditions fundamentally alter how our nervous system interprets and responds to the world. When we experience trauma, our autonomic nervous system can become stuck in states of hypervigilance or shutdown. This dysregulation doesn’t just affect our emotions; it rewires our pain perception, muscle tension patterns, and inflammatory responses.

Chronic pain, whether it originates from injury or develops without clear physical cause, involves similar nervous system patterns. The longer pain persists, the more sensitized our nervous system becomes, creating feedback loops where emotional distress amplifies physical pain, and physical pain intensifies emotional suffering. Breaking these cycles requires interventions that speak directly to the nervous system itself.

What Biofeedback Reveals

Biofeedback technology gives us a window into processes we typically cannot observe—heart rate variability, skin temperature, muscle tension, breathing patterns, and brain wave activity. By making the invisible visible, biofeedback empowers clients to recognize their physiological responses and, crucially, to learn they can influence these responses.

In my practice, I’ve watched clients observe their heart rate variability shift in real-time as they practice breathing techniques. They see their muscle tension decrease as they release held patterns. This immediate feedback creates something traditional talk therapy cannot: concrete evidence that change is possible, happening right now, in this moment.

For trauma survivors who’ve felt betrayed by their bodies, this technology offers something profound—proof that their nervous system can learn new responses. The body that once felt like an enemy becomes a partner in healing.

Somatic Regulation: Listening to the Body’s Wisdom

While biofeedback provides the data, somatic regulation practices provide the method. Somatic approaches recognize that trauma isn’t just a story we tell about the past; it’s a present-tense experience living in our tissues, our breathing patterns, our postural habits.

Somatic regulation involves developing awareness of bodily sensations without becoming overwhelmed by them. We learn to track subtle shifts in energy, temperature, tension, and comfort. We practice pendulation—moving attention between resourced states and more challenging sensations, building capacity gradually.

This isn’t about forcing relaxation or positive thinking. It’s about developing what we might call “befriending” our nervous system—learning its language, respecting its protective responses, and gently expanding its range of possible states.

Practical Integration in Treatment

In working with clients experiencing both trauma and chronic pain, I integrate these approaches through several key practices:

Body scanning helps clients develop granular awareness of physical sensations, distinguishing between pain, tension, numbness, and other states. This awareness itself is therapeutic, as many trauma survivors have learned to dissociate from bodily experience.

Breath work serves as both a biofeedback tool and a somatic intervention. By observing breathing patterns and gradually shifting toward diaphragmatic breathing, clients directly influence their vagal tone and nervous system state.

Movement and tracking exercises help clients notice how different postures, movements, or positions affect their internal experience. Small adjustments—a shift in how weight is distributed while sitting, a gentle rotation of the shoulders—can create significant changes in nervous system regulation.

Resourcing practices build the capacity to find safety and ease in the present moment. Before addressing trauma material or pain patterns, we establish anchors—memories, sensations, images, or places that evoke calm and groundedness.

Why This Matters

Traditional medical models often separate mental health treatment from pain management, sending clients to different specialists who rarely communicate. But trauma and chronic pain are deeply intertwined phenomena that demand integrated approaches.

Biofeedback and somatic regulation offer this integration. They honor both the physiological reality of pain and the nervous system dysregulation that trauma creates. They provide concrete tools that clients can use independently, fostering agency rather than dependence.

Perhaps most importantly, these approaches validate what many clients have known intuitively but been told to dismiss: that their physical symptoms are real, meaningful, and responsive to intervention that addresses the whole person.

The Path Forward

Healing from trauma and chronic pain isn’t linear. There are setbacks, plateaus, and unexpected breakthroughs. Biofeedback and somatic regulation don’t promise quick fixes, but they offer something more valuable: a framework for understanding our own nervous system patterns and practical tools for gradual, sustainable change.

As clients develop these skills, something shifts. The body that once felt like a source of betrayal or suffering becomes a guide. Sensations that once triggered panic or despair become information. And slowly, the nervous system learns what it perhaps forgot during trauma—that safety is possible, that regulation is achievable, and that the body possesses remarkable wisdom for its own healing.

