2025-11-19 09:48:22
A lot of psychological terms don’t mean what people think they mean (at least, not according to psychologists).
There’s an increasing drift between how they get used colloquially in everyday language and the commonly accepted definitions among psychologists. There’s a sense in which the lay usage is “wrong” (in that it doesn’t match more scientific, precise, or technical usage), but of course, language has always been and always will be in flux. At the end of the day, a word does mean what people widely use it to mean. So I think it’s useful to be aware of both definitions for psychological concepts. The everyday concept helps us understand others, whereas the more technical definition is usually more helpful for helping us understand the way the world works. Here’s a list of examples:
1) Gaslighting
Everyday usage: Someone invalidating your perspective or lying to you in order to manipulate you
Precise usage: Manipulation that specifically causes someone to doubt their own senses or their ability to reason
2) Negative reinforcement
Everyday usage: Something bad happens when you do a behavior, so you do it less
Precise usage: Removal of an aversive stimulus after a behavior is engaged in, causing that behavior to increase (not a form of punishment). This is in contact with positive reinforcement, which adds a desirable stimulus after a behavior (which is a different way to get a behavior to increase).
3) OCD
Everyday usage: being a neat freak or someone who needs things done in a specific way
Precise usage: A disorder involving repetitive, intrusive obsessions and/or compulsions (behaviors performed to reduce anxiety) that are time‑consuming or impair function
4) Depression
Every day usage: feeling sad a lot
Precise usage: an ongoing near-daily pervasive depressed mood (sadness, emptiness, and/or hopelessness) or loss of interest or pleasure, that coincides with symptoms like fatigue, suicidality, poor concentration, weight change, or feelings of worthlessness.
5) Antisocial
Everyday usage: a desire to avoid being around other people
Precise usage: a personality disorder (ASPD) involving pervasive disregard for or violation of the rights of others, typically involving deceit, manipulativeness, aggression, and a lack of empathy/remorse.
6) Narcissist
Everyday usage: someone who is self-centered or very vain
Precise usage: a personality disorder (NPD) involving a grandiose sense of self-importance and superiority, need for admiration, and reduced empathy.
7) Trauma
Everyday usage: A very upsetting experience
Precise usage: Exposure to someone dying, serious injury, or sexual violence (DSM), or another extremely threatening or horrific event that has a long-lasting negative impact on a person’s mental function
While there’s a time for going with the flow of culture, and using words however people casually use them, there’s an important role for more technically precise terminology as well. In the cases above, I believe the technical versions of these words are worth knowing about and understanding.
This piece was first written on November 7, 2025, and first appeared on my website on November 18, 2025.
2025-11-18 06:54:53
There are a ton of false narratives that circulate widely in and about the US. To help combat that, here’s a list I’ve been compiling of facts that contradict common narratives related to the US that many people believe. In some cases, these facts contradict common beliefs that most Americans hold, whereas in other cases, they contradict beliefs held mainly just by some subgroups (e.g., subgroups on the far right or far left).
While I’ve spent time fact-checking these, I’m very interested in correcting any mistakes I may have inadvertently made. If you catch any mistakes, please let me know what I’m wrong about and what’s actually true.
Facts about the US that contradict commonly believed narratives:
1) Regarding political violence, the majority of Americans see it as…a big problem in society and as being “never justified” (liberals and conservatives agree on this), and the substantial majority view it as “always or usually unacceptable” to be happy about a public figure’s death.
2) The majority of murderers have…prior criminal history (e.g., arrests or convictions), and the substantial majority of homicides are committed by men under 45.
3) More than half of murder victims who were not murdered by a family member also have prior criminal histories (though, of course, this doesn’t mean that they deserve to be murdered).
4) The majority of homicides are committed due to personal arguments or are related to drug or gang activity, rather than random acts of violence.
5) School shootings kill…vastly fewer children annually than prosaic dangers like unsafe driving (though it’s a horrifying tragedy each time school shootings occur).
6) Mass murders (where 3 or more people are murdered at the same event) are most often… familicide, where a person kills their family, usually committing suicide afterward.
7) Regarding violence, since the 1990s, America has gotten…far less violent (while there was an uptick during the pandemic around 2020, it is still well below the 1990s peak).
8) Compared to alcohol, homicide leads to the death of…very few people (though it’s terrible whenever homicide occurs).
