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  • https://support.rankmath.com/ticket/what-is-corsair-customer-service-number-24-724hr-avialble/
    https://support.rankmath.com/ticket/what-is-corsair-customer-service-number-24-724hr-avialble/
    SUPPORT.RANKMATH.COM
    What is CORSAIR customer service number 24 7?[[@24Hr-Avialble®] - Support - Rank Math
    Corsair's customer service number is +1-855-738-4265(USA), available 24/7 for assistance+1-855-738-4265(USA). For more specific inquiries, you can also visit
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  • https://www.databridgemarketresearch.com/reports/global-pharmaceutical-vials-market
    https://www.databridgemarketresearch.com/reports/global-pharmaceutical-vials-market
    Pharmaceutical Vials Market Players, Size, Technology, Report, Demand, & Forecast Trends By 2029
    The Pharmaceutical Vials Market growth at a CAGR of 7.35 % & expected USD 23934.78 million by 2029. It is divided as material, neck type, cap size, market drug type, capacity, capacity, distribution channel and end-user.
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  • https://www.databridgemarketresearch.com/reports/global-pharmaceutical-vials-market
    https://www.databridgemarketresearch.com/reports/global-pharmaceutical-vials-market
    Pharmaceutical Vials Market Players, Size, Technology, Report, Demand, & Forecast Trends By 2029
    The Pharmaceutical Vials Market growth at a CAGR of 7.35 % & expected USD 23934.78 million by 2029. It is divided as material, neck type, cap size, market drug type, capacity, capacity, distribution channel and end-user.
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  • https://www.maximizemarketresearch.com/market-report/global-cyclic-olefin-copolymers-market/33395/
    The demand for cyclic olefin copolymers for packaging market is propelling owing to increasing use in the manufacturing of packaging solutions like vials, bottles, syringes, packaging films, lenses, medical devices, and among others. The primary driving factor for the growth of cyclic olefin copolymers for the packaging market is the growing demand from the healthcare industry. Additionally, cyclic olefin copolymers for packaging are used in the packaging of pharmaceuticals, electronics, optical, and among other sectors
    https://www.maximizemarketresearch.com/market-report/global-cyclic-olefin-copolymers-market/33395/ The demand for cyclic olefin copolymers for packaging market is propelling owing to increasing use in the manufacturing of packaging solutions like vials, bottles, syringes, packaging films, lenses, medical devices, and among others. The primary driving factor for the growth of cyclic olefin copolymers for the packaging market is the growing demand from the healthcare industry. Additionally, cyclic olefin copolymers for packaging are used in the packaging of pharmaceuticals, electronics, optical, and among other sectors
    WWW.MAXIMIZEMARKETRESEARCH.COM
    Cyclic Olefin Copolymers Market - Global Industry Analysis and Forecast (2024-2030)
    Cyclic Olefin Copolymers Market is expected to reach US$ 1.30 Bn. by 2030, at a CAGR of 5.2% during the forecast period.
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  • https://www.databridgemarketresearch.com/reports/global-pharmaceutical-vials-market
    https://www.databridgemarketresearch.com/reports/global-pharmaceutical-vials-market
    Pharmaceutical Vials Market Players, Size, Technology, Report, Demand, & Forecast Trends By 2029
    The Pharmaceutical Vials Market growth at a CAGR of 7.35 % & expected USD 23934.78 million by 2029. It is divided as material, neck type, cap size, market drug type, capacity, capacity, distribution channel and end-user.
    0 Comments 0 Shares 301 Views 0 Reviews
  • ADHD-
    Giving Voice to Adult ADHD.
    What it's really like to live with adult ADHD.

    KEY POINTS-
    True understanding of ADHD usually comes when it affects someone's life or someone around them.
    For people unfamiliar with ADHD, the stories of people with ADHD and their experiences can shed light on it.
    Several interview studies explored the experiences of adults with ADHD with diagnosis, treatment, and coping.

    Is it difficult to figure whether adult ADHD is a negative or a positive? Do others' doubts about ADHD affect you? Read what other adults with ADHD have to say about it.
    Apart from having something touch one’s life or the life of a loved one, enlightenment and changing human minds and beliefs often happens through hearing and empathizing with the accounts and stories of people facing those difficulties1—in this case, adult ADHD.

    Several qualitative studies using interviews and accounts of the lived experience of adults with ADHD have been published in recent years, including a psychiatrist-in-training’s personal and professional experiences with his own ADHD.2-5 A singel post will not do justice to the nuances of these accounts, but here are some takeaway themes that resonated with me.

    Issues with recognizing ADHD and help-seeking
    Adults with ADHD often struggle for a long time before seeking help, often due to social stigma about ADHD. The process of getting a specialized evaluation for adult ADHD itself is often difficult and laborious, which is another impediment.

    The fact that attention problems are highly context-specific—such as adults with ADHD being able to focus well on interesting topics—creates doubts in their minds and in the minds of others about the relevance of ADHD despite undeniable problems in their lives, not to mention that ADHD involves much more than attention problems.

    Impulsivity problems are frequently cited in accounts of adults with ADHD and hyperactivity is often minimized because it is experienced as an internal sense of restlessness. Such examples of not fitting the stereotype of what ADHD looks like and stigma further delay recognition (especially for women with ADHD).

    Many adults with ADHD eventually seek help at the encouragement of others in their lives.

    The experience of “chaos,” difficulties structuring one’s time, and the corresponding emotional effects (anxiety, agitation, and mood lability) are commonly cited problems. Emotional dysregulation may lead adults with ADHD to first seek help for mood and anxiety issues based on the assumption (now understood to be mistaken) that emotions are not associated with ADHD.

    There are common reports of ambivalence about an ADHD diagnosis. For some adults, the reaction is positive, including relief and clarity. For others, there are negative and sometimes resistant reactions to a diagnosis, such as regret for lost opportunities. Most late-identified adults with ADHD go through a re-examination process of their sense of self-identity. Ultimately, though, the eventual ADHD diagnosis is generally not regretted and, in fact, is seen as validation of their circumstances.

    The psychiatrist-in-training expressed the realization that “high functioning does not exclude dysfunction.”

    Coping experiences
    A consensus was that ADHD makes “everything a little harder.”

    Everyone in these qualitative studies cited the use of some form of time management and organizational strategies to manage adult ADHD.

    Another common theme was setting up ADHD-friendly environments and systems to support coping and well-being.

    Increased self-awareness and accurate understanding of ADHD helped reduce self-blame as well as to identify personal strengths and aptitudes. For some, this included a sense of courage and resilience that grew from navigating difficulties, setbacks, and even failures.6

    On the other hand, many adults found their difficulties with adjusting to new situations and roles to be stressful—such as a new job, moving, or parenthood.

    Treatments and support
    Medications, psychosocial treatment, various accommodations, and support groups adapted to adult ADHD were reported as helpful options with positive effects on functioning.

    The psychiatrist-in-training with ADHD avoided ADHD medications for a while due to their negative reputation in his field, though he later found them to be very helpful. He still noted that despite their obvious benefits for his ability to focus, he had side effects in which he felt they inhibited his “real me” personality, at times.

    Psychological effects of adult ADHD
    Many individuals reported a sense of low self-esteem or a “less than” self-view, at some point.

    Individuals had diverse ways to view and describe their ADHD:

    ADHD as a difference or trait versus disorder.
    ADHD as a limiting label versus self-identifying with ADHD.
    ADHD as an interface of both negative and positive aspects.
    Ultimately, most individuals in the qualitative studies reported learning to approach various tasks and roles differently to account for the effects of ADHD and with a greater sense of optimism.

    The effects of others’ opinions
    There were accounts of citing ADHD symptoms and related difficulties to others (including helping professionals) and having them be trivialized, dismissed (“You’re in college. You can’t have ADHD"), or attributed to negative characteristics, such as “laziness.”