This work requires patience, compassion, and a willingness to meet ourselves exactly where we are. But for those struggling with the intertwined challenges of trauma and chronic pain, these approaches offer genuine hope—not the false promise of perfection, but the real possibility of transformation.

Veteran & Military Mental Health Conditions: What You Need to Know

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How Does Military Service Affect Mental Health?

When people serve in the military, they’re separated from family members, friends, and other forms of social support, often for extended periods. Military service also requires people to work in stressful or traumatic environments, facing combat stress and other factors. As a result, service members face many risks, including the risk of physical harm. 

In addition to the challenges faced during service, post-traumatic stress disorder can make it difficult for veterans to transition to civilian life. Relationship struggles, social exclusion, personality disorder, and homelessness are all problems encountered by veterans, and these issues severely impact mental health. 

What percentage of veterans suffer from mental health conditions?

Military service is a sacrifice that puts many people at increased risk for a variety of physical and mental health conditions. One study found that nearly 25% of non-deployed, active-duty military members show symptoms consistent with a serious mental health condition. Within that group, 11% had symptoms of multiple conditions. 

Common Mental Health Conditions in Veterans

Military service can take a toll on health and well-being, which is why military mental health concerns are so prevalent and must be better addressed. 

While several conditions affect veterans, research shows that the following are particularly common. 

PTSD

Post-traumatic stress disorder (PTSD) rates are significantly higher in veterans than in the general populace. While approximately 6.8% of adults are diagnosed with PTSD, reports show that about 12.9% of veterans receive a PTSD diagnosis. In a study from 2014, 87% of veterans reported exposure to at least one traumatic event. If you know a veteran struggling with PTSD, or helping veterans is something you’re passionate about, learn how to help veterans with PTSD. 

Depression & suicide

Approximately 23% of active service members and veterans have depression, making it the most common mental health condition among military members. Tragically, suicide rates are high among veterans with depression (particularly depression in men) and other mental health symptoms. According to the U.S. Department of Veteran Affairs, the suicide rate for veterans is 57% higher than for civilians. 

Addiction

Many veterans struggle with addiction, and more than 1 in 10 have a substance use disorder. 65% of veterans seeking addiction treatment report alcohol as the primary substance they abuse. Some veterans have injuries that leave them with severe pain, increasing their risk of opioid addiction. 

Psychiatric disorders post-traumatic brain injury

From 2000 to 2017, the Department of Defense reported over 375,000 traumatic brain injuries (TBIs) among members of the armed forces. These injuries can lead to many complications, including mental health issues. The National Health Institute reports that up to 1 in 5 people experience mental health symptoms after a TBI. 

The Stigma Around Mental Health in the Military

Although military mental health issues are common, many people never seek treatment. One study found that more than 60% of military members don’t get help for mental health concerns. The stigma surrounding mental health issues can keep service members from getting the care that they need. 

Many active-duty service members fear that mental health treatment could harm their careers. In addition, military members may feel that asking for help is a sign of weakness. Unfortunately, veterans face similar stigmas, and studies indicate that most veterans who struggle with mental health never seek treatment. According to research conducted by the Wounded Warrior Project, 34.8% of veterans struggle accessing mental health care within the VA system, despite approximately 75% of veterans suffering from PTSD. 

Mental Health Resources for Veterans

Although there are many issues surrounding veterans and mental health, resources are available to veterans who are ready to seek treatment. These resources include:

The Veterans Crisis Line

The Veterans Crisis Line is an emergency hotline that provides veterans with 24/7 support. They can call, text, or chat online to connect with a qualified care provider. Responders can connect veterans with local resources and support.

Vet Centers

Vet Centers are counseling centers located across the United States. These centers offer professional counseling and other services designed to help veterans transition to civilian life. Many staff members at Vet Centers are also veterans and can provide guidance and support. 