9) The majority of gun-related deaths are…suicides, not homicides.
10) In rural areas, the suicide rate (per million people) is…highest (urban areas actually have lower rates).
11) The vast majority of reported disappearances of children are…relatives taking a child (e.g., custody disputes) or runaways (rather than kidnappings).
12) Most rapes are carried out by someone the victim already knows (though in about 1 in 5 cases, the perpetrator is a stranger).
13) Women experiencing sexual assault are not…at all uncommon (more than 20% of adult women have been sexually assaulted at some point in their lives).
14) The most dangerous activity that is very common for people under 30 to engage in on a daily basis is…driving in cars.
15) Commercial airline crashes are…incredibly rare (despite the media attention), and commercial flights are far safer than driving per mile (whereas per hour they are closer to being on par).
16) For adults 25 to 35, the biggest killer is…accidental poisoning (which mostly consists of drug overdoses), not car accidents, and considering the whole adult population, opioid related deaths exceed deaths from motor vehicles.
17) Most personal bankruptcy is related to…sudden job loss or illness (which can simultaneously lead to large medical bills and loss of work).
18) The significant majority of federal taxes that the government collects come from…the top 20% of earners.
19) The percent of Americans who pay no federal income tax is…about 35% (though they still pay payroll taxes and sales taxes, and may pay property taxes and state taxes).
20) Regarding health insurance, the vast majority of Americans…are insured (about 90%), and while some people get extremely screwed by the system by being stuck with huge bills they can’t afford due to unavoidable medical challenges, most Americans say they are satisfied with their health insurance, even though they usually also say that the system overall is substantially flawed and needs significant reforms.
21) Most US federal government spending goes to…social security, health care (e.g., Medicaid/Medicare), military-related expenses (e.g., staff costs, veterans, vehicles), and interest payments on national debt (since interest rates have risen).
22) On average, legal immigrants commit crimes…at a lower rate than natural-born citizens.
23) Where immigration status is reliably recorded, undocumented immigrants have an incarceration rate…lower than that of U.S.-born residents.
24) It’s extremely rare that trans people…get murdered (of course, it’s a horrible tragedy when it does occur, and there are uncertainties around data collection); but current data indicates that suicide is a vastly more common life-threatening risk to trans people, and also, that trans people experience a substantially elevated risk of non-fatal violence compared to cis people.
25) Unarmed Black people who are stopped or engaged by the police have…an extremely low chance of being killed by those police (of course, it’s a horrendous tragedy when it does occur); however, Black people are substantially more likely than white people to be stopped by police without clear cause, and are far more likely than white people to be murdered by criminals.
26) Black Americans mostly want the level of police presence in their area…to stay unchanged (i.e., neither be decreased nor increased), with only about 1 in 5 wanting less policing, though most Black Americans do want other major changes to policing to be made.
27) Currently, much of the recycling that occurs…ends up being wasteful once you factor in all extra fuel burned in order to recycle those materials, the amount of “recycled material” that fails to actually be recycled, and alternative enviromental efforts goverment money spent on recyclying could have gone to instead; whether recycling is effective depends on the region as well as the type of material being recyled (e.g., aluminum is especially useful to recycle, whereas plastic recycling tends to be inefficient).
28) Our landfills are…mostly not close to running out of capacity (and when there are shortages, they are almost always local issues).
29) From a danger perspective, nuclear power is…extremely safe (especially when compared to many other sources of power, like coal), as well as very environmentally friendly (with almost no emissions and reliable solutions for storing the toxic waste produced); new reactor designs are dramatically safer than past ones, yet, nuclear power largely is stopped from being cost-effective due to excessive regulations that are extremely costly to comply with.
30) Almost all suffering that humans cause to domesticated land animals is due to…practices at large farms, such as tiny cages that animals spend almost their whole lives in, or being densely packed together in unpleasant conditions with little to no outdoor access and limited ability to engage in their natural behaviors.
31) Most individuals who experience homelessness are homeless for less than 12 months, but most of the people you see living on city streets, who are typically the most visible homeless people, are experiencing longer-term homelessness.
32) The majority of people who experience chronic homelessness are either experiencing a drug addiction or a significant mental health challenge, or both (though for some of these people, the addiction or mental health challenge occurred after homelessness began); a non-negligible percent (perhaps 20%, but estimates differ substantially) have neither challenge.