    Such negative messaging was described as contributing to masking problems, avoidance of help-seeking, being overly apologetic to avoid criticism, and a sense in at least one case of viewing others as “putting up with me.”

    The psychiatrist-in-training noted that, once diagnosed and treated, he could be more empathic with patients and their experiences of medication side effects, not just patients with ADHD. He also cited the stigma about ADHD in behavioral healthcare, including individuals (including other doctors) who choose to pay out of pocket for behavioral health services covered by their insurance to avoid their psychiatric diagnosis coming to light in some manner.

    Summary
    The number of individuals providing accounts in these published studies is not large. However, they are enough to start giving voice to adult ADHD. Their voices will hopefully echo through classic data-driven studies to help others hear and see adults with ADHD and help them obtain effective help and support.
    ADHD- Giving Voice to Adult ADHD. What it's really like to live with adult ADHD. KEY POINTS- True understanding of ADHD usually comes when it affects someone's life or someone around them. For people unfamiliar with ADHD, the stories of people with ADHD and their experiences can shed light on it. Several interview studies explored the experiences of adults with ADHD with diagnosis, treatment, and coping. Is it difficult to figure whether adult ADHD is a negative or a positive? Do others' doubts about ADHD affect you? Read what other adults with ADHD have to say about it. Apart from having something touch one’s life or the life of a loved one, enlightenment and changing human minds and beliefs often happens through hearing and empathizing with the accounts and stories of people facing those difficulties1—in this case, adult ADHD. Several qualitative studies using interviews and accounts of the lived experience of adults with ADHD have been published in recent years, including a psychiatrist-in-training’s personal and professional experiences with his own ADHD.2-5 A singel post will not do justice to the nuances of these accounts, but here are some takeaway themes that resonated with me. Issues with recognizing ADHD and help-seeking Adults with ADHD often struggle for a long time before seeking help, often due to social stigma about ADHD. The process of getting a specialized evaluation for adult ADHD itself is often difficult and laborious, which is another impediment. The fact that attention problems are highly context-specific—such as adults with ADHD being able to focus well on interesting topics—creates doubts in their minds and in the minds of others about the relevance of ADHD despite undeniable problems in their lives, not to mention that ADHD involves much more than attention problems. Impulsivity problems are frequently cited in accounts of adults with ADHD and hyperactivity is often minimized because it is experienced as an internal sense of restlessness. Such examples of not fitting the stereotype of what ADHD looks like and stigma further delay recognition (especially for women with ADHD). Many adults with ADHD eventually seek help at the encouragement of others in their lives. The experience of “chaos,” difficulties structuring one’s time, and the corresponding emotional effects (anxiety, agitation, and mood lability) are commonly cited problems. Emotional dysregulation may lead adults with ADHD to first seek help for mood and anxiety issues based on the assumption (now understood to be mistaken) that emotions are not associated with ADHD. There are common reports of ambivalence about an ADHD diagnosis. For some adults, the reaction is positive, including relief and clarity. For others, there are negative and sometimes resistant reactions to a diagnosis, such as regret for lost opportunities. Most late-identified adults with ADHD go through a re-examination process of their sense of self-identity. Ultimately, though, the eventual ADHD diagnosis is generally not regretted and, in fact, is seen as validation of their circumstances. The psychiatrist-in-training expressed the realization that “high functioning does not exclude dysfunction.” Coping experiences A consensus was that ADHD makes “everything a little harder.” Everyone in these qualitative studies cited the use of some form of time management and organizational strategies to manage adult ADHD. Another common theme was setting up ADHD-friendly environments and systems to support coping and well-being. Increased self-awareness and accurate understanding of ADHD helped reduce self-blame as well as to identify personal strengths and aptitudes. For some, this included a sense of courage and resilience that grew from navigating difficulties, setbacks, and even failures.6 On the other hand, many adults found their difficulties with adjusting to new situations and roles to be stressful—such as a new job, moving, or parenthood. Treatments and support Medications, psychosocial treatment, various accommodations, and support groups adapted to adult ADHD were reported as helpful options with positive effects on functioning. The psychiatrist-in-training with ADHD avoided ADHD medications for a while due to their negative reputation in his field, though he later found them to be very helpful. He still noted that despite their obvious benefits for his ability to focus, he had side effects in which he felt they inhibited his “real me” personality, at times. Psychological effects of adult ADHD Many individuals reported a sense of low self-esteem or a “less than” self-view, at some point. Individuals had diverse ways to view and describe their ADHD: ADHD as a difference or trait versus disorder. ADHD as a limiting label versus self-identifying with ADHD. ADHD as an interface of both negative and positive aspects. Ultimately, most individuals in the qualitative studies reported learning to approach various tasks and roles differently to account for the effects of ADHD and with a greater sense of optimism. The effects of others’ opinions There were accounts of citing ADHD symptoms and related difficulties to others (including helping professionals) and having them be trivialized, dismissed (“You’re in college. You can’t have ADHD"), or attributed to negative characteristics, such as “laziness.” Such negative messaging was described as contributing to masking problems, avoidance of help-seeking, being overly apologetic to avoid criticism, and a sense in at least one case of viewing others as “putting up with me.” The psychiatrist-in-training noted that, once diagnosed and treated, he could be more empathic with patients and their experiences of medication side effects, not just patients with ADHD. He also cited the stigma about ADHD in behavioral healthcare, including individuals (including other doctors) who choose to pay out of pocket for behavioral health services covered by their insurance to avoid their psychiatric diagnosis coming to light in some manner. Summary The number of individuals providing accounts in these published studies is not large. However, they are enough to start giving voice to adult ADHD. Their voices will hopefully echo through classic data-driven studies to help others hear and see adults with ADHD and help them obtain effective help and support.
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  • Myths, Mischief, and Misconceptions.
    Informal misuse of psychiatric diagnoses stigmatizes those who suffer.
    Reviewed by Tyler Woods

    KEY POINTS-
    Informal mischaracterization of psychiatric diagnoses increases stigma.
    Just as we should confront racist and misogynist remarks, we should challenge misuse of psychiatric diagnoses.
    Let us begin to stand up to those who use psychiatric terms that devalue others.

    Medical terminology frequently drains into the non-professional population, which often adopts medical diagnoses inappropriately. Phrases like, “You’re giving me a heart attack,” or, “Don’t get psychotic about it” are usually said flippantly, without harmful intent, but can be offensive. Recognition that open acknowledgment of an illness might produce discomfort causes many people to whisper phrases like, “He has cancer.”

    In particular, the invocation of psychiatric diagnoses by the lay public frequently reinforces misinformation that leads to increases in stigmatizing psychiatric patients. The term, schizophrenia, was first used by Swiss psychiatrist Eugen Bleuler over 100 years ago to describe a specific form of psychosis. Bleuler employed the word—schizo, meaning “split”; and phrenia, meaning “mind”—to describe patients’ confusion and fragmented thinking. However, the literal meaning has caused many in the general population to erroneously assume that the illness describes split (or, multiple) personality. In many cases “diagnosis epithets” are used as hurtful accusations. There are common examples:

    “He acts strange; is he an Aspy, on the spectrum” implies that nonconforming behavior suggests a diagnosis of autism and devalues individuals with the disorder.

    “My first wife was borderline” is code for describing the spouse as difficult to live with and subtly blames her for the failure of the marriage.

    “I wish you wouldn’t get all excited and manic about this” suggests the person who may be moderately hyperactive has bipolar disorder, a very serious illness.

    “Don’t be anorexic; have dessert with me” invokes the label of a serious illness to challenge the dining behavior of the companion.

    “You are so OCD” accuses an individual who may be especially careful or perfectionistic of possessing pathological traits.

