Becoming more comfortable with sex after sexual abuse

by Kali Munro, M.Ed., Psychotherapist

Many sexual abuse survivors struggle to have positive and enjoyable sex lives. It can be very hard to feel comfortable with and enjoy sex when you've been sexually abused. Even people who haven't been sexually abused struggle to feel comfortable with their sexuality and sex. This article may be helpful to anyone who has issues with sexuality.

Many Survivors Are Vulnerable to Further Abuse

For many sexual abuse survivors, sex becomes linked with sexual abuse. As a result, some survivors will mistake unsatisfying and unpleasurable sex, or even sexually abusive behavior, for sex. This means that survivors can be vulnerable to being further abused. As a survivor, this is not your fault. You may not know: that you have the right to enjoy yourself sexually; what a mutually satisfying sexual experience is; what you want sexually, and that those needs deserve respect; and that you can say "no" and have that respected.

Abuse teaches the opposite - during abuse, your needs don't matter; you have to cater to someone else's sexual needs. Your sexual desires don't exist, and if they do exist they don't count. And of course you have no power to stop the abuse.

Some survivors believe that's what sex is - unenjoyable and abusive - or that that is how it is with a man, or with a woman. They may also believe that's all they are good for, that they can't expect anything better, and that if sex isn't enjoyable it's their fault or the result of their own inadequacy - they are "damaged". These reactions and beliefs are outcomes of abuse and need to be challenged - because they are not true.

Sexual Abuse Is Not Sex

One of the hardest things for abuse survivors to do is separate sexual abuse from sex. I know you may know this intellectually, but it's worth repeating many times - sexual abuse is not sex. Even if you liked the attention, approached your abuser for attention, were aroused, or had an orgasm, it's still not sex and you are not responsible.

Placing responsibility on the abuser is one of the most important steps in separating the sexual abuse from your sexuality and sex life. That may involve feeling anger at your abuser, holding him/her responsible (in your own mind), grieving your victimization and powerlessness, and reassuring the hurt child inside you that it wasn't her/his fault.

Sexual Abuse Becomes the Model For Sex

Sexual abuse is often the child's first introduction to sex. Children are too young to understand what sex is so it's not surprising that many abused children mistake abuse for sex. After all, it does involve sexual contact, sexual body parts, and sexual stimulation. Sadly, sexual abuse becomes the child's model for future sex.

It is crucial to find ways to separate your sexuality and sex from sexual abuse, and to create an entirely new association with sex - one that is positive, safe, and fun. You may need to discover your own sexuality - what it means to you, what you enjoy, and what gives you pleasure. It helps to develop a sexual relationship with yourself including self-pleasuring and discovering how you like to talk, move, dance, or interact with others when you're in touch with your sexual feelings.

You may want to fantasize or read about sex, view erotica, and talk about sex with your friends or partner. If you have a partner try to be playful about sex - cuddle, massage each other, talk about fantasies, and ask for what you want sexually. Sex can be playful, fun, and safe.

The Myth That Sexual Abuse Causes Survivors' Sexual Orientation

Because same-sex abuse is considered to be the same as lesbian and gay sex, many people believe that same-sex abuse causes survivors to be gay. On the flip side, when a survivor has been abused by a member of the other sex and the survivor identifies as gay, it's assumed that that, too, is the result of abuse. This can cause a lesbian or gay sexual abuse survivor to question her/his sexual identity. Many heterosexual survivors also struggle with questions about their sexuality because of the confusion and negative associations about sex that are created by sexual abuse.

It might help to try and remember if you had any sense of your sexual desires prior to the abuse. What gender(s) were you attracted to then? If you can't remember or you were abused very young, you may need to start paying attention to who you are attracted to now, who you feel most comfortable with emotionally and sexually, and who you fantasize about. You may need to see or read about positive images of lesbian, gay, bisexual, or heterosexual sex to help you discover what feels right for you.

The challenge is to find ways to connect deep inside yourself and unearth your own truth - your own sexual desires, fantasies, passion, and emotional and sexual attractions. Working on separating the abuse from your sexuality will help clear some of the confusion. If you are gay and fear that your sexual orientation was caused by the abuse, you may want to learn more about gay sexuality from a positive perspective - for example read some gay-positive books, look at lesbian and gay websites, and talk to a gay helpline or a gay-positive therapist.

When You Don't Feel Safe With Sex

Sexual abuse robs survivors of their ability to feel safe in the world and with themselves. Internal safety is the extent to which you feel safe when the situation you are in is safe. Many survivors feel unsafe even when the person they are with or the situation they are in is safe. There is a difference between feeling safe and being safe. The first is a feeling and is affected by your past experiences with safety or lack of safety. The second is an actual fact about whether or not the people you are with or the situation you are in is safe.