33) The primary causes of high housing prices are…factors that increase the costs of building new housing or that completely prevent it from being built (such as zoning, excessive regulations, lengthy approval processes, and local opposition), as well as, for popular places like New York City, net migration into those areas.
34) The majority of people in prison in the US are there for…violent crimes, not non-violent drug-related crimes or victimless offenses.
35) Almost nobody who is charged with a crime goes to trial (they mostly take plea bargains).
36) The significant majority of people who are charged with a serious crime and go to trial are…convicted.
37) Regarding the US federal minimum wage, very…few people actually get paid that amount (in part due to higher minimum wages that many states have, and in part due to naturally occurring labor market prices that are simply higher than the federal minimum).
This piece was first written on November 2, 2025, and first appeared on my website on November 17, 2025.
2025-11-18 04:41:13
What causes bad things? It sounds like a huge question, but maybe it’s not as big as it seems. Here’s my updated/improved list of high-level causes of bad things in the world. Note that these are not mutually exclusive categories. I’ve also added some potential solutions for each cause.
I’d be interested to know: what is missing from my new list of causes of bad things and potential types of solutions? Thanks to those of you who commented on my prior version!
Causes of bad things in the world:
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1) EXTERNAL CAUSES
1i) Nature or evolution (e.g., malaria, cancer) -> Potential solutions: technological development, such as medical cures
1ii) Bad luck (e.g., landslides, earthquakes, droughts) -> charity, government programs providing social safety nets
1iii) Scarcity (e.g., insufficient food or water in an area) -> migration away from high scarcity areas, technological development to increase food production
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2) FAILINGS OF HUMAN NATURE
2i) Highly selfish actions by non-evil people (e.g., some of the crimes that are committed, some of the manipulation that occurs) -> cultural norms discouraging selfishness, cultural norms to punish those taking highly selfish actions
2ii) Harmful actions taken in highly emotional, confused, or desperate mental states (e.g., crimes of passion, harmful, desperate reactions out of fear, harm caused during extreme mental illness) -> widely available and effective mental health treatment, widespread education/training related to mental health and emotional regulation
2iii) Well-intentioned ideologues who are convinced that their simple but wrong model of the world is the absolute truth (e.g., some of the genocides and wars, many harmful yet well-intentioned policies) -> rationality education/training, a robust culture of respectful disagreement and debate
2iv) Cognitive biases leading to actions with severe negative consequences (e.g., greatly misjudging whether a project will bring enough benefit to be worth the cost, excessive fear towards or devaluing of ‘othered’ outsiders leading to mistreatment or harm to outsiders, lack of preparation for likely occurrences that are not salient) -> rationality education/training, careful design of systems to counteract biases, strong moral norms of respect towards all, moral circle expansion
2v) Retaliation or revenge (e.g., cycles of retribution) -> a culture of forgiveness, effective dispute resolution methods and institutions, reliable enforcement of laws
2vi) Evil people acting alone (e.g., serial murder, child abuse) -> effective police forces, high crime clearance rates, enforcement of laws, scientific investigation into the root causes of evil
2vii) Evil people who rally supporters (e.g., some genocides and wars, some extractive government policies) -> strong norms around truth telling and social punishment for lying, a robust culture of respectful disagreement and debate, a culture of empathy toward and acceptance of those who are different than you, a well-educated and informed citizenry, scientific investigation into the root causes of evil, a strong constitution, a strong independent judiciary, strong norms around maintaining freedom and independence of thought
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3) CHALLENGES OF COORDINATION AND INFORMATION
3i) Negative-sum competition (e.g., fighting over food when there isn’t enough to go around) -> technological innovation to increase abundance, thoroughly enforced laws forbidding negative-sum behaviors
3ii) Unintended side effects of actions that are not innately unethical (e.g., addiction caused by the invention of social media, new promising-seeming medical treatments that turn out to have horrendous side effects) -> a robust and low-transaction cost systems for those who were harmed to be compensated by those who caused the harm, hard to undermine enforced regulation requiring organizations to ameliorate harms once they have been identified
3iii) Collective action problems and negative externalities caused by individually reasonable behavior (e.g., pollution, climate change, overuse of resources) -> methods for assigning prices to negative externalities so that someone bears the cost, regulation to limit negative externalities
3iv) Prisoner’s dilemmas and difficulties of pre-commitment and coordination (e.g., arms races, such as with nuclear weapons) -> technology to facilitate coordination and simultaneous action, public projects by governments and private donors
What other broad causes of bad things or potential types of solutions am I missing?