    “When he gets angry, he goes all schizo” reflects the speaker’s attitude that this expressed anger is unreasonable, suggestive of psychosis, such as schizophrenia.

    “She is so ADHD” might be a description of someone who appears disorganized, distracted, or forgetful.

    “The horror movie upset him so much, it gave him nightmares and PTSD” conflates a serious and well-defined psychiatric diagnosis that usually persists for long periods with an acute, minor upset.

    "Don't be antisocial, come to the party" misidentifies a person who resists socialization as a sociopath.

    Examples like these usually are not meant to bestow formal psychiatric diagnoses. Most are not intended to be taken literally or even seriously. But referencing psychiatric terminology by nonprofessionals promotes misinformation and, when used in negative ways, expands stigmatization of individuals who suffer from mental illness.

    These mischaracterizations trivialize the suffering endured by those disabled by the disorder. Just as many people will assertively confront others who use racist or misogynistic phrases, now, in May, which is formally designated as “Mental Health Month,” let us begin to stand up to those who use psychiatric terms that devalue others.
    Myths, Mischief, and Misconceptions. Informal misuse of psychiatric diagnoses stigmatizes those who suffer. Reviewed by Tyler Woods KEY POINTS- Informal mischaracterization of psychiatric diagnoses increases stigma. Just as we should confront racist and misogynist remarks, we should challenge misuse of psychiatric diagnoses. Let us begin to stand up to those who use psychiatric terms that devalue others. Medical terminology frequently drains into the non-professional population, which often adopts medical diagnoses inappropriately. Phrases like, “You’re giving me a heart attack,” or, “Don’t get psychotic about it” are usually said flippantly, without harmful intent, but can be offensive. Recognition that open acknowledgment of an illness might produce discomfort causes many people to whisper phrases like, “He has cancer.” In particular, the invocation of psychiatric diagnoses by the lay public frequently reinforces misinformation that leads to increases in stigmatizing psychiatric patients. The term, schizophrenia, was first used by Swiss psychiatrist Eugen Bleuler over 100 years ago to describe a specific form of psychosis. Bleuler employed the word—schizo, meaning “split”; and phrenia, meaning “mind”—to describe patients’ confusion and fragmented thinking. However, the literal meaning has caused many in the general population to erroneously assume that the illness describes split (or, multiple) personality. In many cases “diagnosis epithets” are used as hurtful accusations. There are common examples: “He acts strange; is he an Aspy, on the spectrum” implies that nonconforming behavior suggests a diagnosis of autism and devalues individuals with the disorder. “My first wife was borderline” is code for describing the spouse as difficult to live with and subtly blames her for the failure of the marriage. “I wish you wouldn’t get all excited and manic about this” suggests the person who may be moderately hyperactive has bipolar disorder, a very serious illness. “Don’t be anorexic; have dessert with me” invokes the label of a serious illness to challenge the dining behavior of the companion. “You are so OCD” accuses an individual who may be especially careful or perfectionistic of possessing pathological traits. “When he gets angry, he goes all schizo” reflects the speaker’s attitude that this expressed anger is unreasonable, suggestive of psychosis, such as schizophrenia. “She is so ADHD” might be a description of someone who appears disorganized, distracted, or forgetful. “The horror movie upset him so much, it gave him nightmares and PTSD” conflates a serious and well-defined psychiatric diagnosis that usually persists for long periods with an acute, minor upset. "Don't be antisocial, come to the party" misidentifies a person who resists socialization as a sociopath. Examples like these usually are not meant to bestow formal psychiatric diagnoses. Most are not intended to be taken literally or even seriously. But referencing psychiatric terminology by nonprofessionals promotes misinformation and, when used in negative ways, expands stigmatization of individuals who suffer from mental illness. These mischaracterizations trivialize the suffering endured by those disabled by the disorder. Just as many people will assertively confront others who use racist or misogynistic phrases, now, in May, which is formally designated as “Mental Health Month,” let us begin to stand up to those who use psychiatric terms that devalue others.
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  • Egg and Sperm Donors: It's Complicated.
    Some common thoughts and feelings surrounding selling one's gametes.
    Reviewed by Kaja Perina

    KEY POINTS-
    Donating/selling one's eggs or sperm is much more than a simple business transaction.
    Most donors are not properly counseled and educated beforehand and their genetic material may be sold for many years or decades into the future.
    Because anonymity is not possible, donors can prepare for connections with offspring.
    Egg donors have unique health risks that are often minimized by clinics.
    As a counselor or as a member of a donor family, it is important to understand some of the themes that commonly arise with people who donated (sold) their gametes. Available research and decades of anecdotal reporting reveal the feelings and experiences of these sperm and egg donors.1,2

    Why do people sell their gametes?
    Becoming a sperm or egg donor is certainly not for everyone. So what exactly draws people to become gamete donors? Not surprisingly, the top reason for donating is for financial gain: egg donors can make $5,000 - $15,000, or more, for a single donation, while sperm donors can make $14,000 - $16,000 or more in the minimum one-year donation contract and many donors donate for many years. The other most common reasons at the top of the list are to help families who want children and to “pass along my genes”.3,4 But, selling one's gametes is far more than a financial transaction, with many far-reaching effects for future decades.

    Donor Concerns
    There may be frustration about a lack of pre-donation education or counseling and feel that they were not prepared for the possibility of contact with any resulting children born as a result of their donation under a false concept of anonymity.

    Curiosity about offspring is very common.5,6 Many donors wonder if their offspring think of them, have concerns about the well-being of children created, and feel frustrated about not being able to know or contact them.4 One study suggested that about three-quarters of donors have feelings about wanting to contact donor children and not being able to; another quarter feels worried about their donor children's well-being.3 Another study showed that ninety-four percent of surveyed sperm donors were open to contact with offspring, with 85% being open to meeting them and 78% open to establishing a relationship with them.4 New research also tells us that a majority of egg donors would like to make contact with offspring and have the means to do so as thousands of donors have made mutual consent contact on the Donor Sibling Registry and via other methods.7

    Many are concerned about anonymity. Many donors donated long before commercial DNA testing existed, and more recent donors were not provided with information about commercial DNA companies that could be used by parents and children to find them. Younger donors may be more neutral as many were given a choice of whether to be anonymous for 18 years or forever. Older ones may be more biased towards wanting to meet offspring.3 The ones who favor anonymity may want to protect the donor child's parents from feeling threatened. They may want to protect their own families or their own lying by omission about being a donor and/or having medical issues.

    Once donors realize that contact is possible and probable, there can be fear:
    about their parental rights and financial responsibilities (there are none for egg clinic/sperm bank donors).
    about disappointing the offspring or not being successful or good enough as some donors were not 100% honest about their academic backgrounds when filling out their donor profiles and now feel ashamed.
    of being found out that they were not truthful on their donor profile.
    about their relatives being contacted via DNA websites.
    or embarrassment associated with their family and friends finding out that they sold their gametes and/or that there are resulting children.
    or worry about being exposed for their serial donating history, as it's very common for donors to sell their gametes to more than one, or many facilities.4
    of rejection, as many donor-conceived people (DCP) with non-bio parents see connecting with the donor as a betrayal of sorts, and therefore do not wish to establish relationships. DCP protecting their non-bio parents can appear as though they are rejecting the donor.
    When a donor attempts to report updated medical information or history that may affect their current or potential offspring, there may be frustration over the dismissive responses and lack of follow-up from their gamete vendor and the lack of guidelines for how to provide this information.6 Donors may feel guilt after finding out about medical issues amongst their donor offspring that they could be responsible for, or shame if the medical issue was something they hid in order to be accepted as a donor.

