Are you scrolling through the ever-worrysome newsfeed, searching for the next update on what else is going on in this chaotic world?
You’re not alone. From Iran to Gaza, Ukraine to Mexico, the world feels like a constant emergency, demanding our attention. And when I say attention, I mean the human consciousness itself: that sense of guilt when witnessing the suffering of people caught behind politicians’ decisions. Attention that carries discomfort, weight, and tension.
Out of this environment, something deeper than simple worry begins to grow. It is a kind of chronic anxiety that begins to feel almost inseparable from our everyday life.
We go online, we scroll through news and commentary, and within minutes we are confronted with politics, wars, ideological battles, and endless arguments about what is right and what is wrong. The world begins to look like a chaotic arena of competing narratives. On one side we see ideological movements pushing boundaries further and further. On the other side we see strong resistance and reaction. Each camp claims an absolute truth and certainty. Each claims moral clarity. And somewhere in the middle sits the ordinary observer, trying to make sense of it all.
The human mind naturally tries to classify information. We want to know who is right and who is wrong. Which country is the aggressor, which one is the victim. Who represents justice, and who represents danger. But reality rarely offers such simple answer. At the same time, we are witnessing wars unfold and grow in real time. Images of destruction circulate constantly. Reports appear hour after hour. Political alliances shift, tensions rise, and commentators speculate about what might happen next. Even when we are geographically far from these conflicts, our minds absorb them as part of our psychological environments. Conflicts are layered, historical, and deeply complex. Yet our minds continue searching for clear moral categories because uncertainty itself is psychologically uncomfortable.
This produces a strange emotional mixture. On one hand there is anger. Anger at violence, at political decisions, at the apparent irrationality of the world. On the other hand there is a deep sense of helplessness. What exactly can an individual do while sitting in an office or at home, scrolling through headlines? One reads more articles, watches more analysis, tries to understand the situation better. But often the only result is that the anxiety quietly grows.
The mind can easily become trapped in this cycle. More information leads to more questions. More questions lead to more uncertainty. And uncertainty feeds anxiety. The individual begins to feel psychologically entangled in a global chaos that has no clear endpoint.
Media ecosystems further amplify this effect. Different channels promote different narratives. Some support one political position, others attack it. Each interpretation intensifies emotional reactions in its audience. Instead of clarity, the result is often psychological overload.
When the mind is exposed to this atmosphere day after day, it can begin to internalize a darker conclusion: that everything is unstable, everything is deteriorating, and nothing is likely to improve. If this pattern becomes dominant, anxiety may gradually give way to something heavier—a sense of meaninglessness or even depressive thinking. If the world appears permanently broken, motivation itself can start to fall apart.
In this sense, global crises, media amplification, and the human need for certainty form a powerful psychological triangle. Together they shape the emotional landscape of modern life and quietly influence how we think, feel, and interpret the future.
So what to do, would be the adequate question?
Creating Psychological Distance: Protecting the Mind in an Age of Constant Crisis
While we cannot stop global conflicts or political chaos from unfolding, we can learn to regulate how much psychological space they occupy in our minds. The goal is not ignorance or indifference, but healthy distance from the constant stream of distressing information.
Below are several simple techniques that can help interrupt the cycle of anxiety and information overload.
1. Information Boundaries
One of the simplest but most effective strategies is limiting exposure to distressing news.
Continuous scrolling activates the brain’s threat detection systems again and again. Instead of being informed, the mind becomes flooded with signals of danger. Switch off the notifications from news outlets and check the news once or twice a day. (Hey, if something too bad has happened or is to happen – you will learn about it anyway!)
2. The Cognitive “Stop” Technique
A classic tool from Cognitive Behavioral Therapy is the STOP technique.
When you notice your mind spiraling into catastrophic thinking (“Everything is collapsing”, “This will only get worse”), mentally say “Stop.”
Then pause and ask yourself:
What am I actually thinking right now?
Is this a fact, or a prediction?
Do I have evidence for this conclusion?
This interrupts the automatic chain between thought → anxiety → more catastrophic thoughts.
3. Controlled Breathing to Calm the Nervous System
Anxiety is not only cognitive—it is physiological.
Slow breathing can signal to the nervous system that the body is safe.
A simple exercise:
Inhale slowly for 4 seconds
Hold for 4 seconds
Exhale slowly for 6 seconds
Repeat for 2–3 minutes
This activates the parasympathetic nervous system, which reduces stress responses.
4. Mindful Awareness Instead of Mental Immersion
Instead of mentally absorbing every crisis, try observing your reaction itself.
Notice:
“I feel tension reading this.”
“My mind is predicting the worst outcome.”
“My body is reacting as if this threat is immediate.”
This form of mindful awareness creates a small but important space between the event and your emotional response.
As a conclusion, I want to specifically highlight that: The modern mind is exposed to far more information about suffering, conflict, and uncertainty than any previous generation in history. Protecting one’s psychological boundaries is not denial – it is a necessary skill for maintaining clarity, empathy, and emotional balance in an overwhelming world.
About the Author
Arsen Aghasyan is a communications expert and clinical mental health enthusiast with over a decade of experience in international organizations including the OSCE, KfW Development Bank, MSF and IPC GmbH. His interests lie at the intersection of psychology, technology, and communication — exploring how emerging tools like AI are reshaping human thought and connection.
By Elina ASRIYAN, Davit GEVORGYAN,Lilit MESROBYAN, Mher NAGHDALYAN
DOI: 10.24234/wisdom.v23i3.848
Abstract: This article aims to present the analysis of systematic approaches to the treatment of PTSD and war-related mental health issues adopted in Armenia and to illuminate possible differences and similarities between the latter and the best practices implemented in the USA. The analysis of the aforementioned mental health systems has been carried out based on three main axes: general treatment management, diagnosis and treatment planning, treatment and subsequent follow-up. As a result, we have concluded that despite the absence of a regulatory framework of the Armenian mental health system and the lack of a well-thought-out organization of patient admission, therapy and follow-up procedure, the model in place has more similarities than differences with the U.S. system. In particular, the therapeutic modalities, the format of psychotherapy, and the clinical supervision of specialists implemented in the psychological centres across Armenia are in line with U.S. standards. Nevertheless, as the psychological assistance delivered to veterans is not regulated on a national level and as there is currently a significant lack of institutional and professional resources, the improvement of the efficiency and the quality of mental health services in Armenia remains an important challenge
Introduction
In recent years the world has witnessed many armed conflicts such as wars in Iraq, Lebanon, Nagorno-Karabakh (Artsakh), Ukraine etc. Along with physical destruction of infrastructures, losses of human lives and other apparent consequences, the effects of war include long-term psychological harm to people directly or indirectly involved in armed conflicts and even their family members. In particular, people who have been exposed to traumatic events, i.e. shocking, scary, or dangerous experiences (Coping with traumatic events, n.d.), may later develop PTSD (post-traumatic stress disorder), a specific syndrome from which, according to some estimates suffer around 354 million adult war survivors worldwide (Hoppen & Morina, 2019).