Solid Start

The VA’s Solid Start program works to support military personnel as they transition to civilian life. Solid Start representatives help veterans manage stress and connect them with resources to help them during this adjustment period. 

The National Center for Post-Traumatic Stress Disorder 

The National Center for Post-Traumatic Stress Disorder is a research and educational center focused on traumatic stress and PTSD. While the center strives to help all people with PTSD, there is a focus on the needs of veterans. The center seeks to help people understand PTSD better and get the help they need. 

The Veteran Affairs Polytrauma System of Care 

The Veterans Affairs Polytrauma System of Care is a network of rehabilitation programs that help veterans suffering from traumatic brain injuries and polytrauma. These programs offer various services, including case management, care plans, rehabilitation treatments, and psychosocial support.

Addressing Mental Health with Therapy for Veterans

The risk of mental health issues and PTSD in veterans is significant. On average, there are 17 veteran suicides each day, which is why it’s critical for veterans to seek treatment. No matter what kind of military mental health concerns you’re struggling with, therapy can help.

Sources:

  1. Veterans & Active Duty. NAMI. https://www.nami.org/Your-Journey/Veterans-Active-Duty  Accessed October 23, 2022. 
  2. Kessler RC, Heeringa SG, Stein MB, et al. Thirty-day prevalence ofDSM-ivmental disorders among nondeployed soldiers in the US army. JAMA Psychiatry. 2014;71(5):504. doi:10.1001/jamapsychiatry.2014.28. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1835338. Accessed October 23, 2022.
  3. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry. 2005;62(6):617. doi:10.1001/archpsyc.62.6.617. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/208671. Accessed October 23, 2022.
  4. Wisco BE, Marx BP, Wolf EJ, Miller MW, Southwick SM, Pietrzak RH. Posttraumatic stress disorder in the US veteran population. The Journal of Clinical Psychiatry. 2014;75(12):1338-1346. doi:10.4088/jcp.14m09328. https://pubmed.ncbi.nlm.nih.gov/25551234/. Accessed October 23, 2022.
  5. Moradi Y, Dowran B, Sepandi M. The global prevalence of depression, suicide ideation, and attempts in the military forces: A systematic review and meta-analysis of Cross Sectional Studies. BMC Psychiatry. 2021;21(1). doi:10.1186/s12888-021-03526-2. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03526-2. Accessed October 23, 2022.
  6. 1. Fales A, Choi J, Borger C, et al. 2016 Wounded Warrior Project ® Survey Report of Findings.; 2016. https://www.woundedwarriorproject.org/media/qibpphny/2016-wwp-annual-warrior-survey.pdf
  7. Veteran Suicide Data and Reporting. Va.gov: Veterans Affairs . https://www.mentalhealth.va.gov/suicide_prevention/data.asp. Published September 14, 2018. Accessed October 23, 2022. 
  8. Miller L. Statistics on veterans and substance abuse. veteranaddiction.org. https://veteranaddiction.org/rehab-guide/veteran-statistics/. Published August 19, 2021. Accessed October 23, 2022. 
  9. Lin L(A, Peltzman T, McCarthy JF, Oliva EM, Trafton JA, Bohnert ASB. Changing trends in opioid overdose deaths and prescription opioid receipt among veterans. American Journal of Preventive Medicine. 2019;57(1):106-110. doi:10.1016/j.amepre.2019.01.016. https://www.ajpmonline.org/article/S0749-3797(19)30076-5/fulltext. Accessed October 23, 2022.
  10.  Mental Health – Effects of TBI. Va.gov: Veterans Affairs. https://www.mentalhealth.va.gov/tbi/index.asp. Accessed October 23, 2022. 
  11. Stein MB, Jain S, Giacino JT, et al. Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury. JAMA Psychiatry. 2019;76(3):249. doi:10.1001/jamapsychiatry.2018.4288. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2722564. Accessed October 23, 2022.
  12. Sharp M-L, Fear NT, Rona RJ, et al. Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews. 2015;37(1):144-162. doi:10.1093/epirev/mxu012. https://academic.oup.com/epirev/article/37/1/144/423274
  13. Kline AC, Panza KE, Nichter B, et al. Mental health care use among U.S. military veterans: Results from the 2019–2020 national health and resilience in veterans study. Psychiatric Services. 2022;73(6):628-635. doi:10.1176/appi.ps.202100112. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100112. Accessed October 23, 2022.
  14. Veterans Crisis Line. https://www.veteranscrisisline.net/. Accessed October 23, 2022. 
  15. Program VC. Va.gov: Veterans Affairs. U.S. Dept of Veteran Affairs. https://www.vetcenter.va.gov/. Published August 15, 2013. Accessed October 23, 2022. 
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  17.  Polytrauma/TBI System of Care. Va.gov: Veterans Affairs. https://www.polytrauma.va.gov/index.asp. Published August 15, 2013. Accessed October 23, 2022. 
  18. Reducing military and veteran suicide. Centers for Disease Control and Prevention. https://www.cdc.gov/washington/testimony/2022/t20220615.htm. Published June 24, 2022. Accessed October 28, 2022.

