Your stomach feels like it’s in severe pain. You get a headache, and it feels debilitating. You feel a sharp pain in your leg, but despite no clear cut, the pain is extreme and unmanageable. Others may even comment that it seems like you have low pain tolerance, and you worry that you’re missing something more severe.
What if it’s your mental health?
When you’re dealing with anxiety, depression, trauma, or other mental health challenges, pain genuinely hurts more. This isn’t about being weak or dramatic. It’s about how your brain processes pain signals when you’re under psychological distress.
The connection between mental health and physical pain is real, measurable, and backed by neuroscience. Let’s talk about why this happens and what it means for anyone who’s ever felt like their pain response doesn’t match what seems reasonable.
How Your Brain Processes Pain
Pain isn’t just about physical damage. Your brain doesn’t have a simple “pain detector” that objectively measures harm and reports back. Instead, pain is your brain’s interpretation of signals from your body, filtered through emotional state, past experiences, stress levels, and mental health.
When you’re physically hurt, nerve endings send signals to your spinal cord and up to your brain. Your brain then decides how much that should hurt based on context. This is why the same injury can feel different depending on circumstances – a paper cut during a stressful day feels worse than the same cut when you’re relaxed.
Your brain’s pain processing centers overlap heavily with areas that regulate emotion, stress, and mood. The anterior cingulate cortex and the insula — key regions for pain perception — are also involved in processing emotional distress. When these areas are already overactivated by anxiety, depression, or trauma, they amplify pain signals.
This means that when you’re struggling mentally, your pain threshold drops. Your nervous system becomes more sensitive. The volume gets turned up on everything.
Depression and Pain Amplification
Depression doesn’t just affect your mood. It fundamentally changes how your nervous system functions. People with depression have altered pain processing at a neurological level.
Research shows that people with depression have increased activity in brain regions associated with pain and decreased activity in areas that regulate and dampen pain signals. Essentially, the brain’s natural pain control system stops working as effectively.
This can look like:
Chronic Unexplained Pain — You have back pain, headaches, or body aches that don’t have a clear physical cause. Doctors run tests that come back normal. The pain is real, but it’s being generated or amplified by the depressed nervous system.
Lower Pain Threshold — Minor injuries hurt more than they should. A slight bump feels like a major collision. You’re not exaggerating. Your brain is genuinely perceiving more intense pain from the same stimulus.
Prolonged Pain Recovery — When you do get hurt, the pain lasts longer. What should be a few days of soreness turns into weeks. Your nervous system can’t downregulate the pain response effectively.
Increased Sensitivity to Temperature — Cold feels colder, heat feels hotter. You’re more uncomfortable in situations that wouldn’t bother someone without depression.
Depression also causes inflammation throughout the body. Inflammatory markers increase, which sensitizes nerve endings and makes everything hurt more. Chronic pain and depression create a feedback loop — pain worsens depression, depression amplifies pain.
Anxiety Makes Your Body Hypervigilant
Anxiety puts your nervous system on high alert. Your body is constantly scanning for threats, and that includes potential sources of pain or discomfort. When you’re anxious, your pain sensitivity increases because your nervous system interprets pain as a potential danger signal that needs immediate attention.
This is what anxiety-related pain sensitivity looks like:
Muscle Tension Creates Real Pain — Anxiety causes chronic muscle tension. Your shoulders, neck, jaw, and back are constantly tight. This tension creates genuine pain — headaches, back pain, jaw pain from clenching. The pain isn’t “just anxiety.” It’s real physical pain caused by the sustained muscle contraction that anxiety produces.
Hyperawareness of Body Sensations — This is a big one. With anxiety, especially panic attacks, you notice every twinge, every ache, every uncomfortable sensation. Your nervous system is hyper-focused on potential threats, and physical discomfort registers as a threat. When you have panic disorder or health anxiety, your brain not only interprets everything it feels as a threat – it also amplifies it, and then your brain is convinced something terrible is happening because, subjectively, you are experiencing something terrible happening.
Pain Catastrophizing — When you feel pain, your anxious brain immediately jumps to worst-case scenarios. This catastrophizing actually intensifies the pain experience. Your brain interprets the pain as more dangerous, which increases the pain signal.
Heightened Startle Response — When you’re anxious and something causes sudden pain or discomfort, your reaction is more intense. You jump more, tense more, feel more distressed. You physically react faster and more strongly to stimuli.
People with panic disorder often experience chest pain, stomach pain, and other physical symptoms that feel identical to serious medical conditions. The pain is real. It’s caused by the intense physiological response of panic — muscle tension, hyperventilation, increased heart rate. Your body is genuinely in distress, creating genuine pain.
Trauma Changes Your Nervous System
Trauma fundamentally alters how your nervous system responds to the world. When you’ve experienced trauma, your body becomes hypersensitive to potential threats, and that includes pain.
People with PTSD have a sensitized nervous system. The autonomic nervous system — which controls automatic functions like heart rate, breathing, and pain response — gets stuck in a state of hyperarousal. This means:
Your pain threshold drops significantly. Stimuli that wouldn’t hurt someone without trauma genuinely hurt you more.
Your body holds trauma in physical tension. Muscles remain chronically tight in areas associated with the trauma. This creates ongoing pain.