Previously called by different names such as “shell shock”, “battle fatigue”,and “war neurosis”, the term PTSD first appeared in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll) published by the American Psychiatric Association (Crocq & Crocq, 2000) and is actually a household name for the disorder that may develop after exposure to exceptionally threatening or horrifying events (Bisson, 2015). Pursuant to the Evaluation of the Department of Veterans Affairs Mental Health Services (2018) (hereinafter referred to as “Evaluation”) military-related traumatic events that may trigger PTSD include exposure to war, threatened or actual physical assault, threatened or actual sexual assault, being taken hostage, torture, incarceration as a prisoner of war, and motor vehicle accidents. With some differences between the diagnostic criteria of DSM-5 and ICD-11, in order to diagnose PTSD, both classifications require exposure to the threatening, horrific event, followed by symptoms of intrusion (re-experiencing of the traumatic event(s) in the present day with emotions of fear or horror), avoidance (avoidance of traumatic reminders), alterations in arousal and reactivity (sense of a current threat manifested as hypervigilance and/or an exaggerated startle response) (Haravuori, Kiviruusu, Suomalainen, & Marttunen, 2016; Trauma-informed care in be-havioural health services, 2014; Bisson, 2015). As it can be inferred from the joint analysis of generally accepted symptoms of PTSD, if not treated properly, the latter may lead to significant psychological, social and physical complications and adaptation problems. The use of psychological interventions, namely cognitive behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE) and cognitive processing therapy (CPT), are regarded as effective treatments for PTSD by a range of authoritative sources such as the APA guidelines, VA/DoD guideline, NICE guideline (Megnin-Viggars, Mavranezouli, Greenberg, Hajioff, & Leach, 2019; Watkins, Sprang, & Rothbaum, 2018). Research and systematic improvements in PTSD treatment approaches are of particular importance in countries that are periodically or have at least once been involved in an armed conflict. This is due to the fact that PTSD symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning (VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder, 2017), which eventually affects the general working ability of these persons. Moreover, PTSD among military personnel may create risks to the proper replenishment of the armed forces. In particular, mental disorders have been shown to be the most common reason for leaving military service, compared to hospitalization for any other disease category (Hoge et al., 2002; The occupational burden of mental disorders in the U.S. military: Psychiatric hospitalizations, involuntary separations, and disability, n.d.). This is why the mental health of military personnel and veterans should be a priority for state bodies. Among other factors, the probability of over-coming a mental disorder largely depends on the effectiveness of the psychological intervention. Implementation of an effective system of PTSD treatment requires addressing issues regarding treatment accessibility, proper diagnosis, treat-ment,and follow-up. This study aims at analyzing the methodological approaches to the treatment of PTSD in the Armenian mental health system in comparison with the best practice implemented in the United States of America. In order to accomplish this research objective, our study was divided into four different phases: 1. Creating a Questionnaire in order to evaluate the process of general treatment management, diagnosis and treatment of veterans. 2. Choosing the centres in Armenia focused on the treatment of veterans and collecting the data. 3. Research on the U.S. best practices of veter-ans’ mental health treatment.4. Comparative analysis. So in order to examine the existing practice in Armenia, we have developed a questionnaire based on the main sections of the OEF/OIF/OND Veterans’ Access to Health Services Survey, presented in the framework of the Evaluation of the Department of Veterans Affairs Mental Health Services (2018). The questionnaire (31 questions) consisted of open and closed questions aimed at identifying specific information related to the following three areas:
1.General management of treatment/therapy.
2.Diagnosis and treatment/therapy planning.
3.Treatment/therapy and subsequent follow-up
In the second stage, we have selected fifteen psychological centres operating in Armenia and have sorted out eight of them that have a proven intensive track record of working with patients suffering from war-related PTSD (mostly veterans) since at least 2020. After selection, we conducted semi-structured interviews with the heads and specialists of the said psychological centres/ departments based on the specially designed questionnaire. As for the analysis of the U.S. best practices, which comprised the third step of our research, we have conducted thorough research of available scientific articles and publications (mainly on PubMed) regarding the aforementioned topics (general management of treatment/therapy, diagnosis and treatment/therapy planning, treatment/therapy and subsequent follow-up). Organizational issues pertaining to veterans’ mental health care system were analyzed based on the information available on official governmental websites.
Research Overview: General Management of Treatment/Support
U.S. Department of Veterans Affairs (VA) is the second largest agency of the federal government on the basis of the number of employees and has three administrations – the Veterans Health Administration (VHA), the Veterans Benefits Administration, and the National Cemetery Admin-istration. The VA is responsible for overseeing the U.S. largest integrated health care system, providing health care to approximately nine million veterans at 1243 different health care facilities (Greenstone et al., 2019) and offering education opportunities, rehabilitation services and various compensation to veterans and their family members. In particular, as we can find out on Department’s webpage (PTSD Treatment Programs, 2007), VA offers specialized outpatient PTSD programs (SOPPs), where group or one-to-one outpatient treatment is offered. Outpatient mental health services are provided to veterans at VA medical centres (Evaluation of the department of veterans’ affairs mental health services, 2018).
Furthermore, the VA offers specialized intensive PTSD programs (SIPPs), which provide PTSD treatment services in an inpatient or residential setting. According to the “Guide to VA mental health services for Veterans & Families” (Sullivan et al., n.d.), in-patient care may be of-fered to veterans in need of intensive intervention, e.g. suicidal veterans or veterans suffering from very severe or life-threatening illness. Pursuant to the Evaluation, the inpatient program is most commonly located within a VA medical centre or a non-VHA community facility that has an agreement with the VHA. For veterans with a diagnosis of severe and persistent mental illness or severe functional impairment, the U.S. Department of Veterans Affairs (VA) has developed mental health intensive case management (MHICM) program, which operates at VA facilities. MHICM program also is applicable for those with mental illness who are inadequately served by standard outpatient care, have high hospital usage, and are clinically appropriate for outpatient care. MHICM services are “delivered by an integrated, interdisciplinary team that serves as a “fixed point of clinical re-sponsibility” with a focus on frequent contacts, flexibility, community orientation, integration with medical and mental health services provided at the VA system, and natural support systems, rehabilitation, and transition to self-care, independent living, and competitive employment where possible” (Mohamed, Neale, & Rosen-heck, 2009). According to the Evaluation, the VA provides mental health care that is generally of comparable or superior quality to mental health care that is provided in the private and non-VA public sectors, but the accessibility and quality of mental health care services across the system vary by facility. In Armenia, no standards are set for procedures covering psychological assistance in general and psychological rehabilitation for veterans in particular, which is primarily due to the lack of a specific legal framework and a well-thought-out approach and policy in the field of mental health. And as a result, there is no state or umbrella professional institution that regulates and organizes the delivery of mental health services to veterans and other stakeholders.
It is noteworthy that despite the fact that after the war that took place in 2020, the Armenian government undertook an unprecedented initiative to consolidate psychological centres and ser-vices across Armenia and create a consortium of organizations working with the military personnel and their families, no unified regulation of consortium’s activity, nor a general structure, direction and methodology of work has been put in place. As a result, we get a methodologically wrong situation where each individual centre applied its own methodology of therapeutic and effectiveness assessment and understanding of the clinical needs of veterans.
Also, since the government’s efforts were primarily directed at providing veterans with their first psychological aid in a short period of time (the program lasted 6 months), the organization of a unified veteran’ mental health system has not been setout as a priority. In December 2021, the state program ended, but the need for psychological rehabilitation of veterans and their families has remained. Since then, this need has partly been covered by private psychological centres (most of which have been surveyed in the framework of this study) on a volunteer basis or based on the means received from international grants, which has not, however, proved to ensure the provision of an effective, systematic and sus-tainable rehabilitation service.
When addressing the issues related to the implementation of an effective mental health system, one of the first questions is the initiation of to the implementation of an effective mental health system, one of the first questions is the initiation of mental health treatment. Some research has proven, awareness of mental health services for veterans is one of the main barriers that affect the decision to seek or not to seek help (Bovin et al., 2019). As it may be inferred from our findings, the vast majority of patients who have received mental health diagnoses in the U.S. are seen in primary care (Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment, n.d.). Therefore, general practitioners play gatekeeper roles and decide whom to refer for psychological therapies (Stavrou, Cape, & Barker, 2009). As stated in the Evaluation, eligible veterans enrolled to receive VHA health care can access mental health care services in outpatient, inpatient, and residential settings in several ways, such as by going to a VHA facility or a Vet Center on their own, by receiving their mental health services within the primary care setting, or entering the VHA health care system via emergency service departments, either at VHA facilities or at civilian hospitals.