This piece was first written on November 2, 2025, and first appeared on my website on November 17, 2025.
2025-11-04 05:36:58
People often say things like the following about anger’s relationship to other emotions – but are they B.S.? They say:
While there is debate about these ideas among people in the field, my opinion is that these statements are misleading and, in some cases, wrong. I think these statements can promote misunderstandings about the nature of anger, depression, and sadness, as well as what their connection to each other actually is.
In my view:
If I’m largely right about the points above, what then is the connection (if any) between anger and sadness and between anger and depression?
Well, some things can generate a mix of anger and other emotions.
We’d likely feel both anger and sadness if we believed that someone had permanently destroyed something we really value. For instance, if we believed that someone had purposely burned down our beloved home.
We’d likely feel both anger and depression if we felt that someone (or something) had rendered our future devoid of value. For instance, if we believed that someone had sabotaged our career prospects.
Additionally, emotions are not all equally available or comfortable to talk about. When we feel anger and sadness at the same time, we may be more aware of one of the two emotions, or more willing to express one of the two emotions to others, which can make it seem like one of them is hidden “beneath” the other.
But can other anger take the place of other emotions? Well, as one example, in some situations where we find it too emotionally difficult to blame ourselves for something bad that happened (that we, in fact, caused), we may blame others as a self-protective mechanism, which may mean we experience anger (towards these others), whereas if we accepted responsibility, we may feel depression rather than anger (e.g., due to viewing ourselves as worthless due to having caused the bad event).
On the flip side, our sadness or depression might suddenly turn to anger if we switched from believing that we had caused a great loss of something we value, to believing that someone else had been the cause of the loss.
Another way that anger can connect to sadness or depression is that if a person feels ashamed of being sad or depressed, and someone tries to get them to talk about their sadness or depression, they may respond with anger, for example, due to feeling pressured or judged.
So yes, anger can be connected to sadness or depression, though it isn’t always. And no, depression is not anger turned inward (they are distinct feelings), anger is usually not sadness’s bodyguard (though sometimes we can cast blame at others, leading to anger, to protect against blaming ourselves), and anger is not necessarily an iceberg (though we can have multiple emotions at a time, and some can be easier to notice or talk about).
This piece was first written on September 29, 2025, and first appeared on my website on November 3, 2025.
2025-11-03 03:34:05
It’s interesting how studies on the negative effects of social media on mental health are mixed: some find an effect, some don’t (or only find a very small effect). Some take this as proof that social media is actually fine for mental health.
My hypothesis is different. I think that the effects of social media are extremely heterogeneous based on app, population, and dosage: that in some subgroups, some social media apps (when used in high doses) have substantially negative effects on mental health, but in other subgroups, using other social media apps in moderate doses has no negative effect on mental health.
For instance, 13-year-old girls in the US using TikTok or Instagram for 4 hours a day may be very differently impacted than 25-year-old men in Denmark using Twitter/X or WhatsApp for 30 minutes per day.
The current studies may be like trying to answer the generic question: “Do non-prescription drugs have a negative mental health effect?” This question can’t be answered because it combines too many dissimilar things. In particular, the answer hinges on which drugs we’re talking about (cannabis vs. fentanyl), the age of the person doing the drug (teenagers vs. adults), and the quantity of drug use (occasional vs. extreme usage).
If my hypothesis is true, then getting to the bottom of the true impacts of social media on mental health will require carefully designed studies that subdivide by app and by population (ideally after preliminary research is done to figure out what apps and which populations are reasonable to group together – for instance, it may be essential to segment by gender and rough age group and even by culture, but it’s important to get these segmentations right if the research is going to make progress).
Another thing that makes this research so tricky is that social media literally adapts itself to what you pay attention to. So if you tend to click on upsetting things, it will show you more upsetting things, which can create a self-reinforcing cycle, whereas if you click on things that are interesting and pleasant, you’ll get more of those instead. So even at the level of the individual, social media can provide highly varied experiences. It’s instructive to compare your social media feed to a friend’s (on the same app). When I’ve done this, it’s been remarkable to see just how different our experiences on that app are.