It's so important for survivors to develop a sense of safety (internal safety) as well as to have ways to identify whether or not people and situations are safe (external safety). Both internal and external safety are needed for enjoyable consensual sex. Without internal safety, sex can feel very scary and triggering. Without external safety, the sex will not be safe, consensual, or pleasurable.

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Some ways to develop internal safety:

• Create a safe place for yourself inside your home - a comfortable place that you can call your own. No one should go into this space without your permission, it is yours.
• Imagine what an ideal safe place would look like. It doesn't have to be reality based, you can create a fantasy safe place. Really let your imagination go with this; you can imagine anything you want. What would be there? What would you see, hear, smell, and be able to touch? How would you feel in this safe place? Spend time with this imaginary safe place on a regular basis to strengthen your internal experience of safety.

Some ways to develop external safety:

• Explore your definition of external safety. What does it mean for a person or a situation to be safe? How do you know when you are safe? How do you know when people or situations are not safe? What contributes to your feeling safe, and what interferes with your ability to feel safe? What are your internal signs that tell you when someone or a situation is not safe?
• Identify what helps you to feel safe with a sexual partner. Do you need to talk during sex? Do you need to talk about issues before having sex? Do you need to know that you can stop at any time? Do you need to practice saying "stop" or "no" during sex? Do you need to have opportunities to initiate sex?

When Trust Is an Issue

Because sexual abuse is such a major violation of trust, many abuse survivors have difficulty trusting their own perceptions and trusting other people. Building trust in yourself - knowing and trusting your feelings, thoughts, beliefs, intuition, and perceptions - is crucial, and will help you to know who you can trust.

Without a minimum of trust, sex is scary, unsafe, and unenjoyable. Different people require different amounts of trust in order to enjoy sex. Some survivors require a great deal of trust, and must know the person they are going to have sex with a long time before they feel comfortable to have sex. Others do not require as much trust to enjoy themselves sexually. Both are okay; it's just important to know your own boundaries and to respect them.

Developing internal trust means becoming aware of and respectful of your own feelings, physical sensations, intuition, thoughts, beliefs, and perceptions - or in other words, your own reality. They are your guides and can be relied upon. At the same, it's important to know the difference between what you have learned to be drawn to or are comfortable with because of its association with the abuse, and what is coming from a deeper, wiser place from within you. Exploring these issues in more depth will help you to make those distinctions.

Building a Comfort Level With Intimacy

For many abuse survivors being intimate - emotionally or sexually - can be very scary. Many survivors dissociate from intimacy, yet they crave the closeness at the same time. Fear of intimacy is often rooted in fear of being vulnerable with another person and of being hurt by them.

Some suggestions to build a comfort level with intimacy:

• Take little steps whenever you can to increase your intimacy with someone you trust and are safe with. This could mean sharing something personal, talking about your feelings, touching them, asking for a hug, holding eye contact, inviting them out, calling a friend, reaching out when you are upset, or staying present for as long as you can in their presence.
• During sex, take it slow, stop when you need to, and breathe in and feel what you are feeling. Be aware of how you are feeling in your body. Take your time. Hold eye contact. Touch your partner. Stay connected with your partner. Talk about how you are feeling.

Being In Your Body

Because sexual abuse is an invasion and an attack on the body, many survivors feel cut off or distant from their bodies. They may view their bodies as being responsible for the abuse, or at very least intimately linked with the abuse. This negative association between your body and the abuse needs to be broken. Your body doesn't deserve to be thought of this way.

Many abuse survivors hate their bodies, and feel betrayed by their body's response during abuse. Some survivors refer to their body as "the body", distancing themselves from their bodies in order to not feel pain.

Being in touch with and living in your body is key to enjoying your sexuality and sex. But often that means going through a lot of body and emotional pain first. This happens because our bodies hold tension and feelings from the abuse as well as our responses to the abuse. This tension needs to be released so that you can feel your sexual feelings and enjoy them.

Some ways to become more in touch with or connected to your body:

• Breathing exercises. For example, close your eyes, and focus your awareness on the natural rhythm of your breath as it moves in and out of your body. If you get distracted, keep bringing your focus back to your breath.
• Body awareness exercises. For example lie down and become aware of what you notice in different areas of your body, such as tension, feelings, associations, visual images, and memories.
• Relaxation exercises. For example, lie down and tense up one area of your body, holding your breath at the same time. Hold your breath for the count of ten, then let your breath and tension go. Continue like this with all areas of your body.
• Notice how you feel in your body when you are feeling sexual. This includes different kinds of sexual feelings - for example, when you feel attracted to someone, when you feel sensual, when you are aware of yourself as a sexual being, when you are sexually aroused, and when different areas of your body are sexually aroused. Breathe into those feelings and areas of your body. Spend time with those feelings on your own and with a partner. Learn to ride the waves of all your feelings, including sexual feelings.