In Armenia, psychological support is mainly provided by private psychological centres. Therefore, people in need of help (including veterans and their families) mostly find specialists and/or mental health services by themselves. This fact has also been confirmed by the results of our research (see Fig. 1), which suggests that the vast majority of veterans who applied to the surveyed centres for psychological help found their contacts through the internet and/or the media. In addition, as we may infer from the collected data, state/international institutions, as well as primary care physicians, referred veterans to psychosocial centres in only half of the centres.
Figure 1: How Do Veterans Generally Learn about or Find Psychosocial Services in Armenia?
Any healthcare program or system requires detailed methodological regulatory standards and codes that define the scope, modalities, mechanisms, limits and ethical rules for services. The Veterans Health Administration (VHA) Handbook (2008), which defines the minimum clinical requirements for VHA Mental Health Ser-vices, acts as a fundamental document in U.S. practice. This VHA Handbook incorporates the new standard requirements for VHA Mental Health Services nationwide. It also specifies the services that must be provided at each Department of Veterans Affairs (VA) Medical Center and each Community-Based Outpatient Clinic (CBOC).
The VHA Handbook defines the responsibilities of different types of mental health providers, the principles of their collaboration and co-management, the principles of the Consensus Statement (National Consensus Statement on Mental Health Recovery, n.d.), the mechanisms of the services’ implementation, the structure, management, reporting and monitoring of services, the inpatient and outpatient services system, the principles of care transitions, psychosocial rehabilitation and recovery services, etc. As already noted, there is no general regulation of psychological services for veterans in Armenia. However, half of the surveyed centres claimed that they have internal regulations of services that include a general description of the main stages of work with veterans, methods for assessing their mental health, as well as temporal and technical features of the services provided. But it is obvious that this is not enough to provide a systematic approach to rehabilitation.
Another important consequence of the unregulated mental health services system is that half of the organizations surveyed do not have any limitations on veterans’ comorbid disorders. This means that in half of the cases, all veterans, regardless of their mental, neurological and somatic status, are admitted into treatment/psychotherapy without proper evaluation conducted by specialized professionals. The VHA Handbook also does not mention any restrictions for the provision of psychological services to veterans with comorbid disorders in the U.S.;however, this issue is covered by the presence of a variety of narrowly targeted health programs with a well-functioning referral system designed for veterans. Obviously, this is not the case in Armenia.
Nevertheless, half of the surveyed Armenian organizations noted as a limitation the presence of severe neurological disease, cognitive impairment or brain injury, as well as substance addiction and mental retardation.
There is a strict distinction between psychological problems/services and psychiatric disorders/treatment in Armenia. Thus, 7 out of 8 organizations provide only outpatient services, and only one organization has an inpatient service, but it does not provide psychiatric treatment. Most veterans with psychiatric disorders (psychosis, bipolar disorder, etc.) receive pharmacological treatment either in a special military psychiatric unit or in civilian psychiatric clinics. It needs to be emphasized that in these clinics, psychosocial services are secondary and generally not carried out at the proper level. In contrast, in the U.S., both psychiatric and psychological inpatient treatments are well-integrated into the unified Mental Health Treatment Programs, which ensures more flexibility and effectiveness in the provision of mental health services.
Diagnosis and Treatment Planning
Concerning the diagnostic evaluation process, it should be noted that in the U.S.,the assessment of PTSD may include both initial screenings used for the identification of exposure to a stressor (DSM-5, Criterion A) among a large number of people and the eventual revelation of people at-risk for PTSD, which is typically conducted in primary care clinics and a more advanced assessment conducted with the aim of establishing a clinical diagnosis (Lancaster, Teeters, Gros, & Back, 2016). VA policy requires that all new patients seen in the VA health sys-tem be screened for PTSD. In addition, patients in primary care are rescreened annually unless there is a clinical need for more frequent assess-ment (Evaluation of the department of veterans’ affairs mental health services, 2018).
As we can learn from the U.S. Department of Veterans Affairs (VA) website (How is PTSD assessed?, n.d.), “good assessment of PTSD can be done without the use of any special equipment”, nevertheless it may be inferred that PTSD assessment is generally conducted by using two types of measures –structured interview, where the interviewer asks a set of prepared questions, and self-report questionnaire, which represents a set of questions handed to the interviewee to answer. Clinician-Administered PTSD Scale (CAPS) and Structured Clinical Interview for DSM-5 (SCID-5) are examples of widely used structured interviews. A common example of a self-report questionnaire is the PTSD Checklist for DSM-5 (PCL-5) which is a 20-item self-report measure that assesses the presence and severity of PTSD symptoms and can also be used in order to monitor the treatment progress (Using the PTSD checklist for DSM-5 (PCL-5), n.d.).
The VA/DoD guideline suggests that the PTSD diagnosis can be made on the basis of a clinical interview or a structured diagnostic in-terview (CAPS, SCID-5 and PSSI-I (Post traumatic Stress Disorder Symptom Scale Interview for DSM-5)).
This study has revealed that for diagnostic purposes, the psychological centres operating in Armenia use methods of clinical interview, psychological testing and psychiatric assessment. In particular, five centres claim to implement PCL 5 and CAPS, and another one uses Hamilton Clinical Anxiety and Depression Questionnaires. Despite the fact that these tools are comparable to the U.S. diagnostic standards, however, based on the fact that the marked questionnaires and structured clinical interviews are not adapted and not standardized for the Armenian population, their reliability is doubtful.
In addition, although all of the surveyed or-ganizations noted the presence of a psychiatric evaluation in the process of diagnosing veterans, most of them (6 out of 8) stated that their patients are not always referred to a psychiatrist for evaluation. It turns out that the decision to conduct a psychiatric assessment is made by the psychologists based on their observations and experience, which, given the fact that psychologists often are poorly prepared in the field of clinical psychology and psychiatry, is not always justified.
One of the important components of treatment planning after diagnosis is the choice of the type of therapy: monotherapy or combined therapy (psycho and pharmacotherapy). As shown in Figure 2, half of the surveyed centres rarely offer combined therapy (only in cases where there are obvious mental disorders), and 37% of organizations often offer combined therapy (more than 50% of cases).
Figure 2: How often is Combined Therapy Offered in Armenia (Pharmacotherapy and Psychotherapy)?
In the U.S., combined therapy is a very common form of intervention for veterans, particular-ly in the treatment of PTSD, depression and anxiety disorders. And in cases of serious mental disorders and substance use disorders, the combination of psycho and pharmacotherapy is mandatory (VHA Handbook, 2008). However, as Simiola, Neilson, Thompson, and Cook’s(2015) review showed, when in-formed of PTSD treatment options and offered a choice, most people prefer psychotherapy over medication, but data from the VA showed that a larger proportion of patients with PTSD are treated with medication than psychotherapy (Spoont, Murdoch, Hodges, & Nugent, 2010). A possible explanation offered by Harik (2018) is that providers are not adequately eliciting or considering patients’ treatment preferences.
Figure 3: Veterans‟ Engagement in Shared Decision-Making on Their Treatment in Armenia
Thus, another important issue in therapy planning is the involvement of veterans in the decision-making process regarding their treatment. As the VHA Handbook states, the treatment plan needs to be developed with input from the patient, and when the veteran consents, appropriate family members (VHA Handbook, 2008). So far, no published studies have systematically assessed the extent to which shared decision-making is used in PTSD treatment. However, patients randomized to receive a shared deci-sion-making protocol (Mott et al., 2014) or a decision aid (Watts et al., 2015) have demonstrated superior outcomes relative to usual care (Harik, 2018).