Your nervous system struggles to downregulate pain signals. Once pain starts, it’s harder for your system to calm down and reduce the intensity.
Touch can be painful or uncomfortable even when it’s not meant to be. Your nervous system interprets touch as a potential threat, making even gentle contact uncomfortable.
Somatic therapy works specifically with this body-held trauma. The goal is to help your nervous system recalibrate, to bring down the baseline level of activation so that pain responses become more proportionate again.
Trauma also affects how your brain stores and recalls pain memories. If you were hurt during a traumatic event, your brain can reactivate that pain response when triggered, even without new physical injury. This is why people with trauma histories sometimes experience pain in areas associated with past injuries, even when those areas have healed.
OCD and Sensory Hypersensitivity
OCD doesn’t just create intrusive thoughts. It often comes with sensory hypersensitivity that makes physical discomfort feel intolerable.
People with OCD frequently experience:
“Just Right” Physical Sensations — Clothes feel wrong, textures are unbearable, tags cause intense discomfort. This isn’t about being picky. Your nervous system is genuinely distressed by these sensations.
Hyperawareness of Bodily Functions — You notice your breathing, heartbeat, swallowing, blinking. This awareness can create discomfort where none existed before. The sensation becomes the focus, which intensifies it.
Compulsive Checking of Pain or Discomfort — When you feel pain, you check it constantly, which keeps your attention on it and makes it feel worse. The checking behavior reinforces the pain rather than relieving it.
Contamination OCD and Physical Discomfort — If you have contamination fears, the feeling of “contamination” can create genuine physical discomfort. Your skin crawls, you feel dirty, you experience real physical distress.
The relationship between OCD and pain is bidirectional. OCD increases sensitivity to discomfort, and experiencing pain or discomfort can trigger OCD symptoms as your brain tries to control or fix the sensation.
Eating Disorders and Pain Perception
Eating disorders fundamentally alter how you experience physical sensations, including pain. Malnutrition, over-exercise, and the psychological stress of an eating disorder all change pain processing.
When your body is malnourished, your nervous system becomes hypersensitive. Everything hurts more because your body doesn’t have the resources to regulate pain effectively. People recovering from anorexia often describe this — as they begin eating again, they become more sensitive to temperature, touch, and pain because their nervous system is recalibrating.
Over-exercise, common in eating disorders, creates chronic pain that becomes normalized. You push through pain that should be a warning signal, which trains your brain to ignore some pain signals while becoming hypersensitive to others.
The psychological distress of body image concerns and eating disorder thoughts also amplifies pain. The constant stress keeps your nervous system activated, which increases overall pain sensitivity.
The Stress-Pain Connection
Regardless of which mental health challenge you’re facing, stress is often at the core of increased pain sensitivity. Chronic stress changes your nervous system in measurable ways.
When you’re stressed, your body produces cortisol and other stress hormones. Short-term, these hormones help you respond to threats. Long-term, they increase inflammation, sensitize nerve endings, and impair your body’s natural pain regulation systems.
Chronic stress also causes:
Muscle Tension — Sustained tension creates real pain in your neck, shoulders, back, and jaw.
Digestive Issues — Stress affects your gut, causing genuine stomach pain, cramping, and digestive discomfort.
Headaches and Migraines — Stress is a major trigger for tension headaches and migraines, which are genuine neurological pain conditions.
Sleep Disruption — Poor sleep lowers your pain threshold even further, creating a cycle where pain interferes with sleep and lack of sleep increases pain.
The relationship between stress and pain is so strong that chronic pain is now understood as partly a stress-related condition. When you’re under sustained psychological stress, your body can develop chronic pain even without clear physical injury.
What This Means for You
If you’re struggling with mental health and you feel like pain hits you harder than it should, you’re not being dramatic. You’re not weak. You’re not exaggerating. Your nervous system is genuinely processing pain differently.
This doesn’t mean the pain is “all in your head.” That phrase dismisses real suffering. The pain is real. It’s happening in your body. The fact that it’s influenced by your mental state doesn’t make it less valid.
This connection is important for several reasons:
You Can Stop Blaming Yourself — When you understand that your nervous system is sensitized, you can stop wondering if you’re overreacting. You’re not. Your pain is real.
Treatment Becomes Clearer — Addressing the underlying mental health condition often reduces physical pain. Therapy helps regulate your nervous system, which brings down overall pain sensitivity.
You Can Advocate for Yourself — When doctors dismiss your pain or suggest it’s “just anxiety” or “just depression,” you can explain that mental health conditions create real changes in pain processing. You deserve treatment for both the mental health condition and the pain.
Mind-Body Approaches Make Sense — Recognizing the connection helps you see why treatments like CBT, EMDR, somatic therapy, and DBT can reduce physical pain. They’re working with your nervous system to recalibrate pain processing.
If you’re experiencing increased pain sensitivity alongside mental health challenges, therapy can help with both. At Flourish Psychology, we work with the mind-body connection, understanding that psychological distress manifests physically and that physical pain affects mental health.
We offer individual therapy and specialize in evidence-based treatments that address both the psychological and physical aspects of mental health conditions. Our therapists understand that when you say something hurts, it genuinely hurts. We take that seriously.