    There may also be thoughts and concerns about the number of offspring that have been created using their gametes. Most egg donors feel that it is important/very important to know the number of offspring born from their donations.3 More than 40% of surveyed egg donor parents say that they were not asked by their clinic to report the birth of their child, so births are grossly underestimated.2,8 There is no entity keeping track of births and because all reporting is voluntary, accurate records are nowhere in sight. Many sperm donors now understand that they were lied to about the limits of the 10 or 20 offspring or families that they were promised and feel overwhelmed by the implications of how many offspring they have, as some have come to find out that they have more than 100 or even 200 donor children. Most sperm donors didn't realize that one single donation can be broken up into between 4-24 sellable vials, so their 2x or 3x a week donating for years can result in a slew of sellable vials. There may be concerns over how large numbers of offspring might demand too much of their time and/or attention and therefore affect their family negatively, especially if their family stability is not on solid ground. Donors may feel overwhelmed and that they (or their spouses) just don't have the emotional bandwidth to deal with dozens or hundreds of offspring.

    Many donors are excited to learn about and connect with their donor progeny and reports of donors connecting with their donor-grandchildren are becoming more common.6 Many need some time and patience to figure out how to define these new relationships with their genetic children and their families. Expanding family and creating new family systems can be a bit of a challenge as the process unfolds until relationships become better defined and accepted.

    Moneypantry
    Earlier research suggests that about half of the egg donors feel that their relationship with their offspring is only genetic, while the other half view it as a connection beyond biological.3 More recent 2021 research asked egg donors how they viewed any children who may have resulted from their donations. The most common response (36.2%) was “special designation but not acquaintance, friend, or family” and the second most common was “my biological child” (25.7%).7 There may be fear about how the egg retrieval process might affect their future health and fertility. Several studies have raised concerns about Ovarian Hyperstimulation Syndrome (OHSS), secondary infertility, and cancer risks.1,2

    All too often, donors are not properly counseled and educated about the ongoing ramifications for themselves, their families, and any children born: the ones they're raising and the donor-conceived children who will share approximately 50% of their DNA and who may be very curious about their close genetic relatives, ancestry, and medical family history. However, there is now a wealth of information and support for all members of the donor family.

    The interests and well being of the children — all of them — are paramount. I believe that I do have responsibilities to the children born as a result of my donations. At the very least, those children have a right to know what my part of their genetic heritage is. I will be more than happy to get in touch, if and when they do desire. I think about them often and wonder who, where, and how they are, and what is happening in their lives. I think, that if one day some of my unknown offspring do make contact with and meet me, it might be – for them primarily and for me too — a wonderful 'jigsaw' experience! The prospect of it actually happening is a little daunting, in some ways. What if they do not like me, or I them? What if they feel unhappy with my having contributed to their creation, but then taken no responsibility for them — especially if they have had an unhappy life? How will my own family react to and view them? On and on my thinking goes. However, at the base of all of this I am quite clear in my mind, that these wonderful children do have a right to know, what they want to know about me — because in them, there is a part of me." — Former donor
    Egg and Sperm Donors: It's Complicated. Some common thoughts and feelings surrounding selling one's gametes. Reviewed by Kaja Perina KEY POINTS- Donating/selling one's eggs or sperm is much more than a simple business transaction. Most donors are not properly counseled and educated beforehand and their genetic material may be sold for many years or decades into the future. Because anonymity is not possible, donors can prepare for connections with offspring. Egg donors have unique health risks that are often minimized by clinics. As a counselor or as a member of a donor family, it is important to understand some of the themes that commonly arise with people who donated (sold) their gametes. Available research and decades of anecdotal reporting reveal the feelings and experiences of these sperm and egg donors.1,2 Why do people sell their gametes? Becoming a sperm or egg donor is certainly not for everyone. So what exactly draws people to become gamete donors? Not surprisingly, the top reason for donating is for financial gain: egg donors can make $5,000 - $15,000, or more, for a single donation, while sperm donors can make $14,000 - $16,000 or more in the minimum one-year donation contract and many donors donate for many years. The other most common reasons at the top of the list are to help families who want children and to “pass along my genes”.3,4 But, selling one's gametes is far more than a financial transaction, with many far-reaching effects for future decades. Donor Concerns There may be frustration about a lack of pre-donation education or counseling and feel that they were not prepared for the possibility of contact with any resulting children born as a result of their donation under a false concept of anonymity. Curiosity about offspring is very common.5,6 Many donors wonder if their offspring think of them, have concerns about the well-being of children created, and feel frustrated about not being able to know or contact them.4 One study suggested that about three-quarters of donors have feelings about wanting to contact donor children and not being able to; another quarter feels worried about their donor children's well-being.3 Another study showed that ninety-four percent of surveyed sperm donors were open to contact with offspring, with 85% being open to meeting them and 78% open to establishing a relationship with them.4 New research also tells us that a majority of egg donors would like to make contact with offspring and have the means to do so as thousands of donors have made mutual consent contact on the Donor Sibling Registry and via other methods.7 Many are concerned about anonymity. Many donors donated long before commercial DNA testing existed, and more recent donors were not provided with information about commercial DNA companies that could be used by parents and children to find them. Younger donors may be more neutral as many were given a choice of whether to be anonymous for 18 years or forever. Older ones may be more biased towards wanting to meet offspring.3 The ones who favor anonymity may want to protect the donor child's parents from feeling threatened. They may want to protect their own families or their own lying by omission about being a donor and/or having medical issues. Once donors realize that contact is possible and probable, there can be fear: about their parental rights and financial responsibilities (there are none for egg clinic/sperm bank donors). about disappointing the offspring or not being successful or good enough as some donors were not 100% honest about their academic backgrounds when filling out their donor profiles and now feel ashamed. of being found out that they were not truthful on their donor profile. about their relatives being contacted via DNA websites. or embarrassment associated with their family and friends finding out that they sold their gametes and/or that there are resulting children. or worry about being exposed for their serial donating history, as it's very common for donors to sell their gametes to more than one, or many facilities.4 of rejection, as many donor-conceived people (DCP) with non-bio parents see connecting with the donor as a betrayal of sorts, and therefore do not wish to establish relationships. DCP protecting their non-bio parents can appear as though they are rejecting the donor. When a donor attempts to report updated medical information or history that may affect their current or potential offspring, there may be frustration over the dismissive responses and lack of follow-up from their gamete vendor and the lack of guidelines for how to provide this information.6 Donors may feel guilt after finding out about medical issues amongst their donor offspring that they could be responsible for, or shame if the medical issue was something they hid in order to be accepted as a donor. There may also be thoughts and concerns about the number of offspring that have been created using their gametes. Most egg donors feel that it is important/very important to know the number of offspring born from their donations.3 More than 40% of surveyed egg donor parents say that they were not asked by their clinic to report the birth of their child, so births are grossly underestimated.2,8 There is no entity keeping track of births and because all reporting is voluntary, accurate records are nowhere in sight. Many sperm donors now understand that they were lied to about the limits of the 10 or 20 offspring or families that they were promised and feel overwhelmed by the implications of how many offspring they have, as some have come to find out that they have more than 100 or even 200 donor children. Most sperm donors didn't realize that one single donation can be broken up into between 4-24 sellable vials, so their 2x or 3x a week donating for years can result in a slew of sellable vials. There may be concerns over how large numbers of offspring might demand too much of their time and/or attention and therefore affect their family negatively, especially if their family stability is not on solid ground. Donors may feel overwhelmed and that they (or their spouses) just don't have the emotional bandwidth to deal with dozens or hundreds of offspring. Many donors are excited to learn about and connect with their donor progeny and reports of donors connecting with their donor-grandchildren are becoming more common.6 Many need some time and patience to figure out how to define these new relationships with their genetic children and their families. Expanding family and creating new family systems can be a bit of a challenge as the process unfolds until relationships become better defined and accepted. Moneypantry Earlier research suggests that about half of the egg donors feel that their relationship with their offspring is only genetic, while the other half view it as a connection beyond biological.3 More recent 2021 research asked egg donors how they viewed any children who may have resulted from their donations. The most common response (36.2%) was “special designation but not acquaintance, friend, or family” and the second most common was “my biological child” (25.7%).7 There may be fear about how the egg retrieval process might affect their future health and fertility. Several studies have raised concerns about Ovarian Hyperstimulation Syndrome (OHSS), secondary infertility, and cancer risks.1,2 All too often, donors are not properly counseled and educated about the ongoing ramifications for themselves, their families, and any children born: the ones they're raising and the donor-conceived children who will share approximately 50% of their DNA and who may be very curious about their close genetic relatives, ancestry, and medical family history. However, there is now a wealth of information and support for all members of the donor family. The interests and well being of the children — all of them — are paramount. I believe that I do have responsibilities to the children born as a result of my donations. At the very least, those children have a right to know what my part of their genetic heritage is. I will be more than happy to get in touch, if and when they do desire. I think about them often and wonder who, where, and how they are, and what is happening in their lives. I think, that if one day some of my unknown offspring do make contact with and meet me, it might be – for them primarily and for me too — a wonderful 'jigsaw' experience! The prospect of it actually happening is a little daunting, in some ways. What if they do not like me, or I them? What if they feel unhappy with my having contributed to their creation, but then taken no responsibility for them — especially if they have had an unhappy life? How will my own family react to and view them? On and on my thinking goes. However, at the base of all of this I am quite clear in my mind, that these wonderful children do have a right to know, what they want to know about me — because in them, there is a part of me." — Former donor
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  • Testing Your Fear of Rejection in Close Relationships.
    A new study provides questions to test if you’re too sensitive to rejection.
    Reviewed by Michelle Quirk