Only three out of eight surveyed psychological centres in Armenia practice shared decision-making, and four organizations -only in some cases (Fig. 3.). This means that there may be violations of the rights of veterans, in particular in obtaining informed consent for treatment. Also, the passive position of veterans in making decisions about their treatment can be an inhibitory factor in the progress of treatment.
Treatment/Psychotherapy and Follow-Up
One of the initial steps before starting the therapy sessions is the choice of a specific psychological intervention. In the U.S.,trauma-focused CBT therapies incorporating exposure techniques, namely Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye Movement De-sensitization and Reprocessing (EMDR), are considered to be the most effective approaches to dealing with PTSD (Paintain & Cassidy, 2018). The Evaluation emphasizes the importance of ongoing monitoring of patient care during the treatment period in order to manage treatment delivery and assess the effectiveness of care, which is indispensable for the advancement of health care quality. For this reason, the VA collects data on the delivery of evidence-based psychotherapy using electronic clinical progress templates incorporated into veterans’ health records.In the clinical progress templates, providers can document a patient’s symptom changes over the course of treatment. These data are useful for studies examining the impact of treatment on health status and other patient outcomes. In order to check the effectiveness of psychotherapy for patients, clinicians generally state to administer self-report scales (such as the PCL) during the patient’s treatment period; others evaluate the treatment progress by qualitatively assessing both the severity of symptoms and the social and occupational functioning of patients for example by noting that the patient’s relationships have become more stable or that there is a decrease in symptoms etc. (Evaluation of the department of veterans’ affairs mental health services, 2018).
As shown in Figure 4, in the surveyed Armenian centres, the most common type of psycho-therapeutic intervention for veterans is CBT/CPT (all centres), EMDR (5 of the surveyed entities), Brainspotting and group therapy (4 of the surveyed entities). Client-centred therapy, art therapy and prolonged exposure are practised less often.
Figure 4: Psychological Interventions Offered to the Patients with War-Related Trauma in Armenia.
Clearly, there is a big similarity between the U.S. and Armenia in the choice of front-line PTSD therapies, with the exception of Prolonged Exposure, offered to veterans in only one Armenian organization we interviewed.
Although trauma-focused psychotherapies are widely accepted as first-line treatment for PTSD, some authors show concerns that focusing on trauma can destabilize the patients with PTSD and even increase the risk of treatment dropout compared to other forms of treatment (Edwards-Stewart et al., 2021). Moreover, even though the recommended trauma-focused therapies, such as CPT and PE, have been proved to be effective, nonresponse rates are high, and many patients continue to have symptoms (Steenkam, Litz, Hoge, & Marmar, 2015).
Some studies suggest that non-trauma-focused psychotherapies for PTSD may be as effective as trauma-focused approaches (Yager, 2018) and that the supporting evidence in support of the superiority of trauma-focused treatments is proven to be weak (Wampold et al., 2010). For instance, the results of a clinical trial aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) demonstrated that TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (Nidich et al., 2018).
As the research shows, for the patients who prefer non-trauma-focused therapies, the following therapies are considered to have the most empirical support: present-centred therapy (PCT), interpersonal psychotherapy (IPT) and acceptance and commitment therapy (ACT)(Shea, Krupnick, Belsher, & Schnurr, 2020). There are also patients for whom psychotherapy alone is not preferred or fails to produce expected results, in which case pharmacotherapy is recommended as a first-line approach for treating PTSD (Reisman, 2016).
Interestingly, all the organizations interviewed in Armenia stated that they offer veterans not only trauma-focused therapy but also person-oriented long-term interventions. The list of such therapies is quite diverse and differs from the one usually found in the recommendations adopted in the U.S.: existential and client-centred therapies (in seven centres), interpersonal therapy, gestalt therapy, art-therapy, etc.
Another important issue is the possibility of the use of video-teleconferencing (VTC) psychotherapy, and even though we lack any statistical data on the prevalence of its use in the framework of PTSD treatment for veterans, the Guide to VA mental health services for Veterans & Families offers the possibility of mental health care to veterans through VTC. The VA/DoD guideline encourages VTC interventions in the following cases: in-person interventions are not feasible due to various patient access barriers, the patient would benefit from more frequent contact than is feasible with face-to-face sessions, or the patient declines in-person treatment. According to the Evaluation, the actual use of telemedicine across the VA is highly variable and does not seem to be regulated by directed strategic approaches.
In Armenia, seven out of eight surveyed centres provide treatment using VTC, which makes the service accessible for veterans outside big cities. However, the effectiveness of VTC therapy with veterans in Armenia has not been evaluated.
The involvement of the family is another interesting methodological aspect of veterans’ treatment. As a possible decision-making party, family members must be encouraged to participate in inpatient treatment planning and discharge planning to the fullest extent possible (with the veteran’s consent). Also, VA medical centres in the frames of general mental health services must provide family education when it is associated with benefits to the veterans, as well as render psychosocial rehab services, including family psychoeducation and education, training and consultation regarding the recovery transformation. In cases of veterans’ substance use disorders and traumatic brain injury, couples counselling and family therapy/consultations are offered (VHA handbook, 2008).
In Armenia, only two surveyed centres out of eight offer more or less systematic services to veterans’ family members. This includes family counselling and psychoeducation/training on mental health disorders. However, as the interviews showed, these services do not have any common standard, and the inclusion of family members in these processes is not regulated at all.
As for clinical supervision, in the U.S.,the requirement for clinical supervision for mental health specialists is included in the State licensure laws, which require postgraduate clinical supervision experience for psychologists, social workers, and professional mental health counsel-lors in order to obtain/maintain the license. This requirement is in line with the APA Guidelines for Clinical Supervision in Health Service Psychology (2014). Therefore, newly hired recent graduates in these professions work under the supervision of a licensed clinician while completing full licensure requirements (VHA directive 1027, 2019).
Despite the fact that in Armenia,the process of supervision of specialists is not regulated,and there is no licensing system which requires any kind of clinical supervision for specialists, in all eight organizations,psychotherapists work with veterans under supervision/intervision. There are several types/formats of supervision practice in these organizations (see Fig. 5)
Figure 5: The types of Clinical Supervisions Provided to Psychotherapists Working with Veterans in Armenia.
The most commonly practised formats of supervision are internal group and individual supervision, as well as individual external supervision. However, it is noteworthy that in Armenia, there is no system of licensing/certification of clinical supervisors. Therefore, internal supervisions are carried out by more experienced specialists, and external supervisions are provided by licensed supervisors from the U.S., Europe and Russia.
As to the follow-up procedures, we were unable to find any theoretical or statistical data on its implementation in the U.S. mental health system. Nevertheless, the VHA handbook on Uniform mental health service in VA medical centres and clinics (2015) provides some methodological directives, pursuant to which when discharged from inpatient or residential care settings, veterans must be given appointments for follow-up at the time of discharge and receive follow-up mental health evaluations within 1 week of discharge. The handbook strongly recommends the provision of follow-up within 48 hours of discharge. When necessary, because of the distance of the veteran’s home from the facility where the veteran receives follow-up care or other relevant factors, the 1-week follow-up may be by telephone. In all cases, it is stated that veterans must be seen for face-to-face evaluations within 2 weeks of discharge. When veterans refuse these evaluations, the refusal must be documented. When veterans miss scheduled appointments, there must be follow-up and documentation in the clinical records (VHA handbook, 2008).
In Armenia, only one out of eight organizations conduct follow-ups after veterans’ treat-ment termination. Half of the organizations im-plement follow-up in some cases (Fig. 6).