Located in Brooklyn, NY, we serve clients throughout New York City and offer online therapy throughout New York State. Whether you’re dealing with anxiety, depression, trauma, eating disorders, OCD, or chronic pain alongside mental health challenges, we’re here to help.
Contact Flourish Psychology at 917-737-9475 or through our contact page to learn more about how therapy can help regulate your nervous system and reduce both psychological distress and physical pain. Your pain is real, and you deserve support for all of it.
Somatic therapy focuses on the connection between mind and body. It’s based on the idea that emotional and psychological struggles don’t just live in your thoughts — they also show up physically in your body.
When you’ve experienced trauma, chronic stress, or overwhelming emotions, your body can hold onto those experiences long after the event has passed. You might notice tension in your shoulders, a tight chest when you’re anxious, shallow breathing when you’re stressed, or physical pain that doesn’t seem to have a clear medical cause.
Somatic therapy helps you tune into these physical sensations and use them as a pathway to healing. Instead of just talking about what happened or how you feel, you’re also paying attention to how your body is responding and learning to release the tension, stress, and trauma that’s been stored there.
But what does this actually look like in practice? How does paying attention to physical sensations translate into real healing?
Working Through Anxiety That Shows Up as Physical Tension
A person might come to therapy struggling with anxiety that feels overwhelming. They wake up with their jaw clenched, their shoulders tight, and a knot in their stomach that won’t go away. They’ve tried traditional talk therapy and found it helpful for understanding their anxiety, but the physical symptoms persist.
Their somatic therapist would introduce body-centered techniques to help them work with the physical manifestations of anxiety. They might start with body awareness — simply noticing where tension shows up in the body and what that tension feels like.
The patient might realize that whenever they start worrying about work, their shoulders creep up toward their ears and their breathing becomes shallow. The therapist would help them notice this pattern in real time during sessions.
Once the patient can recognize the physical signs of their anxiety, the therapist would teach grounding techniques. One exercise might involve pressing their feet firmly into the floor and noticing the sensation of support beneath them. Another could involve gentle shoulder rolls and deep breathing to release the tension they’re holding.
Over time, the patient would learn to catch themselves when the physical symptoms start — before the anxiety spiral takes over. They could feel their shoulders tensing and use that as a signal to pause, breathe, and ground themselves. The physical symptoms become information rather than something to fear.
The combination of talk therapy and somatic work can help in ways that talk therapy alone sometimes doesn’t. The person understands their anxiety intellectually, but now they also have tools to work with it when it shows up in their body.
Processing Trauma That’s Stored in the Body
Someone might come to therapy years after a car accident. Physically, they’ve healed. But they find themselves constantly on edge while driving. Their heart races, their hands sweat, and sometimes they pull over because the panic is so intense.
They know logically that they’re safe. They may have even worked through the memories of the accident in EMDR therapy. But their body still reacts as if they’re in danger every time they get behind the wheel.
A somatic therapist would explain that trauma can get “stuck” in the nervous system. Even after the conscious mind has processed what happened, the body might still be stuck in the fight-or-flight response that was activated during the traumatic event.
The therapist might use somatic experiencing techniques to help the patient’s nervous system complete the survival response that was interrupted during the accident. This would involve carefully and slowly working through the physical sensations associated with the trauma.
The therapist would have the patient recall a moment from the accident and then immediately notice what happens in their body — the tightness in their chest, the tension in their arms, the urge to brace themselves.
Instead of pushing through these sensations or trying to make them go away, the therapist would help them pendulate — gently moving back and forth between the uncomfortable sensations and a sense of safety and calm in the present moment.
They might also use titration, which means working with small pieces of the traumatic memory at a time rather than diving into the full experience all at once. This allows the nervous system to process what happened without becoming overwhelmed.
Over several months, the patient might notice that their body’s panic response while driving begins to diminish. Their hands still tense up sometimes, but they can recognize it, breathe through it, and remind their body that they’re safe.
Managing Chronic Pain Connected to Emotional Stress
A patient might come to therapy dealing with chronic pain in their lower back that’s persisted for years. Medical tests haven’t found anything structurally wrong, but the pain is real and significantly impacts their daily life.
Their doctor suggests that stress might be contributing to the pain and refers them to therapy. The patient might be skeptical — their pain is physical, not psychological.
A somatic therapist would explain that while the pain is absolutely real, chronic stress can cause the body to hold tension in ways that create physical pain. When you’re under constant stress, your muscles stay tense, your breathing becomes shallow, and your nervous system remains in a heightened state of alert.
The therapist would begin with body awareness exercises. The patient might start noticing that their back pain is worse on particularly stressful days, and that it often intensifies when they’re worried or upset even if they’re not consciously aware of the emotional connection.
The therapist would teach breathing exercises that help regulate the nervous system and release some of the muscular tension contributing to the pain. They might practice progressive muscle relaxation, where the patient systematically tenses and then releases different muscle groups.
The patient might also learn to use movement as a way to process stress before it settles into their body as pain. When they notice themselves starting to feel stressed, they could take a short walk, do some gentle stretching, or practice the breathing techniques they learned in therapy.
