Bloomwave Practice

Tag: Depression

  • The Healthy Adult Mode in Schema Therapy

    The Healthy Adult Mode in Schema Therapy

    What does it mean to be an adult? This is a question that I’m sure, most people grapple with at some point during their lives. Is it when you turn 18? Or 25? When you become financially independent, or maybe when you get married or graduate from university? According to some, it’s only when you have children of your own, or when your parents die.

    Okay, sure, maybe you feel like an adult in some areas of your life, but what does it actually mean to be a healthy adult? One answer is provided by the framework of schema therapy – a form of integrative therapy that helps people defeat ingrained patterns in their life, often stemming from their childhood.

    Schema therapy conceptualizes different ‘modes’ of functioning, some helpful, and some not so helpful, but the main mode it aims to strengthen is the healthy adult mode – a way of functioning that reflects true psychological maturity.

    The healthy adult mode is the part of you that can:

    • Regulate emotions without suppressing them
    • Set boundaries without feeling guilty
    • Take responsibility without hating yourself
    • Comfort yourself
    • Perform responsible adult activities: maintaining your health, athletic activities, pleasurable activities such as sex, working, parenting, etc.
    • Make balanced decisions that align with your values.

    On modes

    Modes in schema therapy are defined as temporary states that include emotions, thoughts, and behaviors, which stared in childhood. We all have modes that we tend to frequently switch into, and below you will find a list of different modes, and you can see what you recognize in yourself:

    Child modes

    These represent the raw emotions and unmet needs of your inner child.

    1. Vulnerable child mode – feels lonely, isolated, sad, misunderstood, unsupported, overwhelmed, incompetent, needy, helpless, hopeless, anxious.
    2. Angry/impulsive child mode – feels angry, enraged, cheated, because core needs are not met, or acts on impulses
    3. Happy child mode – feels loved, connected, playful, fulfilled.

    Critic/unhelpful parent modes

    These represent internalized critical voices based on criticisms or demands received in childhood from authority figures (parents, teachers, other family members)

    1. Demanding parent mode – perfectionism, impossibly high standards, strict rules, avoiding spontaneity or expressing emotions
    2. Punitive parent mode – internal criticism, punishment, berating oneself for perceived failures
    3. Guilt-inducing parent mode – believes you are responsible for others’ wellbeing, triggers shame, anxiety or guilt when you prioritize yourself or set boundaries

    Coping modes

    These represent maladaptive defensive strategies developed in childhood to avoid the pain of vulnerable child mode.

    1. Surrendering coping mode – acts submissively to others, puts own needs aside, people pleases, avoids conflict at all costs, tolerates poor treatment
    2. Avoidant coping mode – avoids, numbs or disconnects from emotions, self-soothes, distracts
    3. Overcompensating coping mode – fights feelings of inferiority by being grandiose, bullying or controlling others, aggressive

    And finally, the healthy adult mode, which will be the focus of this post.

    What is the healthy adult mode?

    You can think of the healthy adult mode as a ‘good internal parent’ in yourself, as it:

    • Nurtures and validates the vulnerable child mode
    • Sets limits for the angry/impulsive child mode
    • Neutralizes or moderates the critical parent modes
    • Combats and replaces the coping modes
    • Promotes and supports the happy child mode

    Basically, imagine how a good parent should act towards their child, and you will understand the healthy adult mode.

    Where does the healthy adult mode come from?

    Ideally, it would develop in childhood, through ‘good parenting’, or early experiences of secure attachment, emotional co-regulation and validation, healthy boundaries and limits, and consistent, predicable caregiving.

    However, many of us have not had these experiences, especially in cases of childhood abuse, neglect or trauma, but also unpredictability, bullying, invalidation or frequent criticism. In adulthood, this can show up as psychological disorders like depression, anxiety or personality disorders, or chronic patterns of perfectionism, harsh self-criticism, shame, emotional avoidance or suppression, relationship difficulties, or emotion regulation issues, for example.

    The healthy adult mode therefore often has to developed intentionally in adulthood: though therapy, self-compassion, and secure relationships. While this can be challenging, the good news is that it’s not impossible, especially if you keep at it. The brain has what we call neuroplasticity – the ability to reorganize itself with practice and time.