Figure 6: Are Veterans Followed-Up in Armenia after the End of Treatment?
The follow-up is usually conducted by the psychotherapist (only in one centre this is done by the social worker) and mostly by telephone or face-to-face meeting, which corresponds to the American experience (Fig. 7)
Figure 7: Veterans‟ Treatment Follow-Up Methods in Armenia.
In organizations that conduct follow-up, in most cases,it is done irregularly, without a stan-dardized frequency and any documentation procedures referring to the follow-up process, results or refusal. In case of a negative follow-up, when a deterioration in a veteran’s mental state is detected, he is basically redirected to another mental health provider. This is likely due to the limited financial and professional resources of the organizations that are unable to re-include the veteran in the treatment process and not because of the individual’s specific health condition.
Conclusion
Comparative analysis of the U.S. and Armenian systems of veterans’ psychological assistance made it possible to conclude that the most serious problem of the Armenian system is of methodological nature – the lack of state standards and a regulated structure of mental health services. In the U.S. system, absolutely all aspects and stages of the procedure for providing psychological as-sistance are strictly regulated by the relevant official documents and directives, thanks to which the interdisciplinary and multi-level structure of psychological support works as efficiently as possible and ensures quality control of the services provided.
Despite the fact that after the Nagorno-Karabakh war of 2020, for the first time, the Armenian government initiated a six-month program to provide unified psychological assistance to veterans, these efforts cannot be sufficient since a comprehensive concept of mental health and services in this area for veterans has not been developed, the program lasted for only couple of months, and the organizations involved in the work had different methodological and regulatory backgrounds. This has been proven by the fact that the need for psychological rehabilitation of veterans and their families remained vital, and the service rejection rate during the first months was quite high. Most veterans are forced to seek quality psychological services on their own through the internet and media and often receive incompetent treatment, in particular, in complex comorbid cases.
On the other hand, the methodology of veterans’ psychological assessment/diagnosis and psychotherapy is generally comparable between the two systems, which indicates that Armenian specialists are trying to meet international professional standards. This is also evidenced by the presence of clinical supervision (individual and group) in all surveyed organizations. However, the lack of a unified approach and licensing system, as well as an acute lack of research on the effectiveness of various diagnostic methods, therapy and clinical supervision for the Armenian population, do not make it possible to correctly assess the situation.
Nevertheless, it may be inferred from the presented analysis that the psychological support system of veterans in Armenia is at an early stage of development and needs an institutional and state approach, which will allow integrating the rich individual experience of individual centres and specialists into a single coherent system of psychological assistance.
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Why do humans write songs about heartbreak? Memoirs after trauma? Paint the scene of their most joyful moment?
If you’ve ever written down your thoughts after a tough conversation or screamed along to a song that hits just right after a breakup, you’ve engaged in creative meaning-making.
Humans use art to make sense of experience. It is one of the ways the brain organizes chaos into coherence.
What Is Meaning-Making?
Meaning-making is the process of integrating events into narrative, reconciling contradiction, and updating self-concept.
There is so much weight in the stories we tell about ourselves. And they are not always true. In the day-to-day, it usually isn’t necessary to make sense of your activities. You go to work, come home, have dinner, maybe spend time with your family, and go to bed. That makes sense.
But when something ruptures your internal model of the world; a breakup, betrayal, diagnosis, or traumatic event, the narrative scaffolding that once held your life together no longer fits. What you believed to be true no longer is.
This is normal: Our brains like order. The brain is a prediction machine, it prefers coherence. When experience contradicts existing beliefs, the discrepancy creates cognitive and emotional strain. Despite how flexible or easy-going you might be, there are certain experiences we go through that shake us to our core. That is where creativity kicks in, and why having a creative outlet may be as necessary as a regular exercise routine and good sleep schedule.
This is where narrative identity theory becomes relevant. Researchers describe narrative identity as the evolving life story we construct to connect our past, present, and imagined future (McAdams and McLean, 2013). We are not just remembering events; We are constantly arranging them into a story line that answers the question, Who am I?
Autobiographical memory plays a central role in this process. These are not isolated snapshots of the past but structured recollections that connect events to the self. When something disruptive occurs, autobiographical memory must be updated. The brain has to decide: Is this an exception? A turning point? A defining moment? A betrayal? A lesson?
Without integration, experience can remain fragmented. Fragmented memory often feels intrusive, repetitive, or emotionally charged, which is what happens in post-traumatic stress disorder (PTSD). Integrated memory becomes contextualized as part of the narrative rather than a threat to it.
When your world is shaken, creativity becomes more than aesthetic expression. It becomes cognitive reorganization. We write to clarify, compose to structure emotion, paint to externalize confusion, and tell stories to restore coherence.
Neuropsychology of Creativity
Creativity is often framed as inspiration, a sudden flash of originality. Neuropsychology suggests something more structured.
Creative thinking emerges from the dynamic interaction between large-scale brain networks that support internal reflection and cognitive control. It is not the product of a single “creative center” but the coordination of systems that generate ideas and systems that refine them.
The brain’s default mode network (DMN) is active during internally directed thought, when the mind turns inward rather than outward. It is engaged during autobiographical memory retrieval, self-reflection, future simulation, and narrative construction. It switches off when attention is directed outward toward external tasks (Menon, 2023). When you imagine an alternative outcome, reinterpret a past event, or write a personal story, you are engaging the DMN.
Menon (2023) proposes that the DMN integrates memory, language, and semantic representations to construct a coherent internal narrative, one that is central to our sense of self and shapes how we perceive ourselves and interact with others.
In other words, it generates raw psychological material. It is associative, expansive, and exploratory. But generation alone is not creativity. Without structure, association becomes rumination or fantasy.
Executive Networks: Shaping Meaning
This is where executive control networks become essential.
Executive systems support cognitive flexibility, inhibition, and working memory. They allow us to evaluate ideas, suppress unhelpful interpretations, shift perspective, and update beliefs.
If the DMN generates possibilities, executive networks impose coherence.
They allow the brain to inhibit rigid or repetitive narratives, shift between interpretations, select adaptive meaning from competing possibilities, and integrate emotional material into structured understanding.
So, while creativity can feel chaotic at times, it is not inherently disorganized. In actuality, it is more often the opposite, a way of reorganizing what does not organically make psychological sense.
When these systems interact effectively, the brain can take a disruptive experience and reorganize it into something coherent: a new narrative, a new interpretation, a new identity conclusion.
Creativity is not merely expression. It is integration.
Key points
Disruption breaks our internal narrative. Creativity is how the brain rebuilds it.
The brain network behind memory and self-reflection is the same one engaged when we create.
Expressive writing heals not by releasing emotion but by organizing it into coherent narrative.
Rumination replays. Creativity rewrites. That difference is what keeps identity flexible.
Why do humans write songs about heartbreak? Memoirs after trauma? Paint the scene of their most joyful moment?
If you’ve ever written down your thoughts after a tough conversation or screamed along to a song that hits just right after a breakup, you’ve engaged in creative meaning-making.
Humans use art to make sense of experience. It is one of the ways the brain organizes chaos into coherence.
What Is Meaning-Making?
Source: Alice Dietrich/ Unsplash
Meaning-making is the process of integrating events into narrative, reconciling contradiction, and updating self-concept.
There is so much weight in the stories we tell about ourselves. And they are not always true. In the day-to-day, it usually isn’t necessary to make sense of your activities. You go to work, come home, have dinner, maybe spend time with your family, and go to bed. That makes sense.
But when something ruptures your internal model of the world; a breakup, betrayal, diagnosis, or traumatic event, the narrative scaffolding that once held your life together no longer fits. What you believed to be true no longer is.