The pain might not disappear completely, but it could become more manageable. More importantly, the patient would feel like they have some control over it rather than feeling victimized by unpredictable pain that seems to have no cause.
Releasing Emotions Held in the Body After Loss
After experiencing a significant loss, a person might come to therapy feeling numb. They know they should be grieving, but they can’t cry. They can’t really feel much of anything. Their chest feels heavy and tight, but no emotions will come.
A somatic therapist might recognize that the person’s grief is stuck. Sometimes when emotions are too overwhelming, the body shuts them down as a protective mechanism. But the feelings don’t go away — they get trapped.
The therapist would use somatic techniques to help the patient access and release the grief that’s locked in their body. The therapist might have them notice the heaviness in their chest and the tightness they describe. They would sit with those sensations together.
The therapist might ask questions like “If that tightness had a shape, what would it be?” or “If you could give that heaviness a color, what color would it be?” These questions help the patient connect to the physical experience of their grief without needing to find words for it.
Sometimes the therapist would guide them through gentle movement — pressing their hands into their chest where they feel the heaviness, or taking deep breaths and imagining space opening up where everything feels tight.
During a session, as the patient focuses on the sensation in their chest, they might suddenly start crying. Not controlled, polite tears, but deep, body-shaking sobs. The grief that had been trapped finally has a way out.
Working with the body’s physical response to loss can give patients access to emotions that they can’t reach through talking alone.
Building a Felt Sense of Safety After Years of Hypervigilance
Someone might come to therapy having grown up in an environment where they never felt safe. As an adult, they’re objectively safe — they have a stable job, supportive relationships, and no immediate threats in their life. But they can’t shake the constant feeling of being on edge.
Their nervous system is stuck in hypervigilance. They can’t relax. They startle easily. They scan every room for exits. Intellectually they know they’re safe, but their body doesn’t believe it.
A somatic therapist would explain that because the patient’s nervous system learned to stay alert during childhood, it doesn’t know how to shift into a calm, restful state. They need to teach their body what safety actually feels like.
The therapist might start with resourcing — identifying people, places, memories, or sensations that make the patient feel even slightly more at ease. This might be thinking about a pet, remembering a peaceful vacation, or visualizing a place where they felt calm.
The therapist would have them bring these resources to mind and notice what happens in their body. Does their breathing slow down? Do their shoulders drop even slightly? Does the tightness in their jaw ease just a bit?
They might practice orienting exercises, where the patient looks around the room and names things they can see, consciously noticing that they’re in a safe space in the present moment rather than in danger from the past.
Over time, the patient’s nervous system could begin to learn that it can relax sometimes. The hypervigilance might not disappear entirely, but they could start having moments — then minutes, then longer periods — where their body feels at ease.
When Somatic Therapy Makes Sense
Somatic therapy isn’t the only approach to healing, and it’s not always the first choice for everyone. But it can be particularly helpful when you notice that your struggles show up physically in your body, when talk therapy alone hasn’t been enough, when you feel disconnected from your body or your emotions, when you’ve experienced trauma that your body still seems to remember, or when you want a more holistic approach that addresses both mind and body.
At Flourish Psychology, our therapists are trained in somatic approaches and can help you determine whether this type of work would be beneficial for you. Sometimes somatic therapy is used as the primary approach. Other times it’s integrated with other modalities like CBT, DBT, or traditional talk therapy to create a more comprehensive treatment plan.
If you’re struggling with anxiety, trauma, chronic stress, or physical symptoms that seem connected to your emotional wellbeing, somatic therapy might offer a pathway to healing that addresses not just your thoughts and feelings, but also the way your body holds and processes your experiences.
Reach out to Flourish Psychology to learn more about how somatic therapy could help you reconnect with your body and find relief from the struggles you’re facing.
The Gottman Method has become one of the most well-known approaches to couples therapy. Many people seeking couples counseling look for it by name. Dr. John Gottman and his wife Dr. Julie Schwartz Gottman didn’t just theorize about what makes relationships work – they observed thousands of couples, tracked them over decades, and identified specific, measurable patterns that predicted whether a relationship would thrive or fail.
The research is compelling. Dr. Gottman’s studies claim to predict with over 90% accuracy whether a couple will stay together or divorce based on observing just a few minutes of their interaction. That’s not intuition or guesswork – it’s data-driven insight into the mechanics of successful partnerships.
But what exactly were the Gottmans looking for? What patterns did they find in couples who built lasting, satisfying relationships? And what behaviors consistently showed up in relationships that were heading toward dissolution?
At Flourish Psychology, the Gottman Method is one of the approaches we may use in our work with couples because it’s grounded in research and provides clear, actionable strategies for strengthening relationships. It is not the only approach, but it is one that – when it is a good fit – can help both partners recognize patterns in their relationship – both the strengths to build on and the vulnerabilities to address.
Dr. John Gottman’s research on relationships began in the 1970s and has continued for decades. His most famous study involved bringing couples into what he called the “Love Lab” – an apartment-like setting where couples were observed while they discussed areas of conflict in their relationship.
The couples were monitored for physiological responses like heart rate, blood pressure, and stress hormones while they talked. Their conversations were recorded and analyzed in detail, with researchers coding every interaction for specific behaviors, facial expressions, tone of voice, and word choice.