Dismissive Avoidant Attachment: Signs Triggers & More

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Signs of Dismissive Avoidant Attachment

Humans have an innate desire for social connection, but people with a dismissive avoidant attachment style are uncomfortable in an intimate relationship. While they can be charismatic and friendly in social settings, they keep an emotional distance. They may withdraw from a romantic relationship when someone gets too close. 

Signs of this attachment style include:

  • Self-reliance: People with this attachment pattern are highly independent and prefer not to turn to others for help. They may respond negatively when other people ask for support.
  • Secretive behavior: When someone is dismissive avoidant, they may be reluctant to share information with others. It’s common to hide feelings or plans, even when they have no reason to keep something secret.
  • Conflict avoidance: Most people with this attachment style are conflict-averse. They may shut down or end a close relationship at the first sign of conflict.
  • Suppressing emotions: Dismissive avoidant people tend to conceal their feelings. In addition to hiding feelings or emotions from others, they may struggle to understand their feelings. 
  • Difficulty trusting others: A general distrust of others is common in people living with this attachment style. They may believe that it’s unsafe to rely on other people.

Causes of Dismissive Avoidant Attachment

Most experts subscribe to attachment theory. What is attachment theory? The theory maintains that attachment styles form in infancy and early childhood. From birth, children look to caregivers to meet their emotional needs. Children develop assumptions about relationships based on how caregivers respond to their needs. 

If caregivers fail to meet a child’s needs or respond negatively when the child is in distress, the child will learn they can’t depend on others to meet their needs. Unfortunately, many children who develop a dismissive avoidant attachment style have caregivers that are unresponsive to their needs or discourage them from expressing their emotions. 

To cope with the stress of an unavailable caregiver, children may learn to shut down their feelings rather than seek comfort and emotional closeness from others. This coping mechanism often forces them to become independent at an early age. Research suggests that attachment styles during childhood usually continue into adulthood, although they can be altered with work. 

While researchers widely believe that a child’s relationships with caregivers primarily determine attachment styles, some studies indicate that there may also be a genetic component. For example, twin studies suggest that some people may be predisposed to avoidant attachment styles. More research is needed to determine how genetics contribute to attachment styles. 

What Triggers Dismissive Avoidant Attachment?

Certain events and interactions likely trigger avoidant behavior in people with this attachment style. These triggers can cause discomfort and may result in someone who’s dismissive avoidant withdrawing from relationships. 

Dismissive avoidant attachment triggers include:

  • Criticism: While people with this attachment style often respond positively to constructive criticism in the workplace, it can be hard for them to handle negative feedback from partners. They may see criticism as evidence that others don’t care about their needs. 
  • Emotional volatility: Dismissive avoidants want to feel like they’re in control. Unpredictability and inconsistent communication can cause significant stress. 
  • Boundary crossing: It’s common for a dismissive avoidant individual to set boundaries to protect themselves. When others ignore their boundaries, they may feel unsafe.
  • Vulnerability: Showing vulnerability can make a dismissive avoidant person feel weak. They may fear that showing vulnerability will allow others to control them. 
  • Lack of validation: It can be very difficult for people with this attachment style to open up to others or let them know they need help. They often react negatively if they’re not validated when they put themselves in a vulnerable position.
  • High expectations: It can be challenging for many people with this attachment style to cope with a partner’s expectations. They may feel overwhelmed by demands for time or attention.