    What does the healthy adult mode look like in practice?

    The healthy adult is not always calm, hyper-disciplined, or completely ‘healed’. Instead, it’s flexible, reflective, and allows for nuance.

    For example:

    • Instead of: ‘I’m such a failure for not reaching this goal’ (punitive parent mode)
      It says: ‘I might not have reached this goal, but I still deserve support and kindness’
    • Instead of: ‘I need to drink to avoid this feeling’ (avoidant coping mode)
      It says: ‘This feels very bad, but I can survive it without drinking’
    • Instead of: ‘My partner is upset with me, and this means I’ve done something wrong’
      It says: ‘Disappointing others is a normal part of relationships, I’ll see what I can do to make amends but I am not responsible for their feelings’

    Why this matters

    Research consistently shows that psychological flexibility, emotional regulation, secure attachment and self-compassion are associated with good mental health outcomes. Therefore, strengthening the healthy adult mode can help with anxiety, depression, perfectionism, relationship issues, trauma recovery, and so much more. In addition, it reduces reliance on unhelpful coping strategies, such as substance use, binge eating, avoiding emotions, people-pleasing, or overworking, to name a few. The benefits are endless!

    How to strengthen the healthy adult mode

    1.  Learn to notice your modes

    The first step is awareness – most people just feel, and are not consciously aware when they shift into any of the unhelpful modes listed above. Start by educating yourself on this, and then, when you feel a negative emotion, try asking yourself:

    • What am I feeling right now?
    • What part of me is activated?
    • What does this part fear? What does it need?

    By simply observing your emotions nonjudgmentally, you can improve emotional regulation and decrease your reactivity in the moment (this is what mindfulness is all about).

    2. Practice self-compassion

    Many of us have inner dialogues that are so harsh we would never speak to another person that way (these are the critical parent modes!) The healthy adult challenges critical voices instead of automatically believing them.

    Try:

    • Imagining how you would speak to a good friend, and then applying this to yourself
    • Asking yourself: ‘Would I say this to someone I love?’
    • Practicing compassionate phrases through journaling, such as ‘It’s okay to make mistakes’, ‘I am doing the best I can right now’

    If you’re not used to this, self-compassion can feel like making excuses or shirking from accountability, but in reality, it does the opposite.

    3. Practice emotion regulation

    Emotion regulation does not mean suppressing your emotions, it simply helps you contain and express them safely. You’re not trying to stop feeling the feeling, you’re simply inviting more awareness.

    Emotion regulation techniques may involve:

    • Grounding and/or breathing exercises
    • Mindfulness or meditation
    • Movement
    • Journaling
    • Taking a break before acting impulsively

    Not all emotion regulation skills work for everyone, and that’s why it can also be helpful to seek therapy if you find your emotions are always all over the place.

    4. Practice balanced discipline

    Discipline is needed to help you reach your goals, and is an essential part of healthy adult functioning, but the key here is that you don’t use punishment, shame or self-criticism to get there.

    Instead, you work on consistency, structure and flexibility. This looks like:

    • Setting realistic goals and expectations
    • Making time for rest
    • Adapting goals based on your capacity or energy levels
    • Building sustainable routines and flexible schedules

    Learn what works for you, rather than trying to fight your brain and fit into a mold created by someone else.

    5. Build safe relationships

    The healthy adult develops in connection with others: we are social animals, after all, and no one can heal relational wounds on an island. Safe and secure relationships can help you way more than therapy and endless ‘focusing on yourself’. And this does not have to mean romantic relationships at all! It can look like focusing on your friendships of familial bonds, going to support groups or structured leisure activities, etc. The goal here is not to be dependent on others nor entirely independent, but develop healthy interdependence. You honor your own needs and boundaries, while respecting and taking others into account.

    Example activities to try that help get into healthy adult mode:

    • Learn something new
    • Exercise or play a sport
    • Take responsibility for something
    • Make a gratitude or positive experiences list
    • Help someone else
    • Organize or plan something
    • Cook a healthy meal or meal prep
    • Journal
    • Read a book
    • Work on your hobbies
    • Etc.

    So, what does it mean to be an adult?