    KEY POINTS-
    The fear of being rejected, known as rejection sensitivity, can become a major hindrance in close relationships.
    New research shows the value of a simple nine-item scale to measure this important quality and understand its meaning.
    By attending to anxiety about rejection and expectations of being turned down, we can improve our mental health and relationships.

    Do you ever have the feeling that you’re not accepted and supported when you’re in the emotional doldrums? Suffolk University’s Kayla Lord and colleagues define this state of mind in a recent paper (2022) as “rejection sensitivity (RS)” or “the predisposition to defensively expect, readily perceive, and react strongly to interpersonal rejection” (p. 1062). In addition to making individuals susceptible to a variety of psychiatric disorders, high rejection sensitivity is associated with a lower sense of well-being.

    Even if this doesn’t apply to you, is there someone you know who fits this description? Perhaps you have a cousin whom you’re very fond of, but whom you try to steer clear of nevertheless. This cousin makes planning for family events very difficult, if not awkward. It’s generally understood in your extended family that formal invitations for such events are hardly necessary. Yet, this cousin sends out what seems to be an endless stream of texts to make sure that she really is welcome. Why, you wonder, must you constantly have to reassure her that the standing invitation is still standing?

    What’s Behind Rejection Sensitivity?
    As potentially trivial as your cousin’s behavior may seem to be, if it’s part of a larger pattern of chronic worry over being left out of things or uncared for, hypersensitivity to rejection may be an indicator of a more serious approach to relationships. Over time, people high in RS may behave in ways that not only perpetuate but heighten the actual rejection experiences they encounter. Thinking about that cousin, isn’t it possible that you’re tempted to drop them from the family get-together list just to avoid having to deal with all those demands for reassurance?

    In the “cognitive-affective-processing” framework outlined by Lord and her fellow authors, RS takes on a self-perpetuating quality for the very reason that constant demands for reassurance can become a turnoff for those in the individual’s social network. As a “self-maintaining defensive motivational system,” RS builds on itself in response to actual rejection experiences that generate the individual’s expectation that future rejections will inevitably continue to occur. This expectation generates behaviors such as anger or withdrawal that paradoxically make those future rejections more likely.

    If people are to avoid having their RS spiral out of control, this cycle of expectations leading to behavior must somehow be broken. The first step to achieving this break in the process is to come up with an accurate way to measure an individual’s level of RS.

    The 9-Item Questionnaire
    Developed by Gettysburg College’s Kathy Berenson and colleagues (2009), the Rejection Sensitivity Questionnaire for Adults (A-RSQ) contains nine scenario-based questions that tap into an individual’s ways of reacting to potential types of rejection. Although the questionnaire was previously published and available in the literature, Lord and her fellow researchers believed that it needed further testing to determine its validity. In particular, its so-called “factor structure” was not previously well-established, and so the meaning of a total score was not completely clear.

    This lack of clear meaning of total scores is also problematic given that RS is intended to relate to such negative outcomes as poor relationship satisfaction as well as to other interpersonal sensitivities, such as insecure attachment style. Furthermore, if RS is to be regarded as distinct from such personality traits as high neuroticism and submissiveness, the status of the A-RSQ as a standalone measure needs to be further documented.

    With this background, it’s time to take a look at the A-RSQ to see how you would rate yourself. Each of the nine items describes a different scenario in which you would get a positive response from someone else. Your responses would fall into the two categories of (a) being concerned or anxious about the other person’s responses and (b) expecting to be given support or help, with both on a 1-to-6 scale:

    You ask your parents or another family member for a loan to help you through a difficult financial time.
    You approach a close friend to talk after doing or saying something that seriously upset him/her.
    You bring up the issue of sexual protection with your significant other and tell him/her how important you think it is.
    You ask your supervisor for help with a problem you have been having at work.
    After a bitter argument, you call or approach your significant other because you want to make up.
    You ask your parents or other family members to come to an occasion important to you.
    At a party, you notice someone on the other side of the room that you'd like to get to know, and you approach him or her to try to start a conversation.
    Lately you've been noticing some distance between yourself and your significant other, and you ask him/her if there is something wrong.
    You call a friend when there is something on your mind that you feel you really need to talk about.

    In the initial scoring for the A-RSQ, each item’s score equaled the product of concern multiplied by expectation. On average, participants in the initial sample involved in the scale’s development received a score of about 9 (indicating moderate RS), and scores above 12 on an individual item would be considered above average.

    The researchers examined the A-RSQ’s validity by comparing these combined scores with the results of an analysis examining concern and expectancy as separate factors. They also examined its relationship to theoretically relevant constructs including social anxiety, depression, stress, attachment style, and personality as a way of assessing the measure’s so-called “convergent” validity. If the measure is valid, it should line up with these similar (but not equal) features of people’s insecurities in general, mood, and ability to establish close and secure relationships.

    The findings supported the A-RSQ’s validity in terms of these connections to other concepts. Importantly, however, the authors found that on a statistical basis, the measure held up better when scoring concern separately from expectancy. rather than using a total score. Additionally, expectancy was associated specifically with lower positive affect, including lower extraversion scores. Concern scores were related to higher levels of negative affect, including scores on distress. As the authors concluded, “rejection sensitivity is a clinically relevant transdiagnostic phenotype that influences symptom manifestation and psychosocial functioning” (p. 1069).

    How to Manage High Rejection Sensitivity
    This strong conclusion on the part of the Suffolk U. authors suggests that RS is an important quality indeed to be able to identify in yourself and others. Moreover, separating out the expectancy that someone will turn you down from concern about rejection seems to provide a worthwhile distinction.

    From a therapeutic perspective, identifying high levels of RS could provide a useful starting point for helping individuals manage their behavior, thoughts, and feelings in close relationships. As the authors suggest, such management could include mindfulness training, where individuals learn to attend to their defensive tendencies regarding acceptance by others. Additionally, because RS can lead to antagonistic behaviors in interpersonal relationships, skill training could also have merit.