How to Overcome Dismissive Avoidant Attachment

While it can be difficult for people with a dismissive avoidant attachment style to form healthy relationships with others, change is possible. Studies show that negative attachment styles can become more secure as we age. 

There are several ways to overcome dismissive avoidant attachment and build stronger bonds with others. 

Reflect on your behavior

Becoming more aware of how your current attachment style impacts your behavior is the first step in changing. Next, it’s essential to learn more about dismissive avoidant attachment and take the time to assess your feelings. Over time, you’ll learn to correct destructive habits and replace them with healthier behaviors. 

Find safe ways to express your feelings

It can be hard for dismissive avoidants to show vulnerability to others. Finding safe outlets for your feelings can make it easier to open up with others. One effective strategy is recording feelings and emotions in a journal. Journaling for mental health is just one of many proven stress management techniques that can help improve your mental health overall. It can also help identify patterns of unhealthy or unhelpful behavior, so you can start to modify your reactions to situations. 

Strengthen your communication skills

Effective communication is key to any healthy relationship. To alter your attachment style, you’ll need to learn to improve how you communicate with others. One way to do this is by becoming aware. If you notice that you’re making assumptions about other people’s feelings, take the time to stop and ask open-ended questions. Set aside time to connect and have constructive conversations with others. There are also communication exercises for couples that you two can learn as well and strengthen communication skills together.

Practice mindfulness

People with this attachment style often struggle to understand their feelings and behaviors. Mindfulness is a practice that can make you more aware of your emotions. Studies demonstrate that mindfulness and meditation for stress help you learn to regulate emotions and tolerate distress without shutting down. 

Get professional help

Reaching out for support can be challenging if you have a dismissive avoidant attachment style. While asking for help may not come easily, it can be one of the most effective ways to begin understanding and changing your attachment patterns.

Working with a qualified therapist can provide valuable guidance as you explore how attachment styles influence your relationships, behaviors, and overall well-being. Through therapy, you can gain insight into your patterns, develop healthier ways of connecting with others, and make meaningful, lasting changes. Over time, this process can help you build deeper, more secure relationships.

Sources:

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Self-Sabotaging in a Relationship: Signs Causes & How to Stop It

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What Is Self-Sabotaging in a Relationship? 

When people self-sabotage, they engage in behaviors that interfere with their well-being or keep them from achieving their long-time goals. In a relationship, self-sabotage can prevent you from having a close connection with your partner. 

Self-sabotage can be conscious or unconscious. From the outside perspective, though, the behavior often appears deliberate.

Reasons for Self-Sabotaging in Relationships

While people might self-sabotage relationships for many reasons, the behavior is often rooted in trauma. During childhood, our relationships with caregivers can have a lasting impact on how we relate to others. People with a history of insecure relationships may automatically assume that future ones are doomed to fail. 

Research backs up the theory that self-sabotage can be a form of self-protection. As discussed, if someone’s afraid of being hurt or abandoned, it might lead to them sabotaging a relationship — subconsciously or purposefully — to try and prevent future harm. 

Fear of abandonment or intimacy is a primary cause of self-sabotage, but research also shows that people might self-sabotage for other reasons, too. For example, trust issues, limited relationship skills, unrealistic expectations, or low self-esteem, among other things, are all common in self-sabotaging relationships. Further, we know that these behaviors often repeat across multiple relationships.

5 Signs of Self-Sabotaging in a Relationship

Since self-sabotage isn’t always conscious, it can be challenging to spot. 