    In reality, this has nothing to do with your age, financial stability, or parenthood status. Being a healthy adult does not mean you have to have your life together, or be a perfectly calm and regulated person in all situations. It’s about caring for yourself and others, experiencing your emotions without getting swallowed by them, and relating to the world in a balanced and compassionate way – being the parent you (maybe) never had.

    And it’s not a destination you can arrive it, but rather a lifelong practice.

    References

    Kabat-Zinn, J. (2003). Mindfulness-based interventions in context.

    Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself.

    Richo, D. (1991). How to be an adult in relationships.

    Taylor, C. D. J., et al. (2017). Schema therapy for personality disorders: A systematic review.

    Waters, E., et al. (2000). Attachment security in adulthood.

    Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide.

  • Gender differences in autism

    Gender differences in autism

    If you’ve been on social media lately, you may have come across more and more people talking about autism and how it affects them.

    Autism spectrum disorder is a neurodevelopmental condition (meaning it starts in childhood) that affects how people communicate and socialize with each other and how they perceive and interact with the world around them.

    Traditionally, autism has been defined by:

    • Difficulties in social interaction and sharing emotions (such as missing social cues or trouble relating to peers)
    • Challenges with nonverbal communication (including facial expressions and eye contact)
    • Restricted or repetitive behaviors or interests (the so-called special interests)

    This is what we often think of when we hear the word autism. And if I asked you to imagine an autistic person, how many of you would imagine them to be male?

    Autism exists on a spectrum, meaning it can look very different from one person to another. More severe cases are usually diagnosed early, while those on the milder end of the spectrum might be missed by the healthcare system. What’s more, it can look very different in women than in men, and it is diagnosed about 4 times as often in males then in females.

    However, many researchers believe the disorder is not actually more common in men, it’s just that the its female presentation is different, and therefore under-diagnosed.

    This post aims to explore the reasons behind this, and ends with what you can do if you suspect you might have autism.

    Genuine gender differences

    First, let’s take a look at reasons why autism may actually be less common in women. These reasons are still being studied, but several hypotheses exist:

    1. Biology and genetics – The ‘Female Protective Effect’ theory posits that women may require a higher level of genetic risk for autistic traits to be expressed.
    2. Hormonal differences – Some research links prenatal testosterone levels to autistic traits. This has led to the theory that autism may represent an “extreme” version of certain cognitive patterns more commonly associated with males.
    3. Brain connectivity differences – There is also evidence that differences in brain connectivity patterns may play a role.

    How autism can look different in women

    1. Social motivation: wanting connection

    One key difference is that autistic women often show higher social motivation than autistic men. This is partially due to socialization, as female children are often encouraged to play more with others, and their activities in general tend to be more community-based.

    This means that:

    • They may want friendships and connection
    • They may put significant effort into fitting in
    • They may appear more socially engaged on the surface

    Because of this, their social difficulties can be less obvious to others, even though they are very much present.

    2. Different types of interests

    Autistic traits are often identified through “special interests.” But what counts as noticeable can be biased. Autistic men may have interests in topics like technology, systems, or mechanics, while autistic women often have interests that appear more socially typical, such as:

    • Animals
    • Books or fictional characters
    • Psychology or relationships

    The difference is not in intensity, but in how socially acceptable the interest appears. This can lead to girls being overlooked.

    3. Internalizing vs. externalizing

    Autistic women are more likely to experience internalizing difficulties, such as:

    These struggles are often less visible than external behaviours (like aggression or hyperactivity), which are more commonly seen in boys and more likely to trigger assessment.

    As a result, many women are first diagnosed with anxiety or depression, while autism remains unrecognized.

    The role of masking

    One of the most important concepts in understanding gender differences in autism is masking. Masking refers to consciously or unconsciously:

    • Copying social behaviors (by observing others, watching movies, etc.)
    • Rehearsing conversations
    • Forcing eye contact
    • Suppressing natural responses (such as stimming or talking about a special interest)

    How to know of you are masking:

    • You feel very tired and drained after social interactions
    • You often find yourself practicing or rehearsing what you’re going to say in advance
    • You frequently copy others’ behaviors, speech patterns, or facial expressions
    • You deliberately stop yourself from stimming or other behaviors that feel natural to you in public settings
    • You feel like you can’t be your true self around others and constantly adjust your behavior to meet social expectations

    Research shows that autistic women are significantly more likely to engage in masking. While this can help them “blend in,” it comes at a cost:

    • Exhaustion and burnout
    • Loss of identity and feeling confused about who you truly are
    • Increased mental health difficulties, such as anxiety, stress, depression or low self-esteem

    Many women report feeling like they are “performing” rather than being themselves.