    To sum up, this simple nine-item measure could provide you with significant knowledge about what keeps people, such as that cousin of yours, stuck in chronically difficult interpersonal situations. Understanding that their behavior is a reflection of a deeper cognitive-affective set of qualities can provide a path away from concerns and expectations of rejection into more healthy and fulfilling relationships.
    Testing Your Fear of Rejection in Close Relationships. A new study provides questions to test if you’re too sensitive to rejection. Reviewed by Michelle Quirk KEY POINTS- The fear of being rejected, known as rejection sensitivity, can become a major hindrance in close relationships. New research shows the value of a simple nine-item scale to measure this important quality and understand its meaning. By attending to anxiety about rejection and expectations of being turned down, we can improve our mental health and relationships. Do you ever have the feeling that you’re not accepted and supported when you’re in the emotional doldrums? Suffolk University’s Kayla Lord and colleagues define this state of mind in a recent paper (2022) as “rejection sensitivity (RS)” or “the predisposition to defensively expect, readily perceive, and react strongly to interpersonal rejection” (p. 1062). In addition to making individuals susceptible to a variety of psychiatric disorders, high rejection sensitivity is associated with a lower sense of well-being. Even if this doesn’t apply to you, is there someone you know who fits this description? Perhaps you have a cousin whom you’re very fond of, but whom you try to steer clear of nevertheless. This cousin makes planning for family events very difficult, if not awkward. It’s generally understood in your extended family that formal invitations for such events are hardly necessary. Yet, this cousin sends out what seems to be an endless stream of texts to make sure that she really is welcome. Why, you wonder, must you constantly have to reassure her that the standing invitation is still standing? What’s Behind Rejection Sensitivity? As potentially trivial as your cousin’s behavior may seem to be, if it’s part of a larger pattern of chronic worry over being left out of things or uncared for, hypersensitivity to rejection may be an indicator of a more serious approach to relationships. Over time, people high in RS may behave in ways that not only perpetuate but heighten the actual rejection experiences they encounter. Thinking about that cousin, isn’t it possible that you’re tempted to drop them from the family get-together list just to avoid having to deal with all those demands for reassurance? In the “cognitive-affective-processing” framework outlined by Lord and her fellow authors, RS takes on a self-perpetuating quality for the very reason that constant demands for reassurance can become a turnoff for those in the individual’s social network. As a “self-maintaining defensive motivational system,” RS builds on itself in response to actual rejection experiences that generate the individual’s expectation that future rejections will inevitably continue to occur. This expectation generates behaviors such as anger or withdrawal that paradoxically make those future rejections more likely. If people are to avoid having their RS spiral out of control, this cycle of expectations leading to behavior must somehow be broken. The first step to achieving this break in the process is to come up with an accurate way to measure an individual’s level of RS. The 9-Item Questionnaire Developed by Gettysburg College’s Kathy Berenson and colleagues (2009), the Rejection Sensitivity Questionnaire for Adults (A-RSQ) contains nine scenario-based questions that tap into an individual’s ways of reacting to potential types of rejection. Although the questionnaire was previously published and available in the literature, Lord and her fellow researchers believed that it needed further testing to determine its validity. In particular, its so-called “factor structure” was not previously well-established, and so the meaning of a total score was not completely clear. This lack of clear meaning of total scores is also problematic given that RS is intended to relate to such negative outcomes as poor relationship satisfaction as well as to other interpersonal sensitivities, such as insecure attachment style. Furthermore, if RS is to be regarded as distinct from such personality traits as high neuroticism and submissiveness, the status of the A-RSQ as a standalone measure needs to be further documented. With this background, it’s time to take a look at the A-RSQ to see how you would rate yourself. Each of the nine items describes a different scenario in which you would get a positive response from someone else. Your responses would fall into the two categories of (a) being concerned or anxious about the other person’s responses and (b) expecting to be given support or help, with both on a 1-to-6 scale: You ask your parents or another family member for a loan to help you through a difficult financial time. You approach a close friend to talk after doing or saying something that seriously upset him/her. You bring up the issue of sexual protection with your significant other and tell him/her how important you think it is. You ask your supervisor for help with a problem you have been having at work. After a bitter argument, you call or approach your significant other because you want to make up. You ask your parents or other family members to come to an occasion important to you. At a party, you notice someone on the other side of the room that you'd like to get to know, and you approach him or her to try to start a conversation. Lately you've been noticing some distance between yourself and your significant other, and you ask him/her if there is something wrong. You call a friend when there is something on your mind that you feel you really need to talk about. In the initial scoring for the A-RSQ, each item’s score equaled the product of concern multiplied by expectation. On average, participants in the initial sample involved in the scale’s development received a score of about 9 (indicating moderate RS), and scores above 12 on an individual item would be considered above average. The researchers examined the A-RSQ’s validity by comparing these combined scores with the results of an analysis examining concern and expectancy as separate factors. They also examined its relationship to theoretically relevant constructs including social anxiety, depression, stress, attachment style, and personality as a way of assessing the measure’s so-called “convergent” validity. If the measure is valid, it should line up with these similar (but not equal) features of people’s insecurities in general, mood, and ability to establish close and secure relationships. The findings supported the A-RSQ’s validity in terms of these connections to other concepts. Importantly, however, the authors found that on a statistical basis, the measure held up better when scoring concern separately from expectancy. rather than using a total score. Additionally, expectancy was associated specifically with lower positive affect, including lower extraversion scores. Concern scores were related to higher levels of negative affect, including scores on distress. As the authors concluded, “rejection sensitivity is a clinically relevant transdiagnostic phenotype that influences symptom manifestation and psychosocial functioning” (p. 1069). How to Manage High Rejection Sensitivity This strong conclusion on the part of the Suffolk U. authors suggests that RS is an important quality indeed to be able to identify in yourself and others. Moreover, separating out the expectancy that someone will turn you down from concern about rejection seems to provide a worthwhile distinction. From a therapeutic perspective, identifying high levels of RS could provide a useful starting point for helping individuals manage their behavior, thoughts, and feelings in close relationships. As the authors suggest, such management could include mindfulness training, where individuals learn to attend to their defensive tendencies regarding acceptance by others. Additionally, because RS can lead to antagonistic behaviors in interpersonal relationships, skill training could also have merit. To sum up, this simple nine-item measure could provide you with significant knowledge about what keeps people, such as that cousin of yours, stuck in chronically difficult interpersonal situations. Understanding that their behavior is a reflection of a deeper cognitive-affective set of qualities can provide a path away from concerns and expectations of rejection into more healthy and fulfilling relationships.
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  • ANXIETY-
    How Uncertainty Causes Anxiety.
    Insights from the neuropsychology of anxiety.
    Reviewed by Gary Drevitch

    KEY POINTS-
    Your brain is a prediction machine, and uncertainty can be quantified in terms of prediction error.
    We evolved anxiety as a response to uncertainty.
    Mindfulness, gratitude, and routine can help minimize uncertainty and maximize well-being.
    Whole or skim milk? Take your normal route home, or an unfamiliar potential shortcut? Flip a hypothetical trolley switch that would kill one person, saving five others?

    All of these decisions have two things in common: uncertainty and anxiety.

    Whether you consciously feel anxious or not in deciding between two similar options at the grocery store, I mean anxious in the technical sense. Anxiety is your brain’s response to uncertainty, big or small.

    The Fantastic Organ
    Neuroscientist Karl Friston has called the brain a “fantastic organ.” The brain is not only an organ which is fantastically complex, but one which is constantly generating fantasies. Your brain is a prediction machine—this is the basis for predictive processing theories of consciousness.

    Most of what your brain and body does is unconscious: There is high predictability, little uncertainty, and attending to these details would be exhausting. We can choose to take conscious control of our breathing, but can you imagine if we had to do this all the time? How tiring, and perhaps even deadly, would it be to exist in a world where our brain couldn’t take over and regulate our breathing unconsciously?