This is normal: Our brains like order. The brain is a prediction machine, it prefers coherence. When experience contradicts existing beliefs, the discrepancy creates cognitive and emotional strain. Despite how flexible or easy-going you might be, there are certain experiences we go through that shake us to our core. That is where creativity kicks in, and why having a creative outlet may be as necessary as a regular exercise routine and good sleep schedule.
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This is where narrative identity theory becomes relevant. Researchers describe narrative identity as the evolving life story we construct to connect our past, present, and imagined future (McAdams and McLean, 2013). We are not just remembering events; We are constantly arranging them into a story line that answers the question, Who am I?
Autobiographical memory plays a central role in this process. These are not isolated snapshots of the past but structured recollections that connect events to the self. When something disruptive occurs, autobiographical memory must be updated. The brain has to decide: Is this an exception? A turning point? A defining moment? A betrayal? A lesson?
Without integration, experience can remain fragmented. Fragmented memory often feels intrusive, repetitive, or emotionally charged, which is what happens in post-traumatic stress disorder (PTSD). Integrated memory becomes contextualized as part of the narrative rather than a threat to it.
When your world is shaken, creativity becomes more than aesthetic expression. It becomes cognitive reorganization. We write to clarify, compose to structure emotion, paint to externalize confusion, and tell stories to restore coherence.
Neuropsychology of Creativity
Creativity is often framed as inspiration, a sudden flash of originality. Neuropsychology suggests something more structured.
Creative thinking emerges from the dynamic interaction between large-scale brain networks that support internal reflection and cognitive control. It is not the product of a single “creative center” but the coordination of systems that generate ideas and systems that refine them.
The brain’s default mode network (DMN) is active during internally directed thought, when the mind turns inward rather than outward. It is engaged during autobiographical memory retrieval, self-reflection, future simulation, and narrative construction. It switches off when attention is directed outward toward external tasks (Menon, 2023). When you imagine an alternative outcome, reinterpret a past event, or write a personal story, you are engaging the DMN.
Menon (2023) proposes that the DMN integrates memory, language, and semantic representations to construct a coherent internal narrative, one that is central to our sense of self and shapes how we perceive ourselves and interact with others.
In other words, it generates raw psychological material. It is associative, expansive, and exploratory. But generation alone is not creativity. Without structure, association becomes rumination or fantasy.
Executive Networks: Shaping Meaning
This is where executive control networks become essential.
Executive systems support cognitive flexibility, inhibition, and working memory. They allow us to evaluate ideas, suppress unhelpful interpretations, shift perspective, and update beliefs.
If the DMN generates possibilities, executive networks impose coherence.
They allow the brain to inhibit rigid or repetitive narratives, shift between interpretations, select adaptive meaning from competing possibilities, and integrate emotional material into structured understanding.
So, while creativity can feel chaotic at times, it is not inherently disorganized. In actuality, it is more often the opposite, a way of reorganizing what does not organically make psychological sense.
When these systems interact effectively, the brain can take a disruptive experience and reorganize it into something coherent: a new narrative, a new interpretation, a new identity conclusion.
Creativity is not merely expression. It is integration.
Source: Unsplash
Why This Matters
Memory is not a fixed archive. The brain encodes and retrieves experiences, reinforcing certain patterns over time, but creativity can reconfigure those patterns. When we create, we are not generating something out of nothing. We are reorganizing what is already there, revisiting emotionally charged material and placing it in a new context. An experience that once signaled humiliation may, when revisited creatively, become evidence of growth. A rupture may become a turning point. The emotional charge remains, but its narrative role shifts.
Without this kind of integration, trauma can become what clinicians describe as “stuck memory.” The event is encoded with high emotional salience but never fully absorbed into the larger life narrative. It remains isolated, easily triggered, and repeatedly retrieved in its original form, stabilizing over time into a fixed conclusion about the self.
Rumination often fills the space. It is not the same as reflection. McAdams and McLean (2013) caution that while self-exploration of difficult experiences promotes growth, narrators who dwell too long without resolution risk sliding into rumination rather than integration. The emotional charge is reactivated, but the narrative never evolves.
Creative processing interrupts this loop. When you engage in structured meaning-making, the event becomes contextualized, part of a larger trajectory rather than a stand-alone rupture. Instead of “This happened and everything changed,” the story becomes, “This happened, and here is where it fits.” Coherence reduces cognitive dissonance and restores a sense of continuity.
Source: Unsplash
Expressive writing research supports this directly. Baikie and Wilhelm (2005) reviewed moe than two decades of studies and found that writing about traumatic or stressful experiences produces significant improvement in both physical and psychological health, including immune functioning, reduced depressive symptoms, and fewer stress-related medical visits.
Klein and Boals (2001) found that students who wrote about emotionally significant experiences show measurable gains in working memory capacity, with benefits linked not to emotional venting but to increases in causal and insight language, markers of narrative coherence. The benefit, across both studies, comes not from releasing emotion but from organizing it.
Emotion without integration reinforces rigidity. Emotion integrated through creative processing promotes flexibility. And that flexibility, or the ability to hold a painful experience without being defined by it, is what allows identity to remain adaptive rather than brittle.
Creativity Is Not a Luxury
Creativity is often misunderstood as performance: something impressive, original, or externally validated. But psychologically, creativity serves a much quieter, more intimate, function.
It is how the mind metabolizes experience.
The act of constructing a narrative, reframing a memory, composing a piece of music, or shaping an idea is not ornamental. It is integrative. It reduces fragmentation and restores continuity. Of course, what comes out of the creative process is often beautiful, which is its own fitting metaphor.
So the next time you find yourself reaching for a pen after a hard conversation, or needing to hear a particular song on repeat, pay attention to that impulse. It is not weakness or avoidance. It is your brain attempting integration, trying to find the narrative thread that makes sense of what just happened and where it fits in the longer story of who you are.
The instinct toward creativity in difficult moments is not incidental. It is the brain’s attempt to restore coherence, and it may be one of the most human things about us.
Artificial Intelligence (AI) has quietly stepped into the intimate spaces of our lives — our work, our creativity, even our thought processes. We ask AI to summarize, to help reason, to predict, to analyze. As a result, the line between human cognition and machine logic is blurring faster than most of us can keep up with.
Yet, beyond the spectacular advances and endless possibilities, AI is reshaping something far more delicate: the human mind itself (sounds a bit too strong, perhaps — but that is the reality we find ourselves in). The way we think, learn, and connect with others is undergoing a subtle, yet profound adjustment.
The Reshaping of Thought
There was a time when knowledge came at the end of long nights, piles of books, and countless underlined sentences. My brother and I would sit under the same lamp, reading for hours: digging through every page to piece ideas together from A to Z. Memory was a muscle we had to train. Reflection and “digestion of information” required patience. Now, one tap delivers the answer — not after hours of reasoning, but in seconds.
It’s convenient, yes, but convenience always has a cognitive price. When information is no longer earned through effort, the brain’s neural networks adapt to this new economy of attention. Learning becomes less about deep processing and more about instant retrieval.
Neuroscientific research already suggests that when tasks become automated, related neural parts in the brain may weaken. Consequently, younger generations who are immersed from early ages in AI-mediated learning might be wiring their brains differently. The result? A mind that is faster, but perhaps less enduring in its focus.
It almost feels as if our neurons have joined the on-demand culture: thinking in shortcuts, constantly looking for instant satisfaction (and gratification), forming rapid but shallow associations. Like fast food for the brain: satisfying, efficient, yet rarely nourishing in depth.
Anxiety, Identity, and Adaptation
But the cognitive shift is only one dimension of this transformation. Emotionally, too, AI has caused a very uncomfortable new reality to many.