Overall, my best guess is that most people’s social media use would be found to have little or no negative causal link to mental health. But I would predict that there is a moderately sized causal negative link to mental health for:
Another hypothesis is that insofar as social media causes negative mental health impacts, it’s because it changes the situation for everyone at once. For instance, if all teenagers in a school are on social media, that can change the way that they socialize (or how much people socialize) and how they interact (e.g., how much bullying or social comparison occurs). By this view, studying what happens to individuals when they use more or less social media misses the important effects. If this is the case, it makes the phenomena even harder to study!
This piece was first written on August 29, 2025, and first appeared on my website on November 2, 2025.
2025-10-31 07:36:56
There’s something really interesting and potentially important happening in the space of people suffering from chronic medical conditions that modern medicine provides no good solutions for, such as Long COVID, IBS, functional dyspepsia, fibromyalgia, chronic back or joint pain without injury/disease, ME/Chronic Fatigue Syndrome, PTLDS/Chronic Lyme disease, and so on. I’m talking here specifically about people where all other reasonable explanations for their conditions (e.g., cancer, injury, autoimmune disease, etc.) have been thoroughly ruled out.
Below is my attempt to summarize patterns across many anecdotal reports. I’d be curious to hear what you think, especially if you currently or have ever suffered from a painful or unpleasant chronic condition that modern medicine doesn’t have good solutions for.
While the evidence on this topic is extremely preliminary, what I say here could turn out to be wrong, and high-quality randomized controlled trials are desperately needed before we can be confident in these approaches being useful, anecdotally, there appears to be a pattern where people with these conditions are reporting substantial benefits (and sometimes even full recovery) from a combination of psychological and behavioral strategies – sometimes even people who have suffered for a decade or longer.
For those who have already tried all the obvious things, ruled out dangerous medical conditions, exhausted all the options presented by knowledgeable doctors, and don’t know what to do next, these ideas may be worth a try.
Important Note: none of what’s below implies that the person in question was never suffering from a disease, or that their pain is any less “real” than any other pain. Additionally, even if this approach works for some people, it will, of course, not work for everyone, and it may even make some people worse, so please explore with caution.
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From what I can tell, the often-repeated common threads reported in anecdotal accounts of those who recover from these conditions (that they attribute their recovery to) appear to have three major elements:
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Element 1: Foundation (this part is boring but important)
A focus on getting the healthy life basics in place, to set yourself up for potential recovery and to help you feel as good as you can (despite the pain). This often includes elements like:
• cutting out junk food and excessive sugar and replacing them with healthy, whole foods, and drinking sufficient water
• focusing on getting enough, high-quality sleep
• daily stress reduction, such as through a daily meditation practice, progressive muscle relaxation, deep breathing, a yoga routine, or massage
• reduce or cut out drugs and alcohol
• daily sunlight through some spent outdoors, ideally in the morning
• whatever daily movement or exercise feels manageable (even if just a short, slow walk outside)
• scheduling enjoyable activities regularly and aiming to find joy in ordinary pleasurable moments
• regular social connection with people you care about or find interesting
• If you are dealing with a mental health challenge (such as depression or anxiety, which are both common for people suffering from painful chronic conditions), seeking treatment from an expert (e.g., a well-trained therapist who specializes in the condition you’re grappling with)
• find ways to explore and process your difficult emotions, whether it be talking with a therapist, a daily journaling habit, just taking a few minutes daily to sit and let yourself fully feel your emotions, or speaking regularly to a trusted friend who is happy to listen
• if you tend to be hard on yourself or engage in a lot of negative self-talk, explore developing self-compassion (treating yourself at least as kindly as you’d treat a friend, and showing yourself compassion like you would to someone you care about)
• getting yourself out of psychologically unhealthy situations to the best of your ability (whether it be an unreasonably demanding work situation, a person in their life who treats you very badly or makes you feel bad all the time, or a people-pleasing mentality of never saying ‘no’ even though you are carrying a huge burden already)
These items in 1, above, are not designed to cure your chronic pain or even to reduce the pain; they aim to set you up for the maximum chance of feeling better, and so are important. Also note that 1 doesn’t involve taking a boatload of supplements or eating a highly unusual diet.