    But when there is uncertainty, prediction becomes much harder. There is no unconscious smooth sailing. The whole reason we have conscious thought is to deliberate between actions when multiple decisions are possible. Our fantastic organ must generate the right fantasy map to navigate us safely to our goals.

    Entropy Equals Uncertainty
    From a computational perspective, uncertainty increases entropy. You may recognize this term from physics. It is a law of nature that entropy always increases. Entropy is chaos, and disorder. Heat dissipates, the universe expands, and order does not stay ordered. Sandcastles collapse every day, but there is no universe in which sand spontaneously arranges itself into castles.

    The caveat, of course, is that it is possible to build sandcastles and to create order in a disordered universe. We cannot create order from nothing; it comes at the cost of energy. Expending energy into work still increases entropy, globally, but we can trade energy from the outside world to maintain order in a narrow context.

    This anti-entropic process of consuming energy to maintain order is the whole basis of life. Homeostasis is an organism’s process of expending energy to maintain itself, whether that energy is gathered from photosynthesis, or from eating other organisms.

    And at a much higher level, your brain, the prediction machine, is fundamentally in pursuit of minimizing entropy. What does a prediction machine want more than anything else? To be right. What does it need to be right? Certainty. Why does it want certainty? There are two answers to this. From a low-level computational perspective, the less uncertainty there is in a problem, the more straightforward the answer. Your brain saves energy. From a high-level evolutionary perspective, the more uncertain your environment is, the less likely you are to survive. We need certainty.

    Of course, if all we wanted was certainty and to minimize brain power, we would be in a constant state of hibernation. This is not a long-term adaptive solution. The best types of prediction machines are those which can handle high amounts of uncertainty, and still come out on top.

    Three Types of Brain:
    The struggle to navigate uncertainty is the best way to understand the evolution of our large brains, and to understand the neuropsychology of anxiety.

    The brain can broadly be divided into three layers:
    First there is the brainstem, which governs basic survival processes. This includes largely unconscious processes like breathing, heartbeat, digestion, and reflexive movement. This most ancient brain system is common to all vertebrates and is sometimes referred to as the “reptilian” or “lizard” brain.

    Next there is the limbic system. The limbic system controls our emotions, ranging from pain and pleasure, love and fear, and hunger and sex drives. Compared to the basic reptilian brain systems shared across all vertebrates, the limbic system is more developed in social species. Whether predator or prey, parent or child, if your survival depends on receiving care from or avoiding harm from others, it pays to have emotions.
    Finally, there is the cortex, or the “rational brain.” (Cortex has the same Latin root as corona, meaning crown; it sits on top of the rest of the brain.) The more intelligent an animal is, the larger its brain (relative to its body), and the more cortex it has. We see the largest cortical brain areas (again, relative to body size) in highly social birds and primates, with humans at the forefront.

    Predictive Processing
    Looking at this in the context of brains as prediction machines, this makes perfect sense. Think about the primitive lizard brain, or better yet, even more primitive fish vertebrates. Yes, they need to survive and reproduce like the rest of us, but these simple organisms may lay dozens, hundreds, or even thousands of eggs at a time. Their prediction machines are straight and narrow; they live largely by reflex. When prediction fails, they die. But what they lack in cognitive flexibility, they make up for in numbers.

    More complex social mammals, like rats, have limbic brain systems (and some cortex) much more similar to us humans. They truly experience anxiety in the face of threat and uncertainty. Their tiny but fantastic organs do have a vested interest in generating fantasies of safety, security, nourishment, and social bonding. We know from decades of animal research that rodents experience anxiety in uncertain environments, and that their anxiety response is very similar to ours. We release the same stress hormone, cortisol, and the same anti-anxiety medications that humans are treated with work on rats. (That is, after all, where they are first tested to make sure they are safe and effective on mammals.)

    Anxiety Is Prediction Error
    The fact that all ties it together, posed by Friston’s model of predictive processing in the brain, is that anxiety is the felt experience of entropy. Your brain is constantly making predictions about the world, and judging those predictions against what actually happens. The greater the prediction error, the greater the entropy. Prediction error can be as simple as a single neuron firing or misfiring at the wrong time, or as dramatic as an entire belief system falling apart.

    This is where humans’ uniquely large prefrontal cortex comes into play for our unique relationship with anxiety. Even for an animal with a sophisticated limbic system, such as a rat, uncertainty is marked by the direct presence or absence of threat. Even for animals with highly developed frontal lobes, such as chimpanzees, uncertainty is marked by uncertainty about the attitudes of others. Where am I in the dominance hierarchy? Is this chimp friend or foe? If I share my food, will the favor be repaid? All of the uncertainty an animal has to keep track of is magnified when living in a social environment. There is uncertainty not only about its own thoughts, feelings, and security, but about everyone else’s as well.

    The most socially complex species have had to evolve the most advanced prediction machines in order to keep up with uncertainty. This is the case for humans as well as primates. But where humans excel—and this is arguably our greatest strength and greatest weakness, when thinking about anxiety—is metacognition, or the ability to think about our own thoughts, and to think in terms of abstract symbols.

    What other species can have an anxiety attack brought on by existential dread—just thinking about the meaning of life, or what happens after death? Our ancient brain regions respond physiologically to uncertainty with anxiety, just as they evolved to. But we are no longer only dealing with uncertainty about an immediate threat. Uncertainty can mean losing your job, or hearing bad news about stock market futures, or flunking a test. It doesn’t matter; our fantastic brain, the prediction machine, still produces the physiological response of anxiety that is meant to protect us from immediate physical threat: Cortisol levels rise. Your heart rate increases. Your pupils dilate. You begin to sweat. All of these are genuinely adaptive responses when faced with uncertainty, in an evolutionary landscape in which uncertainty means fight or flight.

    The problem is that this system is too good at its job. The theory of psychological entropy states that uncertainty is always felt as anxiety, no matter the cause. It does not matter if you are anxious because of prediction error caused by an immediate threat, when you were expecting safety, or because you have begun questioning a worldview that used to give you a sense of security in the world. It does not matter if you are uncertain about something trivial, like whether to buy whole or skim milk. Your brain evolved to deal with uncertainty as a threat, and anxiety is the natural response to that.

    Where does this leave us? Are we doomed to become anxious over everything we can’t predict with absolute certainty—which is, literally, everything—like the neurotic philosopher Chidi in The Good Place? Not quite.

    Living Out the Fantasy
    The optimistic part about the theory of psychological entropy is that it tells us where all emotions are rooted, positive or negative. Fundamentally, it all has to do with prediction error. We inherently experience greater prediction error, greater uncertainty, and greater entropy, as negative. But on the flip side, we inherently experience reduced prediction error as positive. This is why (as mediated by dopamine) it feels so good when you achieve a goal.