Then, the researchers followed up with these couples over time – sometimes for years or even decades – to see whether their relationships thrived, deteriorated, or ended in divorce. By comparing the early observations with the long-term outcomes, Gottman was able to identify which patterns predicted relationship success and which predicted failure.
What emerged from this research wasn’t vague advice about “communicating better” or “being more romantic.” It was specific, observable behaviors that either strengthened the relationship’s foundation or eroded it over time.
“The Four Horsemen” That Predict Relationship Failure
One of the Gottmans’ most significant findings was the identification of what they called the “Four Horsemen of the Apocalypse” – four communication patterns that, when present in a relationship, predict dissolution with remarkable accuracy.
Criticism – This is different from offering a complaint or expressing frustration about a specific behavior. Criticism attacks the person’s character rather than addressing the behavior. Instead of “I feel hurt when you don’t call to let me know you’ll be late,” criticism sounds like “You’re so inconsiderate – you never think about anyone but yourself.” Criticism makes the other person feel attacked, judged, and defensive rather than heard and understood.
Contempt – Contempt is the most toxic of the Four Horsemen and the single greatest predictor of divorce. It involves treating your partner with disrespect, mockery, or disgust. This includes eye-rolling, sarcasm, name-calling, sneering, and hostile humor. Contempt communicates “I’m better than you” and creates a power imbalance that makes genuine connection impossible.
Defensiveness – When criticized or attacked, it’s natural to defend yourself. But defensiveness doesn’t actually protect you – it escalates the conflict. Defensiveness sounds like “It’s not my fault,” “You’re the one who,” or “I didn’t do anything wrong.” It blocks accountability, prevents problem-solving, and communicates that you’re not willing to take responsibility for your part in the issue.
Stonewalling – Stonewalling happens when one partner completely shuts down and withdraws from the interaction. They stop responding, make no eye contact, and essentially put up a wall. This often happens when someone is physiologically overwhelmed and can’t continue the conversation. But to the other partner, it feels like abandonment and rejection.
These four patterns don’t mean a relationship is doomed. But they are a big warning sign that something needs to be changed. When they become habitual – when they’re the default way a couple handles conflict – the relationship is in serious trouble. The good news is that recognizing these patterns is the first step in changing them, and the Gottman Method provides specific tools for interrupting these destructive cycles.
What Successful Couples Do Differently
While the Four Horsemen predict relationship failure, Gottman’s research also identified what successful couples do consistently that keeps their relationships strong.
They Turn Toward Each Other Instead of Away
In successful relationships, partners make what Gottman calls “bids for connection” – small requests for attention, affection, or engagement. This might be as simple as “Look at that bird” or “Did you see this article?” or “I had a rough day.”
Successful couples “turn toward” these bids. They respond with interest, attention, and engagement. They look up from their phone. They ask follow-up questions. They acknowledge their partner’s attempt to connect.
Unsuccessful couples “turn away” – they ignore the bid, respond dismissively, or show no interest. Over time, these small moments of disconnection erode the relationship’s foundation and leave both partners feeling lonely and unimportant.
They Maintain a Positive Perspective
Successful couples maintain what Gottman calls a “positive perspective” on their relationship and their partner. They focus on what’s working rather than what’s wrong. They give their partner the benefit of the doubt. When there’s a problem, they see it as something to solve together rather than evidence that the relationship is failing.
This positive perspective acts as a buffer during difficult times. When conflict arises, couples with a strong foundation of positive feeling are better able to navigate it without the relationship feeling threatened.
They Practice Repair Attempts
All couples fight. The difference between successful and unsuccessful couples isn’t whether conflict happens – it’s what they do during and after conflict.
Successful couples make “repair attempts” – efforts to de-escalate tension, inject humor, or acknowledge when things are getting out of hand. This might be saying “This is getting too heated – can we take a break?” or “I’m sorry, I didn’t mean that the way it sounded” or even just making a silly face to lighten the mood.
In healthy relationships, these repair attempts work. Both partners are willing to step back, de-escalate, and reset. In unhappy relationships, repair attempts are either not made at all, or they’re rejected when they are made.
They Maintain a Strong Friendship
One of Gottman’s most important findings is that successful couples aren’t just romantic partners – they’re friends. They know each other deeply. They’re interested in each other’s lives. They enjoy spending time together.
This friendship is built on what Gottman calls the “Sound Relationship House,” which includes building love maps (knowing the details of your partner’s inner world), sharing fondness and admiration, and turning toward each other in everyday moments.
Couples who maintain this friendship foundation can weather challenges that would break relationships without that connection.
The 5:1 Ratio – The Magic Number for Relationship Success
One of Gottman’s most famous findings is the “magic ratio” – successful couples have at least five positive interactions for every one negative interaction.
This doesn’t mean that conflict should be avoided or that you can’t express frustration or disagreement. It means that the overall balance of your interactions needs to be weighted heavily toward the positive. Compliments, expressions of appreciation, affection, humor, support, and acts of kindness need to far outweigh criticism, complaints, and conflict.
In relationships that are heading toward dissolution, this ratio flips. Negative interactions outnumber positive ones, creating a climate of negativity that makes every interaction feel like a potential conflict.