It’s 2 that is the more novel, potentially critical piece:
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Element 2: Reframing and Reprocessing
Completely reframing your perception of the painful and unpleasant bodily sensations. The goal is to:
i) See these sensations as your body attempting to send you a helpful signal (e.g., some people like to start thanking their body for giving them this signal because they know it’s trying to protect them)
ii) Perceive these sensations as a false alarm. The idea is that the symptoms do not actually mean you are in any danger, nor do they indicate a life-threatening disease (since we’re assuming that has already been ruled out). The symptoms also don’t mean that you are destined to feel bad all day, or that the activity you’re doing when the symptoms emerge is going to cause any lasting harm to you.
The attitude to bring here is not one of bracing against the pain, and not one of trying to fix the feeling.
The concept is that these unpleasant bodily signals (which probably began as signals connected to an injury or disease) have somehow become detached from any injury or disease. Unfortunately, the signals persist – whether due to misfiring in your nerves, your brain misinterpreting benign signals as being dangerous, associative learning (X has preceded Y enough that now X causes Y), or some kind of accidental signal reinforcement (e.g., by responding to the signal as if it’s a sign of danger, the signal gets perpetuated).
Here’s my metaphor for this way of seeing things:
Imagine that your pain or unpleasant bodily sensations are like the barking of a very loyal guard dog. You brought this dog into your home to protect you back when you used to be in a very dangerous area, and the dog was very helpful at that time, barking at the very real danger that was frequently around you.
Now you live in a safe area, with nothing important for the dog to bark at. But the dog desperately wants to be helpful, and only knows one way to do so. Due to his extreme overeagerness and an unrelenting focus on potential danger, the dog ends up barking constantly. Whenever it barks, despite the now safe environment, you subconsciously still interpret this as a sign of genuine danger (since that’s always what it used to mean). This constant barking leaves you constantly anxious, on edge, or in a heightened state, and may have downstream consequences on your body (such as impacting your ability to sleep well or digest food), and generally makes you miserable. Due to the well-meaning dog’s misguided attempt to keep you safe, the barking is ruining your life.
The idea, therefore, is to retrain yourself to view the chronic pain and unpleasant bodily sensations as completely safe. You can facilitate this by noticing when you’re having negative thoughts about the pain and gently letting them go, and by practicing observing the sensations neutrally, without judgment. You can even practice accepting the painful feelings exactly as they are (and when your brain jumps in to label the feeling as “awful” or tells you “you can’t handle it” you can acknowledge those thoughts, gently let go of them, and return to observing the feeling non-judgmentally. As many people (including myself) have experienced exploring this way of viewing pain during meditation, shifting our attitude toward pain can immediately reduce the suffering the pain causes us.
Redirecting to something positive after doing so is also something that people report as a useful addition (whether that’s some other part of your body that feels good right now, a humorous re-interpretation of the event, a pleasing visualization, or an activity that’s pleasant that you’d like to do now instead of focusing on the pain, etc.)
Importantly, for many people, their bodily signals really ARE indicating imminent bodily danger (e.g., if you have a broken bone in your foot, you may actually need to stay off it for a while to let it heal) – that’s typically how pain works. So if you’re considering trying these techniques, it’s important to first rule out that you’re in that group.
Additionally, it’s important to distinguish a bodily signal indicating true danger vs. one merely indicating “you need to rest”, which is not inherently dangerous, but is important to heed and not ignore. It’s not that you should learn to ignore bodily signals – many such signals provide us valuable information, and ignoring our bodies is a recipe for potential problems down the road. It’s instead about changing the relationship to our chronic painful bodily signals, such as experiencing them non-judgmentally with peace and acceptance, viewing them as our bodies attempting to give us useful information, and not responding to them as though they are dangerous.