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Dealing With Triggers During Sex

Abuse survivors are often triggered during sex or while anticipating sex because of its association with abuse. Working on separating the sexual abuse from your body and your sexuality will help you to become less triggered by sex. Focusing on being present in your body and in your immediate environment will also help you to remain rooted in the present.

Some suggestions for dealing with triggers during sex:

• Identify that you are triggered. If you feel any of the following feelings during sex and it's not related to how your partner is treating you then you are probably triggered: scared, numb, dissociated, dirty, ashamed, ugly, self-hating, panicky, and very anxious.
• Know that when you are triggered, you have a choice. You can decide to put the feelings or memories aside to be dealt with later, or you can deal with them at the time. Sometimes this doesn't feel like a choice, but there are ways to contain, separate from, and manage triggers so that you can put them aside and deal with them later. Ways to separate include self-talk, reminding yourself where you are and who you are with, letting yourself know that you are safe, asking for a safe hug, and doing whatever you need to do to feel present again. For instance, you can visualize placing the trigger away for another time by creating an image that represents the abuse and visualize putting that image in a safe place until you are ready to deal with it. You can talk about the trigger and then tell yourself that you want to put it aside for now and be in the present. You can focus on the present moment by looking around the room, noticing what you see, smell, hear, and touch.
• You may choose to go into the trigger by being aware of how you feel, and what you see, hear, smell, and remember. You can let yourself go through the natural rhythm of the trigger. As with any feeling, triggers have their own rhythm of increasing feeling and tension, and then subsiding and decreasing in intensity.
• It may be enough to acknowledge to yourself and/or your partner that you are triggered, and what it's connected to if you know, and then return to the present moment.
• If a certain sexual act triggers you, a good guideline for minimizing the effect of that trigger is to approach the sexual act gently and slowly for a short period of time, and then stop for a while or completely, and come back to it later. Each time spend a little longer on the activity, building up your ability to stay present and to feel the feelings in your body.

Taking Charge of Your Own Sexual Enjoyment

Many survivors wait for others to initiate sexual contact with them or to ask them out on a date. They may fear initiating sexual contact or contact that could potentially become sexual. There are many reasons for this; you will need to discover your own. Some common reasons include a fear of behaving like the abuser or being seen as behaving like a perpetrator; a fear of being rejected and vulnerable; a fear of standing out, being noticed, or being the center of attention; and a fear of being seen as sexually unattractive, undesirable, or unlovable.

Knowing why you are afraid to initiate sexual contact or to ask someone out on a date can help decrease that fear. Working on your specific issues. For example, finding ways to feel better about yourself, your body, your sexuality, and your attractiveness and lovableness. You might want to set small attainable goals such as asking someone out to a movie without having to worry about initiating sex. You could practice touching people in a friendly, casual fashion - not just people you are attracted to, but rather working your way up to that. Role play asking someone out or initiating sex. This can help prepare you and give you the words you're searching for. Just talking about the problem with someone can help, too.

Many survivors feel they must accept whatever their partner does to them sexually, rather than take an active role in their sexual enjoyment. Knowing what you want, what turns you on, and asking for that is crucial to your sexual enjoyment. Only you can really know what feels good and exciting to you.

Many survivors have to overcome a great deal of shame and guilt about their sexuality and their bodies in order to feel comfortable asserting their sexual needs and desires. Most survivors have learned to do the opposite; they've learned to endure, be quiet, please others, and to not be powerful by asking for what they need.

You can become more assertive by discovering with yourself what you enjoy, talking with your partner about it, starting to ask for what you want in other areas of your life, and gradually asking for something that you want sexually. Some survivors find it easier to hold their partner's hand and guide them rather than talk about what they want. Some like to show their partner how they like it by doing it themselves in front of their partner and then letting their partner take over. Whatever works for you is just fine.

Sexual Healing Is Possible

It's definitely possible for survivors to feel better about their sexuality and sex. The key is to break the association between your sexuality and the sexual abuse and to create a new experience - one that is safe, fun, and pleasurable - for yourself as a sexual person. You don't need a partner to do this, although eventually you may want to include someone in your sexual journey. At times, it may feel like it's taking a long time, but try not to get discouraged. Being patient and compassionate with yourself will help your sexual healing.

She drives you crazy -in good ways and bad. Here's why she can't help it

Sometimes it seems like your girl is a freaking superhero, her senses are so highly tuned. Then other times--especially when it comes to sex--she might as well be from another planet. That is, a planet where they never seem to have sex.

But before you drive back to the girlfriend store and try to exchange her for another, less aggravating model, realize this: There are certain biological factors at play that control her behavior. In short, there are distinct differences in the ways sex and the senses are hardwired in men and women.

These gender differences--and the conflicts they create--arise from the deepest recesses of male and female mammalian brains. Being aware of them can make your next trip together to the bedroom--or even the mall--a lot less frustrating.