    Why are women underdiagnosed?

    1. Diagnostic criteria are based on male presentations

    Most autism research has historically focused on boys. As a result:

    • Diagnostic tools, such as the adult autism quotient (AQ) may miss female presentations
    • Clinicians may look for “male-typical” traits

    This creates a systemic bias in assessment, making it more difficult for women to access the understanding, treatment or accommodations they may need.

    2. Social expectations play a role

    From a young age, girls are often socialized to be polite, emotionally aware and focus on social relationships. Because of this, autistic girls may learn to compensate earlier and more effectively.

    They may also be:

    • Seen as shy , quiet or withdrawn (or a pleasure to have in class by teachers)
    • Overlooked as ‘functioning well’ when they withdraw or struggle with internalizing disorders, such as anxiety

    3. Different social experiences

    Research suggests that while autistic boys are more often overtly rejected, autistic girls are more often overlooked or socially excluded in subtle ways that they may not even recognize themselves as rejection.

    Girls tend to have more social contacts, but these relationships can be:

    • Less stable (switching friends or friend groups often)
    • More superficial (casual friendships instead of deep emotional connections)
    • Take more effort to maintain (they may find socializing very exhausting)

    Why this matters

    When autism in women goes unrecognized, it can lead to:

    • Late diagnosis (often in adulthood)
    • Misdiagnosis (e.g., anxiety, borderline personality disorder)
    • Lack of appropriate support or accommodations
    • Long-term mental health struggles
    • A constant feeling that something is off, but being unable to place it

    For many women, receiving an autism diagnosis later in life can be both validating and overwhelming, finally making sense of years of feeling different. This can also be a pathway to increased understanding and coping for both herself and her loved ones, and becoming able to access supports and accommodations at university or work.

    Towards a more inclusive understanding of autism

    Autism is not one single presentation, and understanding gender differences helps us:

    • Recognize more diverse presentations
    • Reduce diagnostic bias
    • Provide better and more tailored support
    • And perhaps most importantly: help people feel seen and understood.

    There is a lot of nuance in this topic, especially since I have not covered intersex, agender, non-binary or transgender people.

    However, if you are a woman, AFAB person, or someone who was raised as a woman, and you feel you have:

    • Difficulties with social interactions – difficulties making friends, superficial relationships, etc.
    • Difficulties with communication – trouble understanding language, jokes or sarcasm, taking things literally, etc.
    • Sensory issues – overstimulation, increased sensitivity to certain sensory inputs, or conversely, sensory seeking (such as spinning around), etc.
    • Emotional overwhelm – emotional meltdowns or shutdowns, overreactions to minor changes, etc.
    • Intense interests and repetitive behaviors or rituals
    • Coping mechanisms that include masking or performing

    It might be useful to investigate this further, and seek help from a professional, such as a psychologist or psychiatrist.

    References

    Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed autistic women

    Baron-Cohen, S. et al. (2015). Prenatal testosterone and autistic traits

    Hull, L. et al. (2017, 2020). Camouflaging in autism

    Lai, M. C. et al. (2015, 2017). Sex/gender differences in autism

    Loomes, R. et al. (2017). Male-to-female ratio in autism

    Robinson, E. B. et al. (2013). Female protective effect

    Sedgewick, F. et al. (2016). Social relationships in autistic girls

  • AI in Mental Health

    AI in Mental Health

    If you’ve ever used ChatGPT or a similar AI language model as a pseudo-therapist, you’re not alone. In fact, its one of the most common uses for AI today, as it can offer comfort and even companionship and an increasingly lonely world. For many, it has real benefits, but research suggests it also carries significant risks, especially when it comes to more complex mental health issues.