For those interested in trying this approach, here’s the final piece of the puzzle:
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Element 3: Practicing and Expanding
• While adopting the points from 2, above, gently and at a manageable pace, challenge yourself with whatever triggers your immediate (acute) symptoms. That is, test the waters with things that would normally make your symptoms immediately feel worse. Do so while maintaining the perspective that the symptoms are safe, they are there in an attempt to help you, and that they do not indicate any actual harm to you. Aim to view the symptoms neutrally and objectively without judgment and keep trying to accept them as they are, without needing them to be different. Then, once that becomes a bit easier, gently push the limits further toward somewhat more intense potential triggers and toward things you’ve been avoiding out of the fear of their impact on your symptoms. An important note: the idea here is NOT to push yourself more and more in an attempt to build up tolerance, strength, fitness, or resistance to fatigue (as one might try to do in Graded Exercise Therapy) – the idea, instead, is to practice reframing and reprocessing symptoms in progressively more challenging situations, while being careful to avoid overdoing it (which can lead to crashes). Many report that pushing yourself too hard, too fast, can backfire. So go slow, be gentle with yourself, and treat yourself with self-compassion.
Expect some setbacks along the way – progress is not likely to be linear, with lots of random daily variation. Be consistent, working at this daily but at a pace that feels comfortable, and track symptoms at the end of each day (e.g., pain level, fatigue level, stress level), which you can check over time to see whether there is a longer-term trend towards progress.
Note: gently pushing your boundary on symptoms doesn’t mean blowing past your limits. For instance, if you know that a 15-minute walk will leave you feeling fine at the time but cause you to crash for the next 2 days, then walking for 15 minutes would not be an example of what I’m describing.
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What’s the point of this whole process? It’s really two-fold:
A) It can simply make it substantially easier to deal with the chronic condition, and mean that you suffer less despite all the pain, and live a happier life even as you have the pain. It may cause the pain itself to feel less bad (through a reframing of the pain), cause you to have less intense negative emotions about the pain (which means reducing the second-order pain and other consequences caused by these negative emotions), and expand the range of activities you engage in that make your life worth living.
This could be a good enough reason to try this approach. And that’s part of why I like this approach. While there’s always a risk of it backfiring, even if it doesn’t cause any huge change, I think it has a pretty good chance of making life more manageable and leading you to suffering less from the pain (i.e., even if the pain is not itself lessened, changing your perception of the pain can mean you suffer less from it).
But, here’s where things get weird and much more speculative:
B ) Some people find that after weeks or a few months of following processes similar to what’s described here, they are completely or nearly completely cured. These reports are still very much anecdotal, and much more rigorous research is needed to be confident in the cause of improvement for such folks (so this should all be taken with a big grain of salt), but it’s quite striking how many people who were sick for years or longer have reported rapid progress with approaches similar to what I’ve described here. Though the exact approaches they use differ, and have a variety of names, and a variety of distinct elements, I’ve included here aspects common to many of them.
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Obviously, there are major caveats here: people could be wrong about this being the cause of their improvements, and even if this approach does cure some people, it’s unclear what percentage of people would be cured if they were to fully take on such an approach. Additionally, there are lots of people this is not appropriate for, such as people who have a life-threatening medical condition, people who have not yet had a thorough medical workup, people experiencing rapid weight loss or fevers, and so on. The evidence here is not strong, and could turn out to be wrong. Just because modern medicine doesn’t have a good understanding of a disorder doesn’t mean that it’s connected to psychology and behavior. And some people even report having tried this approach and had it backfire, where it left them worse off, so please be careful.
If this method does work, though, why does it work? It seems like one or more of the following explanations may be at play (which may vary depending on the individual):
• Pain signals and negative bodily sensations can occur in the absence of injury or disease (for instance, due to misfiring in the nerve, the brain misinterpreting signals, or other causes). A proof of concept where we know this happens is Phantom Pain Syndrome, where a person who has had a limb amputated may experience intense chronic pain that feels to them to be coming from that (now absent) limb, which, of course, it can’t actually be coming from.
• It may be that pain signals or unpleasant bodily sensations can become reinforced by our reactions to them (though this is not well understood). If so, the way we react may inadvertently cause pain signals to persist even past the point of the injury or disease that originally caused them to start. Perhaps somehow our attention to the signals, or our viewing them as dangerous, convinces our brain that the signals are worth sending.