They Manage Conflict Effectively
Gottman’s research found that 69% of relationship conflicts are perpetual – they’re based on fundamental differences in personality, needs, or lifestyle preferences that aren’t going to change. Successful couples don’t solve these problems. They learn to manage them.
Managing perpetual conflict means accepting that your partner is different from you in some fundamental ways, finding ways to live with those differences without resentment, maintaining humor and affection even when discussing areas of ongoing disagreement, and preventing these issues from defining the relationship or overshadowing what’s working.
Unsuccessful couples get stuck trying to solve unsolvable problems. They fight the same fight over and over, each time hoping their partner will finally change. This creates frustration, resentment, and eventually contempt.
They Create Shared Meaning
Successful couples build a sense of shared purpose and meaning in their relationship. They have rituals, traditions, and routines that connect them. They share values and goals. They create a life together that feels meaningful and intentional.
This shared meaning gives the relationship a sense of purpose beyond just coexisting. It creates a “we” identity that helps both partners feel like they’re building something together rather than just managing parallel lives.
The Importance of Physiological Regulation
One of Gottman’s most interesting findings from the Love Lab was the role of physiological arousal in conflict. When heart rate goes above a certain threshold (around 100 beats per minute for most people), the body goes into fight-or-flight mode. At that point, productive conversation becomes impossible.
Successful couples recognize when they’re getting physiologically flooded and take breaks to calm down before continuing difficult conversations. They understand that trying to resolve conflict when both partners are in a heightened state doesn’t work – it just escalates the situation.
This is why Gottman-trained therapists teach couples to monitor their own arousal levels and to implement structured timeouts when necessary – not as a way to avoid conflict, but as a way to have more productive conversations when both partners are calm enough to actually hear each other.
How the Gottman Method Uses This Research in Therapy
The Gottman Method translates this research into practical interventions that couples can use to strengthen their relationship. In Gottman Method couples therapy, couples learn to recognize and interrupt the Four Horsemen when they show up, practice turning toward each other’s bids for connection, build friendship through structured exercises and conversations, improve conflict management skills, increase positive interactions to restore the 5:1 ratio, and create shared meaning and rituals that strengthen the relationship’s foundation.
Couples counseling using the Gottman Method isn’t about venting your feelings or blaming your partner. It’s about learning specific, research-based skills that strengthen the relationship’s foundation and improve your ability to navigate conflict together.
What This Means for Your Relationship
The power of Gottman’s research is that it takes the mystery out of relationship success. You don’t have to guess what makes relationships work – the data shows what successful couples do differently.
If you recognize the Four Horsemen showing up in your relationship, that’s important information. It doesn’t mean your relationship is doomed, but it does mean you need to actively work on changing those patterns before they become entrenched.
If you see that your positive-to-negative ratio is off, you can deliberately increase positive interactions. If you notice you’re turning away from your partner’s bids for connection, you can start turning toward them instead. If you realize you’re trying to solve perpetual problems rather than manage them, you can shift your approach.
The research also makes it clear that waiting until your relationship is in crisis to seek help isn’t ideal. The patterns that Gottman identified develop over time, and they’re easier to change when they’re just beginning than when they’ve been reinforced for years.
Getting Support for Your Relationship
Whether your relationship is struggling or you just want to strengthen what’s already working, couples therapy can help. The Gottman Method is one option that provides a roadmap for building a stronger partnership based on decades of research into what actually works.
At Flourish Psychology, our therapists are trained in the Gottman Method and can help you identify the patterns in your relationship, interrupt destructive cycles, and build the skills that successful couples use to navigate conflict and maintain connection.
Depression can have many symptoms and take many forms. But one of the more common symptoms may not feel like a mental health symptom at all. Depression affects sleep, often in complex, biological ways.
Some people with depression struggle to fall asleep or wake up multiple times during the night. But for others, the problem is the opposite — they sleep constantly. Twelve hours, fourteen hours, sometimes more. They wake up exhausted, go through the day in a fog, and collapse back into bed as soon as possible.
If you’re sleeping excessively and still feeling drained, it may be a symptom of depression. Depression can fundamentally change how your body regulates sleep, and while some parts of it are directly related to thoughts and feelings, others are related to the way that depression rewires and affects hormones in the brain.
How Depression Affects Sleep Regulation
Depression doesn’t just make you feel sad or hopeless. It disrupts the biological systems that control sleep, energy, and alertness.
Your brain relies on neurotransmitters like serotonin, dopamine, and norepinephrine to regulate mood, motivation, and wakefulness. Depression typically involves imbalances in these chemicals, which means the systems that keep you alert and energized during the day aren’t functioning properly. When these neurotransmitters are depleted or dysregulated, your brain struggles to maintain normal wakefulness, and sleep becomes the default state.
Depression also affects your circadian rhythm — the internal clock that tells your body when to sleep and when to wake up. When this rhythm is disrupted, you can feel tired all the time regardless of how much you sleep. Your body loses the ability to distinguish between rest time and active time, so exhaustion becomes constant.
The result is hypersomnia, which is the clinical term for excessive sleeping. People with hypersomnia sleep far more than the typical seven to nine hours but wake up feeling just as tired as when they went to bed. The sleep isn’t restorative because the underlying brain chemistry issues remain unresolved.