    What are the benefits? What can it do better than a human therapist?

    • Fosters positive emotions – always validating and empathetic
    • Memory – bots don’t forget, and can easily access information from previous sessions
    • Accessibility – free, available 24/7 instantly, doesn’t get bored, tired or distracted
    • Non-judgmental – many find it easier to reveal their secrets to a chatbot, instead of taking a chance that another person may judge them
    • Knowledge base – they know everything about everything, and can provide great psychoeducation and any resources the user may need

    What can it help with?

    • Structuring your thoughts – AI can help you make a framework for your thoughts and give structure to what you would like to say, for example, in a conflict situation. Plus, writing it out is a great way to process in any case.
    • Providing psychoeducation – if you need simple information about mental health or psychological disorders such as anxiety or depression, it can be a great starting point, or if you want to learn about specific therapeutic approaches, such as cognitive-behavioral therapy, schema therapy, acceptance and commitment therapy, internal family systems therapy, etc.
    • Offering coping skills – if you need specific coping skills to help you in a period of stress, AI can suggest some great options, just remember to take what you need and leave the rest.
    • Offering structured exercises and journaling prompts – do you want to journal but feel uninspired? Or maybe you’re looking for a connection-building exercise to do with your partner?

    Though these benefits are undeniable, keep in mind that if you do choose to use AI for the abovementioned tasks, remember its limitations, and proceed with caution.

    How can it hurt?

    Lack of the ‘human’ skills needed for therapy

    Across decades of psychotherapy research, one factor consistently predicts positive outcomes more than any specific technique: the therapeutic relationship, which is fundamentally a human social relationship. A psychologist can read body language, notice emotional shifts, offer empathy, and, importantly, know when to challenge instead of simply validate you.

    AI models are there to make money, and therefore are designed to keep you satisfied and engaged, causing an inability to provide criticism, which is a crucial part of therapy.

    Stigma and bias

    AI chatbots across the board show increased stigma for conditions such as alcohol dependence and schizophrenia. This is equally true for more complex and newer models, so simply ‘more data’ is not the solution here. Additionally, since AI systems are trained on human feedback, they often reflect the dominant demographic, therefore lacking understanding of nuanced experiences related to gender, sexuality, race, culture, neurodivergence or socioeconomic background. And while it is true that humans are biased in this way too, they have the potential to adapt based on lived clinical experience.

    Privacy and ethics

    These conversations are not protected by confidentiality like therapy sessions are, and your data may be collected for training bots and marketing, as well as other unauthorized use, identity theft, and scamming. There is also a lack of quality control, clinical oversight or meaningful external regulation.

    Dependence

    The 24/7 availability and validating nature can cause addiction and social isolation: since real human contact is often messy and imperfect, an AI companion can offer a security blanket. With loneliness already on the rise, this a real risk. This sort of on-demand emotional validation can also undermine resilience and autonomy, especially if you already have anxiety or low self-esteem.

    When does it become truly dangerous?

    Enabling distorted thinking

    Chatbots don’t deal well with chaotic and unpredictable situations, which is where human intuition has a great advantage. When it comes to complex mental health conditions, such as bipolar disorder, schizophrenia, psychosis, suicidality, self-harm, eating disorders, antisocial and aggressive impulses or delusions, engaging with AI can have devastating effects.

    The chatbots’ tendency to always validate may cause it to reinforce dangerous or delusional thinking, and encourage the user to act on their impulses. Even for those with milder issues, AI can encourage fallacies like catastrophizing or minimizing, instead of gently correcting them, as a therapist would.

    Crisis situations

    Since AI cannot assess whether the user’s view of reality is accurate, it might, for example, give a suicidal person detailed information on the highest buildings in their area, or encourage a frustrated teenager to cut their parents off. AI can’t know when one might need a higher level of care, or when to call emergency services. And the consequences can be catastrophic.

    So, ultimately, what’s the role of AI in mental healthcare?

    Like it or not, AI is here to stay, but it should be treated as a substitute, not a replacement for therapy, by therapists and clients alike. It can help you reflect, organize your thoughts, and bridge the gap where the human therapist is unavailable. However, as it stands today, it cannot and should not act as a primary provider, especially in high-risk situations.