As algorithms outperform humans in repetitive or analytical tasks, a new wave of existential anxiety emerges. For many, professions once built on expertise now feel outdated. Psychologists, educators, translators, even therapists are asking — if machines can do some of what we do, what remains distinctly human?
This sense of professional insecurity is not merely economic; it touches our core existence. When worth is measured by productivity, and productivity can be automated, humans risk internalizing a sense of uselessness. The result is what could be called “AI-induced burnout” — not from overwork, but from over-comparison.
Paradoxically, what truly secures our relevance is not to think faster like machines, but to think deeper — with emotion, empathy, and ethical reflection.
Communication in the Age of Algorithms
Our ways of connecting have also changed. Emails may now be drafted by language models, presentations refined by smart assistants, and online conversations subtly guided by chatbots. Communication becomes efficient, but a touch more mechanical.
In international organizations, for instance, where time zones and deadlines collide, AI offers remarkable help — grammar, clarity, even diplomacy on demand. Yet something gets lost in this streamlining: the small pauses of uncertainty, the warmth of human tone, the personal color of imperfection. It gets to the point, where people may copy and paste entire paragraphs and sections without giving it a proper review.
Humans bond not just through content, but through the texture of communication — the unpolished, unpredictable, emotionally charged nuances that no algorithm can replicate. Efficiency may win the battle of productivity, but the human touch and empathy still defines the war for meaning.
Between Adaptation and Dependence
The question, then, is not whether AI will change us — it already has — but how consciously we will adapt. The greatest risk is dependence without awareness: letting our mental muscles atrophy while algorithms flex theirs.
However, the human mind is nothing if not adaptive. We’ve coexisted with tools from stone to silicon, each changing us and being changed in return. The challenge today is to ensure that this co-evolution remains symbiotic, not submissive.
AI can expand the boundaries of human intelligence — helping us diagnose diseases faster, analyze complex data, and even explore creativity. But without intentional boundaries, we risk losing the very foundations that birthed AI in the first place: our curiosity, uncertainty, and wonder.
The Fun Side of Serious Change
Let’s admit it — AI can be thrilling. It’s the only “colleague” who never needs a coffee break, never complains about deadlines, and writes with near-perfect grammar. The danger begins when we start wishing our human colleagues were the same.
Our challenge is not to compete with machines but to rediscover what makes thinking humanly beautiful. The small inconsistencies, the moments of doubt, and the messy creative process — these are not inefficiencies; they are the essence of consciousness.
If anything, AI offers a mirror. It reflects just how much of cognition can be simulated, but also how much cannot. Empathy, intuition, moral reasoning, the “art of misunderstanding” and growing from it — still remain uniquely, magnificently human.
Conclusion
AI is here to stay, to assist, and occasionally to perplex us. The task of psychology in this age is not to resist change, but to understand it — to explore how technology is reconfiguring our mental maps and emotional responses.
In the end, the future should be defined not by artificial intelligence, but by augmented humanity — a kind of a partnership where machines handle the repetitive and “boring” part, and humans preserve the reflective.
Perhaps that is the real adaptation we’re called to make: remembering ourselves, even as we design systems that can mimic us. For the times may require us to change our daily tools, but the need for meaning, connection, and self-awareness remains timeless.
About the Author
Arsen Aghasyan is a communications expert and clinical mental health enthusiast with over a decade of experience in international organizations including the OSCE, KfW Development Bank, MSF and IPC GmbH. His interests lie at the intersection of psychology, technology, and communication — exploring how emerging tools like AI are reshaping human thought and connection.
We all have moments when our own thoughts turn against us. One small mistake becomes proof we’ll never succeed; one anxious feeling convinces us something terrible is about to happen. These aren’t just passing notions — they shape how we see ourselves and the world. Cognitive Behavioral Therapy (CBT) begins right here: with the idea that by changing the way we think, we can change the way we live.
Understanding the Thought–Emotion–Behavior Connection
CBT is built on a simple but profound insight: our thoughts, emotions, and behaviors are deeply interconnected. The way we interpret events influences how we feel, and how we feel determines what we do. When our thinking becomes distorted — filled with patterns like catastrophizing, overgeneralizing, or black-and-white reasoning — our emotional lives follow suit.
As psychologist Aaron Beck, one of the founders of CBT, discovered, people aren’t distressed only by external situations but by the meanings they attach to them. If I believe “I always fail,” then every challenge becomes proof of that belief — and my behavior (avoidance, self-criticism, hopelessness) reinforces it. CBT aims to interrupt this cycle.
Thinking Our Way to Change
At the heart of CBT is the process of challenging and reframing negative thought patterns. Clients learn to identify unhelpful automatic thoughts — the quiet inner commentary that colors their perceptions — and to test them against reality.
This isn’t about “positive thinking” in a superficial sense. It’s about developing an honest, flexible way of perceiving ourselves and the world. When we question thoughts like “I’m a failure” or “People will always reject me”, we open space for more balanced views:
“I didn’t succeed this time, but I’ve done well in other areas.” “Some people may disagree with me — but that doesn’t mean everyone will.”
These small shifts can lead to big changes in mood, confidence, and behavior.
Learning by Doing
Cognitive Behavioral Therapy is not just a way of thinking; it’s a way of practicing new patterns. Therapists often set behavioral experiments — small, specific actions that test beliefs in real life. Someone who fears social rejection might start a conversation with a colleague. A person who avoids tasks out of perfectionism might deliberately finish something imperfectly and notice the outcome.
Over time, these experiences build evidence that challenges old assumptions. New beliefs are shaped not by imagination, but by lived proof. This hands-on approach is what makes CBT dynamic and empowering.
Why Cognitive Behavioral Therapy Is So Effective
One reason Cognitive Behavioral Therapy has become one of the most researched and widely used therapies worldwide is its clarity and practicality. It provides tools that can be learned, practiced, and sustained long after therapy ends.
Structured and time-limited: Cognitive Behavioral Therapy usually unfolds over weeks or months, focusing on specific goals.
Collaborative: The therapist and client work as a team, sharing responsibility and discovery.
Evidence-based: Numerous studies confirm its effectiveness for anxiety, depression, stress, trauma, and even chronic pain.
Empowering: Instead of relying solely on the therapist’s insight, clients learn skills to become their own therapists.
These strengths make Cognitive Behavioral Therapy not just a treatment, but a lifelong framework for mental well-being.
Beyond Therapy: A New Way to Live
The principles of Cognitive Behavioral Therapy extend far beyond the therapist’s office. They invite us to approach daily life with awareness, curiosity, and compassion toward our own minds. If every thought is a hypothesis to be tested rather than a verdict to be accepted, then each moment becomes a chance to build resilience.
Imagine responding to setbacks not with self-blame, but with a quiet inner question:
“Is this thought helping me — or holding me back?”
That simple reflection captures the essence of Cognitive Behavioral Therapy. It’s not about denying pain or forcing optimism, but about discovering the freedom to think differently, feel differently, and act differently.
A Final Thought
The beauty of CBT lies in its practicality and humanity. It reminds us that even when we can’t control what happens outside us, we can always influence what happens within.
Changing our thoughts is not a one-time act — it’s a lifelong practice of awareness and kindness toward ourselves. And every new thought is a small step toward a freer, fuller life.
Because when we learn to change the way we think — we often find we’ve already begun to change the way we live.
Incest, defined as sexual relations between close family members, is one of the most taboo yet complex phenomena in human behavior. Beyond its legal and moral boundaries, it represents a profound psychological trauma that damages development, trust, and safety. What should be the safest environment—the family—becomes a place of fear and betrayal.
Definition and Forms
Clinically, incest includes not only biological relatives such as parents or siblings but also step‑parents, guardians, and other authority figures within a family system who misuse their role. Major forms include parent–child abuse, sibling abuse, and sexual violence by extended or surrogate relatives. Each type leaves long‑term emotional and interpersonal scars.