• Or, a subtly but importantly different mechanism may be at play: our negative reactions to pain signals or unpleasant bodily sensations may leave us in a highly elevated state (e.g., anxiety or cortisol), and this elevated state may generate new pain signals or exacerbate existing signals (e.g., increase tightness in the stomach or an inflamed feeling in joints) or new unpleasant bodily sensations (e.g., trouble with digestion, difficulty breathing) which then generate more negative reactions, in a self-perpetuating cycle
• Or, a related possibility, is that your brain has somehow learned associations that are now triggering reactions. Perhaps your brain learned that when X happens, then the proper response is Y, and your brain is now triggering Y in response to X, despite that reaction being useless now and generating negative side effects for you.
• In some cases, behaviors we engage in to avoid pain may actually increase or perpetuate it – e.g., avoiding using a joint because it hurts may actually cause it to be stiff and painful from lack of use, which may cause us to continue to avoid its use.
Pain can be completely real, disabling, and have a biological origin, even in the absence of damaged or diseased tissue.
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One important thing you may wonder: Is there actually evidence that psychological and behavioral approaches can improve the lives of people with these conditions? Well, while this field is, overall, woefully under-researched, there’s quite a bit of evidence that psychological and behavioral strategies can help (even though the nature of these strategies differs, and may only be partially overlapping with what I’m describing in this post). Here is a quick recap of some of that evidence:
(1) IBS: A meta-analysis of randomized controlled trials of psychological treatments for Irritable Bowel Syndrome looked at 15 studies. It found greater improvement in the psychological treatment groups compared to the control group on symptom severity, quality of life, and abdominal pain, but no difference in diarrhea or constipation. Another meta-analysis on psychological therapies for IBS looked at 41 randomized controlled trials and found that CBT and gut-directed hypnotherapy outperformed education and routine care.
(2) Functional Dyspepsia: A meta-analysis of psychotherapy treatments for people with Functional Dyspepsia. It looked at 5 studies and found that those receiving psychotherapy improved in gastrointestinal symptoms.
(3) ME/CFS: A 2011 meta-analysis of randomized controlled trials of treatments for Chronic Fatigue Syndrome looked at 16 studies on Cognitive Behavioral Therapy (CBT) and concluded overall that those receiving CBT had greater symptom improvement than control groups. As a commenter pointed out, those studies used an earlier definition of ME/CFS that didn’t require post-exertional fatigue. A later 2020 Systematic review of randomized controlled trials looked at 12 studies on CBT, and found that 4 showed it to be effective, 2 ‘Partially significant’, and 6 found no effect.
(4) Chronic pain: a Cochrane meta-analysis looked at 75 studies on psychological treatments for chronic pain conditions, including fibromyalgia and chronic low back pain. A number of types of psychological treatment were included, such as CBT, behavioral therapy, and ACT. They conclude: “On average, compared to people who receive no treatment for their pain, people treated with CBT probably experience slightly less pain and distress by the end of the treatment and six to 12 months later (moderate-quality evidence). They may also experience slightly less disability on average (low-quality evidence).”
So the evidence overall quite strongly indicates that psychological and behavioral strategies can help people with these conditions (though, unfortunately, there is little research that has been done directly testing the specific strategies I’m describing here, and there is a lot of heterogeneity in results, especially with ME/CFS).
The most direct evidence of a technique very similar to what I’m describing (that I’m aware of) comes from just one randomized controlled trial on a method known as “Pain Reprocessing Therapy” (PRT) for chronic back pain. It showed promising results (though more studies are very much needed). PRT has many common elements with what I’ve described in this post.
Of course, if you’re suffering from one of these chronic conditions, you may simply want to try Cognitive Behavioral Therapy if it seems promising to you or (if it’s a gut disorder) gut-directed hypnotherapy as there’s reasonable evidence (as described above) that they improve many people’s quality of life who suffer from chronic conditions, even if they don’t provide a cure for most people.
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The best source I know of to learn about these many anecdotal accounts of people improving from these conditions is the YouTube channel of Raelan Agle. She had ME/CFS for 10 years and eventually recovered, and on her channel, she interviews people who have recovered from ME/CFS and Long Covid. These three videos in particular were very influential for what I wrote in this post:
• Raelan’s recovery themes from 200 Interviews:
• What Raelan says about why recovery experts disagree and what they agree on.
There are also interesting books related to this topic, such as “The Way Out” by Alan Gordon and Alon Ziv (which teaches a specific method known as “Somatic Tracking” that’s very related to, but not identical to, what I discussed in this post).
This piece was first written on October 30, 2025 and first appeared on my website on November 10, 2025.