Someone with a history of self-sabotaging relationship patterns may engage in some of the following behaviors.

1. Trust issues

As noted, people prone to self-sabotage often struggle to trust their partners. Experiencing insecurity in relationships due to a lack of trust can lead to accusations and jealous behaviors. In some cases, someone who self-sabotages may search for proof of betrayal, even when there is no indication that their partner has done something wrong. 

2. Gaslighting

Gaslighting in relationships is a form of manipulation and emotional abuse in which someone makes another person doubt their memories, experiences, or feelings. Someone who consistently self-sabotages may deny wrongdoing or dismiss their partner’s feelings when confronted for their behaviors. 

3. Excessive criticism 

Another common form of self-sabotage is looking for excuses to leave a relationship. When some people self-sabotage, they might fixate on the negative emotions and aspects of a relationship while ignoring the positives. They may nitpick their partner’s behaviors, picking fights and searching for fault in everything they do.

4. Avoidance

While some people who self-sabotage look for problems, others may try to avoid conflict entirely. For example, someone who self-sabotages may refuse to talk through issues with their partner. They might insist things are fine. People who cope with avoidance also might deny their feelings or desires in romantic relationships.

5. Infidelity

It’s not uncommon for people who self-sabotage to engage in deliberately hurtful behaviors. They might cheat, for example, to give their partner a reason to leave them. It’s also not uncommon for them to justify their unhealthy behavior by claiming they’re just “hurting their partner before they get hurt.” If you’re experiencing infidelity in your relationship, be sure you learn how to get over infidelity.

How to Stop a Self-Sabotaging Relationship

Self-awareness is key to ending self-sabotaging behavior. If you can recognize destructive patterns of behavior, you can take steps to prevent these behaviors in the future. You can also work to build skills that will help you form healthy, intimate relationships. 

How to end self-sabotaging behavior

Be accountable

To stop self-sabotaging, you must take responsibility for your behavior. First, recognize the role you’ve played in damaging your past relationships. Once you confront these behaviors, you can work to change them. 

Identify triggers

If you have a history of sabotaging a relationship subconsciously, try to figure out what triggers your behavior. Do you tend to lash out after a partner expresses a need for commitment? Are there certain places that put you on edge? Once you figure out what triggers your fears, you can find healthier ways to deal with your feelings.

Share your feelings

Expressing your feelings to your partner can be difficult when you’re afraid of intimacy or abandonment. However, opening up about how you feel can help your partner understand what you’re going through. You can work on issues together when you learn to communicate with your partner about your struggles. 

Seek professional help

Self-sabotage can be deeply damaging, and these behaviors aren’t always easy to overcome. Working with a therapist can help you identify problematic behaviors and heal from past trauma. With professional help, you can develop essential coping skills and work to end the self-sabotaging relationship cycle.

How to help a self-sabotaging partner

Remember that it’s not your fault

Don’t make excuses for your partner’s behavior or blame yourself when they lash out. Self-sabotaging can be deeply hurtful, but it’s important to remember that you’re not at fault for your partner’s actions. Stand up for yourself and ask your partner to take responsibility when they lash out. 

Provide positive reinforcement 

Many people with a history of self-sabotage don’t know what a healthy relationship should look like. When your partner opens up to you about their feelings or takes steps to address their destructive behaviors, offer them support and encouragement. Let them know you appreciate their efforts toward breaking the cycle. 

Encourage them to seek help

While you can give your self-sabotaging partner love and support, you alone can’t fix their issues for them. Remind them how much you care about them and want to see them get the assistance they need. Encourage them to seek help from a professional. 

End Self-Sabotaging Behaviors with Professional Help

It isn’t always easy to stop self-sabotage in a relationship, but if you realize that relationship self-sabotage is something you or your partner are struggling with, get support. It’ll take work, but you can learn how to have a healthy, mutually-rewarding relationship. You and your partner can begin offering one another the love and stability you’re both looking for in a relationship.  

Self-sabotage can be devastating, but it’s something that you can overcome with professional help.

Sources:

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