Underlying Causes
Research identifies several key factors:
Abuse of power – perpetrators exploit authority or emotional dependency.
Intergenerational trauma – prior victims may unconsciously repeat the cycle.
Mental‑health issues and addiction – increase risk and impair boundaries.
Family isolation – secrecy prevents detection and support.
Cultural silence – shame and patriarchal norms sustain denial.
Despite its severity, incest is rarely reported due to fear, stigma, and loyalty conflicts. Global data indicate that one in four girls and one in thirteen boys experience sexual abuse during childhood, often by someone within the family.
Psychological and Neurobiological Impact
Incest is among the most destructive traumas because the abuser is a trusted caregiver. The betrayal fractures the victim’s fundamental capacity to depend on others. Survivors frequently present symptoms of post‑traumatic stress disorder (PTSD) or complex PTSD, including flashbacks, nightmares, emotional numbness, and intense guilt or shame.
Chronic activation of the stress system alters the brain’s HPA axis, elevating cortisol and impairing the hippocampus and amygdala—areas crucial for memory and emotion. These changes explain the concentration and emotional‑regulation difficulties typical in survivors.
Betrayal and Trauma Bonding
When abuse comes from a loved one, victims often repress memories to preserve attachment (betrayal‑trauma theory) or develop emotional dependence through manipulation and fear (trauma bonding). This toxic attachment traps them between affection and terror, complicating their healing.
Clinical Interventions
Because incest trauma is complex and enduring, therapy must be specialized and evidence‑based. Effective approaches include:
Trauma‑Focused CBT (TF‑CBT) – restructures traumatic memory and beliefs.
EMDR (Eye‑Movement Desensitization and Reprocessing) – reprocesses sensory trauma.
DBT and Somatic Experiencing – teach emotional regulation and body awareness.
Treatment emphasizes reconstruction of safety, trust, and self‑worth while integrating memories into a coherent, non‑shaming narrative.
Conclusion
Incest represents one of the deepest violations of human relationship and integrity. Its effects reach beyond trauma symptoms, shaping self‑image, attachment, and physical health. Healing demands patience, clinical competence, and empathy — not only to relieve suffering but to restore the survivor’s sense of life itself. Preventing incest requires open education, awareness, and stronger systems of protection and justice.
What Happens to the Self in an Age of Constant Evaluation?
It is 2026, and modern life is defined by constant information flow, escalating performance expectations, and a culture of continuous comparison. Within this environment, individuals are increasingly prone to chronic self-criticism and a persistent sense of inadequacy.
While “public discourse” emphasizes “mental health awareness,” there remains limited clarity regarding practical psychological self-care. One concept that offers a practical bridge is self-compassion: a way of relating to ourselves that interrupts harsh self-judgment and helps restore emotional balance. Drawing from approaches like cognitive-behavioral therapy (CBT), multimodal therapy, and compassion-focused practices, self-compassion invites us to move beyond self-monitoring and towards mindful self-support. In the following sections, we’ll look more closely at how these pressures shape our inner dialogue and how a practice of self-compassion can begin to undo their effects.
The Culture of Perpetual Evaluation
We inhabit an era of continuous stimulation and evaluation. Digital environments provide uninterrupted streams of information, achievement metrics, and social comparison. Professional domains grow increasingly competitive; educational demands intensify; and expectations for constant self-improvement are normalized and pushed upon. The main message is persistent: one must keep up, optimize, and remain vigilant.
Under such conditions, worry becomes habitual. Individuals report ongoing concerns about adequacy, performance, and future failure. Minor setbacks: missed deadlines, social missteps, imperfect outcomes – are no longer isolated events. Instead, they accumulate cognitively, reinforcing self-evaluative narratives of insufficiency. Over time, these micro-failures are integrated into global self-beliefs (“I am not capable,” “I am falling behind,” “I am not enough”).
Cognitive theory has long demonstrated that maladaptive core beliefs and negative automatic thoughts are central vulnerabilities for depression and anxiety. Chronic self-criticism functions as a maintaining mechanism: it intensifies negative affect, narrows attentional focus toward threat, and reduces behavioral flexibility. In this sense, the competitive climate does not directly cause psychopathology; rather, it amplifies internal threat processing systems that predispose individuals to mood and anxiety disorders.
The Paradox of Mental Health Awareness
In the recent years, public discourse increasingly emphasizes the importance of mental health. However, awareness does not equate to skill or know-how acquisition. While individuals routinely engage in physical health maintenance: medical checkups, nutritional regulation, exercise – there is comparatively little structured education regarding care of cognitive and emotional processes.
Mental self-care is often reduced to vague injunctions (“reduce stress,” “practice positivity”) or commercialized wellness routines. What remains underdeveloped is a psychologically coherent framework that teaches individuals how to respond to their own suffering, failure, and perceived inadequacy.
From the perspective of a psychologist: care for mental health requires more than symptom reduction; it requires modification of one’s stance toward internal experience.
Self-Compassion as Regulatory Mechanism
From a compassion-focused perspective developed by Paul Gilbert, human affect regulation can be conceptualized in terms of interacting motivational systems—threat, drive, and soothing. Modern competitive contexts disproportionately activate threat (fear of failure) and drive (achievement striving), while the soothing system remains underdeveloped. Self-compassion practices are hypothesized to activate affiliative and parasympathetic processes that counterbalance chronic threat activation.
Empirically, self-compassion is associated with lower levels of depression, anxiety, and rumination, as well as greater emotional resilience. Critically, self-compassion does not eliminate standards or goals; rather, it alters the emotional tone with which setbacks are processed
Techniques for Mental Self-Care
Mindfulness and Breathing Practices
Structured mindfulness exercises and regulated breathing techniques enhance metacognitive awareness and physiological down-regulation. By interrupting automatic cognitive fusion with self-critical thoughts, individuals gain psychological distance from evaluative narratives. (Mindfulness Meditation 3 Minute Breathing Space)
Cognitive Interruption Techniques
CBT-based strategies such as the STOPP technique (Stop, Take a breath, Observe, Pull back, Practice what works) provide concrete steps to disrupt escalating threat responses. These micro-interventions are particularly useful in moments of acute self-criticism.
Multimodal Assessment
Drawing from the multimodal framework of Arnold Lazarus, comprehensive self-care must address multiple domains: behavior, affect, sensation, imagery, cognition, interpersonal functioning, and biological factors. Self-compassion can be integrated across these modalities rather than confined to cognitive reframing alone.
Some considerations
It is necessary to avoid romanticizing self-compassion. Now, what do I mean by that? Structural pressures, such as economic instability, sociocultural inequities, occupational precarity – cannot be resolved solely through intrapsychic adjustment. Self-compassion should not become another performance demand (“I must be perfectly self-compassionate”) nor a tool for adapting individuals to unhealthy systemic conditions without critique.
However, within constraints that cannot be immediately altered, self-compassion represents a modifiable internal process that can reduce vulnerability to affective disorders.
Conclusion
In environments characterized by constant comparison and accelerated expectations, individuals are increasingly exposed to chronic self-evaluation. When minor failures accumulate into stable self-critical beliefs, they form a cognitive-emotional substrate conducive to depression and anxiety. While mental health awareness has expanded, practical instruction in mental self-care remains insufficient.
Self-compassion offers a theoretically grounded and empirically supported mechanism for counterbalancing internal threat activation. By integrating mindfulness practices, cognitive interruption techniques, and multimodal assessment, clinicians and individuals alike may operationalize mental self-care in a structured manner. In doing so, self-compassion becomes not a luxury, but a regulatory necessity in contemporary psychological life.