    This is also why practicing mindfulness and routine improves well-being: It minimizes prediction error, directly or indirectly. Gratitude and humility help rein in your fantasies, leaving less room for disappointment. And journaling and self-reflection help you more clearly map out your thoughts and worldview, leaving less room for error. And healthy habits leave less room for uncertainty. For the fantastic organ, reducing psychological entropy is the key to well-being.
    ANXIETY- How Uncertainty Causes Anxiety. Insights from the neuropsychology of anxiety. Reviewed by Gary Drevitch KEY POINTS- Your brain is a prediction machine, and uncertainty can be quantified in terms of prediction error. We evolved anxiety as a response to uncertainty. Mindfulness, gratitude, and routine can help minimize uncertainty and maximize well-being. Whole or skim milk? Take your normal route home, or an unfamiliar potential shortcut? Flip a hypothetical trolley switch that would kill one person, saving five others? All of these decisions have two things in common: uncertainty and anxiety. Whether you consciously feel anxious or not in deciding between two similar options at the grocery store, I mean anxious in the technical sense. Anxiety is your brain’s response to uncertainty, big or small. The Fantastic Organ Neuroscientist Karl Friston has called the brain a “fantastic organ.” The brain is not only an organ which is fantastically complex, but one which is constantly generating fantasies. Your brain is a prediction machine—this is the basis for predictive processing theories of consciousness. Most of what your brain and body does is unconscious: There is high predictability, little uncertainty, and attending to these details would be exhausting. We can choose to take conscious control of our breathing, but can you imagine if we had to do this all the time? How tiring, and perhaps even deadly, would it be to exist in a world where our brain couldn’t take over and regulate our breathing unconsciously? But when there is uncertainty, prediction becomes much harder. There is no unconscious smooth sailing. The whole reason we have conscious thought is to deliberate between actions when multiple decisions are possible. Our fantastic organ must generate the right fantasy map to navigate us safely to our goals. Entropy Equals Uncertainty From a computational perspective, uncertainty increases entropy. You may recognize this term from physics. It is a law of nature that entropy always increases. Entropy is chaos, and disorder. Heat dissipates, the universe expands, and order does not stay ordered. Sandcastles collapse every day, but there is no universe in which sand spontaneously arranges itself into castles. The caveat, of course, is that it is possible to build sandcastles and to create order in a disordered universe. We cannot create order from nothing; it comes at the cost of energy. Expending energy into work still increases entropy, globally, but we can trade energy from the outside world to maintain order in a narrow context. This anti-entropic process of consuming energy to maintain order is the whole basis of life. Homeostasis is an organism’s process of expending energy to maintain itself, whether that energy is gathered from photosynthesis, or from eating other organisms. And at a much higher level, your brain, the prediction machine, is fundamentally in pursuit of minimizing entropy. What does a prediction machine want more than anything else? To be right. What does it need to be right? Certainty. Why does it want certainty? There are two answers to this. From a low-level computational perspective, the less uncertainty there is in a problem, the more straightforward the answer. Your brain saves energy. From a high-level evolutionary perspective, the more uncertain your environment is, the less likely you are to survive. We need certainty. Of course, if all we wanted was certainty and to minimize brain power, we would be in a constant state of hibernation. This is not a long-term adaptive solution. The best types of prediction machines are those which can handle high amounts of uncertainty, and still come out on top. Three Types of Brain: The struggle to navigate uncertainty is the best way to understand the evolution of our large brains, and to understand the neuropsychology of anxiety. The brain can broadly be divided into three layers: First there is the brainstem, which governs basic survival processes. This includes largely unconscious processes like breathing, heartbeat, digestion, and reflexive movement. This most ancient brain system is common to all vertebrates and is sometimes referred to as the “reptilian” or “lizard” brain. Next there is the limbic system. The limbic system controls our emotions, ranging from pain and pleasure, love and fear, and hunger and sex drives. Compared to the basic reptilian brain systems shared across all vertebrates, the limbic system is more developed in social species. Whether predator or prey, parent or child, if your survival depends on receiving care from or avoiding harm from others, it pays to have emotions. Finally, there is the cortex, or the “rational brain.” (Cortex has the same Latin root as corona, meaning crown; it sits on top of the rest of the brain.) The more intelligent an animal is, the larger its brain (relative to its body), and the more cortex it has. We see the largest cortical brain areas (again, relative to body size) in highly social birds and primates, with humans at the forefront. Predictive Processing Looking at this in the context of brains as prediction machines, this makes perfect sense. Think about the primitive lizard brain, or better yet, even more primitive fish vertebrates. Yes, they need to survive and reproduce like the rest of us, but these simple organisms may lay dozens, hundreds, or even thousands of eggs at a time. Their prediction machines are straight and narrow; they live largely by reflex. When prediction fails, they die. But what they lack in cognitive flexibility, they make up for in numbers. More complex social mammals, like rats, have limbic brain systems (and some cortex) much more similar to us humans. They truly experience anxiety in the face of threat and uncertainty. Their tiny but fantastic organs do have a vested interest in generating fantasies of safety, security, nourishment, and social bonding. We know from decades of animal research that rodents experience anxiety in uncertain environments, and that their anxiety response is very similar to ours. We release the same stress hormone, cortisol, and the same anti-anxiety medications that humans are treated with work on rats. (That is, after all, where they are first tested to make sure they are safe and effective on mammals.) Anxiety Is Prediction Error The fact that all ties it together, posed by Friston’s model of predictive processing in the brain, is that anxiety is the felt experience of entropy. Your brain is constantly making predictions about the world, and judging those predictions against what actually happens. The greater the prediction error, the greater the entropy. Prediction error can be as simple as a single neuron firing or misfiring at the wrong time, or as dramatic as an entire belief system falling apart. This is where humans’ uniquely large prefrontal cortex comes into play for our unique relationship with anxiety. Even for an animal with a sophisticated limbic system, such as a rat, uncertainty is marked by the direct presence or absence of threat. Even for animals with highly developed frontal lobes, such as chimpanzees, uncertainty is marked by uncertainty about the attitudes of others. Where am I in the dominance hierarchy? Is this chimp friend or foe? If I share my food, will the favor be repaid? All of the uncertainty an animal has to keep track of is magnified when living in a social environment. There is uncertainty not only about its own thoughts, feelings, and security, but about everyone else’s as well. The most socially complex species have had to evolve the most advanced prediction machines in order to keep up with uncertainty. This is the case for humans as well as primates. But where humans excel—and this is arguably our greatest strength and greatest weakness, when thinking about anxiety—is metacognition, or the ability to think about our own thoughts, and to think in terms of abstract symbols. What other species can have an anxiety attack brought on by existential dread—just thinking about the meaning of life, or what happens after death? Our ancient brain regions respond physiologically to uncertainty with anxiety, just as they evolved to. But we are no longer only dealing with uncertainty about an immediate threat. Uncertainty can mean losing your job, or hearing bad news about stock market futures, or flunking a test. It doesn’t matter; our fantastic brain, the prediction machine, still produces the physiological response of anxiety that is meant to protect us from immediate physical threat: Cortisol levels rise. Your heart rate increases. Your pupils dilate. You begin to sweat. All of these are genuinely adaptive responses when faced with uncertainty, in an evolutionary landscape in which uncertainty means fight or flight. The problem is that this system is too good at its job. The theory of psychological entropy states that uncertainty is always felt as anxiety, no matter the cause. It does not matter if you are anxious because of prediction error caused by an immediate threat, when you were expecting safety, or because you have begun questioning a worldview that used to give you a sense of security in the world. It does not matter if you are uncertain about something trivial, like whether to buy whole or skim milk. Your brain evolved to deal with uncertainty as a threat, and anxiety is the natural response to that. Where does this leave us? Are we doomed to become anxious over everything we can’t predict with absolute certainty—which is, literally, everything—like the neurotic philosopher Chidi in The Good Place? Not quite. Living Out the Fantasy The optimistic part about the theory of psychological entropy is that it tells us where all emotions are rooted, positive or negative. Fundamentally, it all has to do with prediction error. We inherently experience greater prediction error, greater uncertainty, and greater entropy, as negative. But on the flip side, we inherently experience reduced prediction error as positive. This is why (as mediated by dopamine) it feels so good when you achieve a goal. This is also why practicing mindfulness and routine improves well-being: It minimizes prediction error, directly or indirectly. Gratitude and humility help rein in your fantasies, leaving less room for disappointment. And journaling and self-reflection help you more clearly map out your thoughts and worldview, leaving less room for error. And healthy habits leave less room for uncertainty. For the fantastic organ, reducing psychological entropy is the key to well-being.
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