Depression and Fatigue
Depression causes profound physical and mental fatigue that goes beyond ordinary tiredness. Everything feels harder — getting out of bed, making decisions, holding conversations, even basic tasks like showering or eating. This overwhelming exhaustion makes sleep feel like the only relief available.
Part of this fatigue comes from the mental and emotional work depression creates. Your brain is constantly processing negative thoughts, managing feelings of worthlessness or hopelessness, and fighting against the weight of despair. That takes enormous energy, even if you’re not consciously aware of it. By the end of the day — or even by mid-morning — your brain is depleted, and sleep becomes the easiest escape.
Depression also reduces motivation and interest in activities that would normally energize you. When nothing feels rewarding or enjoyable, there’s no reason to stay awake. Sleep becomes preferable to facing another day where everything feels pointless.
For some people, excessive sleep also functions as avoidance. When you’re asleep, you’re not dealing with the pain, the negative thoughts, or the overwhelming sense that nothing will get better. Sleep offers a temporary reprieve from the emotional burden of depression, which makes it incredibly appealing even when you’ve already slept for hours.
Why Some People Sleep More While Others Sleep Less
Not everyone with depression experiences hypersomnia. Some people develop insomnia instead, lying awake for hours unable to shut off their racing thoughts or falling asleep only to wake up repeatedly throughout the night.
The type of depression you have can influence which sleep pattern emerges. People with atypical depression — a subtype characterized by mood reactivity, increased appetite, and sensitivity to rejection — are more likely to experience hypersomnia. Those with melancholic depression, which involves a persistent inability to feel pleasure and early morning waking, tend toward insomnia instead.
Your brain chemistry, stress levels, and individual physiology also play a role. Some people’s bodies respond to depression by shutting down and conserving energy, leading to excessive sleep. Others experience heightened anxiety or rumination that keeps them awake despite their exhaustion.
Treatment Options for Depression-Related Hypersomnia
If depression is causing you to sleep excessively, treatment needs to address both the depression and the sleep disturbance.
Therapy — particularly Cognitive Behavioral Therapy (CBT) — helps identify and challenge the negative thought patterns that fuel depression and the behaviors that reinforce excessive sleep. CBT for insomnia can be adapted to address hypersomnia by focusing on sleep restriction, activity scheduling, and gradual reintroduction of structure and routine.
Light therapy can help reset your circadian rhythm, especially if you’re sleeping through daylight hours. Regular exposure to bright light in the morning signals your brain that it’s time to be awake and alert, which can gradually restore a more normal sleep-wake cycle.
Establishing a consistent sleep schedule — even when you don’t feel like it — helps retrain your body’s internal clock. Going to bed and waking up at the same time every day, limiting naps, and creating boundaries around sleep can gradually reduce hypersomnia.
Another option is exercise. Physical activity, though difficult when depression saps your energy, can improve both mood and sleep quality. Even short walks or gentle movement can help regulate your sleep cycle and boost the neurotransmitters that depression depletes.
Getting Help for Depression and Sleep Problems
If you’re sleeping excessively and feeling trapped in a cycle of exhaustion and depression, reaching out for professional support can help you break that pattern. Depression-related hypersomnia responds well to treatment, but it requires addressing the underlying depression rather than just trying to force yourself to sleep less.
Flourish Psychology’s therapists in Brooklyn specialize in treating depression and understand how sleep disturbances complicate recovery. We use evidence-based approaches like CBT and other modalities to help you regain control over your sleep, your energy, and your life.
You can reach Flourish Psychology at 917-737-9475 to schedule a consultation, or connect through the website to learn more about services and availability.
Do You Mentally Prepare for Conversations That Haven’t Happened?
You’re lying in bed at 11 PM, trying to fall asleep, when your brain decides it’s the perfect time to rehearse tomorrow’s conversation with your boss. You run through what you’ll say, how they’ll respond, what you’ll say back. You plan for every possible objection, every dismissive comment, every worst-case scenario.
Or maybe you’re in the shower, mentally replaying a text message you sent three hours ago, crafting better versions of what you should have said. You imagine the other person’s reaction, prepare your defense, plan your follow-up.
This mental rehearsal – this constant preparation for conversations, confrontations, and scenarios that may never happen – is one of the most common patterns therapists see in people struggling with anxiety, and while it feels productive, like you’re getting ready for something important, it’s actually keeping you stuck in a cycle of worry and stress.
What Is Mental Rehearsal?
Mental rehearsal is when you repeatedly imagine future conversations, events, or confrontations in your mind. You script out what you’ll say, anticipate how others will respond, and plan your reactions to their responses. Sometimes you’re rehearsing something that’s actually scheduled to happen. Other times, you’re preparing for conflicts or conversations that exist only in your imagination.
This pattern shows up in different ways for different people. Some people mentally rehearse difficult conversations with partners, preparing for fights that haven’t started. Others rehearse work presentations over and over, imagining every question that could be asked. Some people rehearse explanations or defenses for situations that haven’t even occurred yet.