    If you are struggling, be it with anxiety, depression, burn-out, identity questions, relationships, or feeling disconnected, speaking to a licensed psychologist remains the safest and most effective option. Technology may support mental health, but healing still happens in relationship.

    References

    Jesudason, D., Bacchi, & Bastiampillai, T. (2025). Artificial intelligence (AI) in psychotherapy: A challenging frontier

    Kuhail, M. A., et al. (2025). Human-Human vs Human-AI Therapy: An Empirical Study

    Moore, J., et al. (2025). Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers

    Olawade, D. B. (2024). Enhancing mental health with Artificial Intelligence: Current trends and future prospects

  • Get into awe

    Get into awe

    Feeling stuck, disconnected, depressed? Unsure what you want from life, unfulfilled, but don’t know what to do about it?

    Let me ask you this: have you ever felt a sense of completeness, fulfilment or peace standing while looking at a beautiful sunset or at a concert, completely mesmerized by the sense of community along with the music you grew up with? Then, you have experienced awe. Awe as am emotion arises when we encounter something vast or ‘beyond us’ – think nature, collective gatherings, music, art, spiritual experiences, birth or death, or psychedelic experiences, for example. Awe makes you stop, wonder, and forget about yourself and your daily routine or annoyance for a second, and helps you see the bigger picture.

    There is research out there suggesting that experiencing awe can increase both our mental and physical wellbeing.

    A study by Monroy & Keltner (2022) proposed five pathways to how this works:

    1. Physiological changes – in simple terms, awe reduces the activation of our sympathetic nervous system (this means your fight or flight response), increases the production of oxytocin (the love hormone) and reduces signs of inflammation in the body.
    2. Reduced focus on yourself – feeling like you’re a part of something bigger rather then focusing on your imperfections
    3. Increase in prosocial behaviour – this means increased generosity and helping others, which make you feel much better, too!
    4. Increased feeling of connection with others – and this common humanity increases our empathy and helps us connect with our social environment.
    5. Increased sense of purpose or meaning in life – again, seeing the bigger picture!

    Awe experiences thus reduce anxiety, depression and stress – and promote optimism, resilience and a sense of connection and meaning in life – the antidote to disconnection! Additionally, a reduction in physical stress can lead to improved cardiovascular health and longevity.

    Of course, these experiences can be rare, especially in our fast-paced society – who’s got the time to slow down and really take in our surroundings? Well, I say – make time. For your own good, and for your loved ones and society at large.

    But how?

    1. Seek out awe experiences, big and small. Below is an example list of things to try:

    • Spend time in nature – This could mean taking a holiday, or simply going for a bike ride or walk near where you live. It can be especially powerful if you live in a big city, or where there aren’t a lot of opportunities for getting away (The Netherlands is great – but we do have a lack of forests!)
    • Go to a concert – Either with friends or by yourself, the experience of listening to your favorite music alongside others who feel the same way, can make you feel more connected to humanity, almost like a trance-like state.
    • Watch the sunrise or sunset on a beach – While this may require either getting up very early or going to bed late. the payoff is great.
    • Look at the starts and constellations at night – For night owls, or if you can’t sleep, this can help you feel more connected to the universe, and see yourself as just one amazing part of it.
    • Attend an art installation – Creativity elicits awe, and it might even awaken your own desire to create!
    • Listen to music loudly at night – Bonus points if it’s while you’re walking alone (as long as it’s safe, of course), or dancing in your room
    • Share, or listen to stories of great human achievement or kindness – With so much tragedy in the world, sometimes it’s nice to tune out of that and look on the other side.

    2. Practice mindfulness and being truly present in the moment – so you don’t miss out on everyday wonders!

    Awe is course only one piece of a very complicated puzzle. Improving your mental health is not straightforward and never one-size-fits all. In addition to increasing everyday wonder, you might also want to seek therapy and learn new skills. In addition, if you are very stuck or depressed, even the most beautiful of sunsets may fail to evoke the coveted feeling of awe. However, if you can, try it. It might just improve your outlook.

    References

    Monroy, M., & Keltner, D. (2023). Awe as a Pathway to Mental and Physical Health. Perspectives in Psychological Science.