The problem is that mental rehearsal rarely stops at one run-through. You rehearse the conversation, then you revise it. You think of a better response, so you run through it again. You imagine a new objection, so you prepare for that too. Before you know it, you’ve spent 30 minutes or an hour mentally preparing for a conversation that might take five minutes – or might not happen at all.
Why Your Brain Does This
Mental rehearsal isn’t random. Your brain has a reason for doing this, even if it’s not helping you.
It Feels Like Control — When you’re anxious about something, your brain looks for ways to manage that anxiety. Mental rehearsal creates the illusion of control. If you can anticipate every possible response, plan every counterargument, you feel more prepared. The problem is that real conversations don’t follow scripts, and the more you rehearse, the more anxious you become about deviating from your mental plan.
It’s Avoidance In Disguise — Mental rehearsal can be a way to avoid actually dealing with uncomfortable situations. As long as you’re “preparing,” you don’t have to take action. You can tell yourself you’re being productive when you’re actually procrastinating or avoiding the real issue.
Every time you mentally rehearse a difficult conversation, you’re reinforcing the idea that the conversation is something to fear. Your brain doesn’t distinguish between imagined threats and real ones, so rehearsing a confrontation triggers the same stress response as actually having it. The more you rehearse, the more anxious you become about the real thing.
When you’re constantly running through future scenarios in your mind, you’re not fully engaged in what’s happening right now. You miss conversations happening in front of you because you’re too busy preparing for ones that haven’t happened yet.
How CBT Addresses Mental Rehearsal
Cognitive Behavioral Therapy offers specific, practical tools to interrupt this pattern and help you respond differently when your brain wants to start rehearsing.
Identifying The Pattern — The first step in CBT is recognizing when you’re doing this. Many people rehearse conversations so automatically that they don’t even realize it’s happening. CBT helps you become aware of the pattern – noticing when your mind shifts from the present moment to mentally preparing for future scenarios.
Examining The Thoughts — Once you recognize the pattern, CBT helps you look at the thoughts driving it. What are you afraid will happen if you don’t rehearse? What do you think you’re accomplishing by going through the conversation in your mind? Often, you’ll find that the mental rehearsal is based on assumptions that aren’t accurate.
Challenging Cognitive Distortions — Mental rehearsal is often fueled by cognitive distortions – thinking errors that make situations seem worse than they are. Common distortions include catastrophizing (assuming the worst possible outcome), mind reading (assuming you know what the other person will say or think), and fortune telling (predicting negative outcomes with certainty). CBT helps you identify these distortions and challenge them with more balanced, realistic thoughts.
Testing Your Predictions — One of the most effective CBT techniques is behavioral experiments – testing whether your predictions actually come true. If you’re mentally rehearsing a conversation because you’re convinced it will go badly, CBT encourages you to have the conversation without all the preparation and see what actually happens. Often, you’ll find that your predictions were wrong, and the conversation went differently than you imagined.
Developing Tolerance For Uncertainty — Mental rehearsal is often driven by a need for certainty and control. CBT helps you build tolerance for not knowing exactly how a conversation will go, for being unprepared in the moment, for trusting yourself to respond appropriately without a script. This is uncomfortable at first, but it’s useful for breaking the rehearsal pattern.
These CBT techniques give you tools to interrupt the mental rehearsal loop and redirect your attention to the present moment. Over time, you learn to trust yourself in real conversations without needing to prepare for every possible outcome.
What This Looks Like in Practice
In CBT sessions, addressing mental rehearsal might look like this:
You come to therapy reporting that you spent two hours last night mentally preparing for a conversation with your partner about household responsibilities. Your therapist helps you identify the thoughts driving the rehearsal – maybe you’re afraid your partner will get defensive, or you’re worried you won’t be able to articulate your needs clearly.
Together, you examine whether those fears are based in reality or distorted thinking. Your therapist might ask whether past conversations have actually gone the way you predicted, or whether your partner has shown the ability to hear your concerns without becoming defensive.
Then you work on an alternative approach. Instead of rehearsing the conversation, you might practice grounding techniques to stay present. You might identify the core point you want to make and trust yourself to communicate it without a script. You might even intentionally have the conversation without any preparation and observe what happens.
This process doesn’t happen all at once. Breaking the mental rehearsal habit takes time and repeated practice. But with consistent work, you start to notice the pattern earlier, challenge it more effectively, and trust yourself more in real-time conversations.
When to Seek Support
Mental rehearsal becomes a problem when it’s taking up significant time, interfering with your sleep or daily activities, increasing your anxiety rather than reducing it, or preventing you from being present in your actual relationships and interactions.
If you find yourself spending hours mentally preparing for conversations, replaying interactions over and over in your mind, or feeling more anxious despite all your preparation, it might be time to work with a therapist who specializes in CBT.
At Flourish Psychology, our therapists use evidence-based CBT techniques to help clients break free from patterns like mental rehearsal and develop healthier ways of managing anxiety and uncertainty. If you’re ready to stop spending so much mental energy preparing for conversations that haven’t happened and start being more present in your actual life, we can help.
Call (917) 737-9475 or fill out our from to schedule an appointment with one of our NYC therapists who specializes in Cognitive Behavioral Therapy.
Location: 300 Cadman Plaza West Floor 12 - Brooklyn, NY 11201
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