FOREPLAY

Sexually, you're a Porsche: Testosterone allows men to go from zero to horny in under six seconds. Your girlfriend is more like a Rolls-Royce. "Estrogen is slower and pickier, and female arousal is much more gradual," says Deborah Blum, author of Sex on the Brain. "That's because, in a year, a male can impregnate hundreds of women, but a woman can successfully get pregnant only once, so she has to choose more deliberately." This lends itself to foreplay, which for her isn't what happens 10 minutes before the Main Event. "It's the whole tone of the relationship," says Dr. Aline Zoldbrod, a Boston-based sex therapist and author of Sex Smart. "It's whether you remembered to call her yesterday or whether you rubbed her shoulders this morning while she made coffee." This is part of why the search for a "female Viagra" is so elusive. For men, foreplay is simple mechanics. For women, it's about an entire relationship.

SEXUAL AROUSAL

Men's arousal is closely tied to sight and visual images (hence, the multibillion-dollar porn industry), while women are more attuned to touch. A woman's sense of touch evolved for the care of babies. You, on the other hand, have hands designed for coarser work--like hitting buffaloes on the head with rocks, followed by swift guttings. So when it comes to sexual touching, forget the Golden Rule: Don't do unto her as you would have her do unto you. Men are aroused by firm, direct genital touching at any time: before sex, during sex, in line at Kmart. "Women like a much lighter touch, and little or no genital contact until we're really, really into it," says Zoldbrod. "Rather than fixating on the vagina, think of her arousal as an electric current running throughout her whole body." Or, as MF sex columnist Sarah Hedley puts it, "Men should train themselves to be less peno-centric."

SEX DRIVE

The two genders usually start out on the same sexual page but end up reading two totally different books. "During a relationship's 'Oh wow!' phase, men and women see sex the same way," says Zoldbrod. "They can't get enough. But afterward, men prioritize sex much higher than women do, which leads to conflict." Women view sex as something that requires surplus energy. A man wants to boff even if he has only one calorie left in his body. "It makes sense," says Zoldbrod. "Women are much more distractible, and they have to work harder and focus more to have an orgasm. For women, sex is like cross-country skiing, while for men, it's an easy downhill run." The trick: Help ease her burdens outside the bedroom and thus help save her energy for, you know, later. Maybe that means you're picking up the dry cleaning or doing the dishes.

INTUITION

Women are more astute readers of facial expressions--and for good reason. "Early in our history, men were not only dangerous to other men, but to women, too," says Blum, "and females needed to be able to recognize subtle danger signals. Besides, women have always needed to read the faces of infants." Not surprisingly, males often miss subtle expressions that indicate changes in mood--especially when distracted by, say, Game 7 of the Series. For modern men, this may result in chronic "Honey, I didn't know you were upset" syndrome. In other words, your lady can signal to you that she's pissed without throwing a cartoonish tantrum or acting like the angry protagonist of an Alanis Morissette song. Watch her face for subtle signs--she's watching yours.

SENSE OF SMELL

Sampled the bouquet from your overstuffed laundry bag lately? Notice the smell of weapons-grade tuna salad in your refrigerator permeating the kitchen? No? Well, she does. Women have a much stronger olfactory sense than men. "They get crucial partner information from scents--especially the sweat of men," says Blum. "They are more emotionally attuned to smell than guys when selecting a mate." What to do? Aside from being hygienic and healthy, you can't do much about your personal chemistry. And don't ever try to change that fact by bathing in a bottle of Turbo cologne. "This is one of the biggest mistakes men make," says Blum. "Let the female choose the cologne--she'll have an attachment to it, and to you." One more thing: Never try to cover the stench of eau de Pabst and an evening at a strip club with an Altoid. She'll know. Trust us.

SWEET TOOTH

When was the last time you sidled up to the bar at your local watering hole and asked for an "Apple Flirtini"? Neither have we. "Women are much more attuned to sweet tastes," says Allan Pease, co-author of Why Men Don't Have a Clue and Women Always Need More Shoes. "It's an important ability, going back to when they had to gather berries and determine which were good and which were poison." Indeed, the key to a woman's heart--and attendant girly parts--may well be her stomach. If, that is, you have enough Godiva truffles. "The chemicals in good chocolate can put women into a kind of trance," says Zoldbrod. "It may well also be cultural, as men love chocolate, too. But some women even prefer chocolate to sex if their partner isn't up for the job. I suspect that's not so true of men."

EYESIGHT

Is it just us, or does it seem like women have eyes in the back of their heads? "Unlike most men, most women can see at 45-degree angles from each side of their head without actually having to turn," says Pease. "In crowded social situations, your girlfriend knows not only who is looking at you, but what they're saying about you. She also knows you snuck a glance at that blonde in the corner." So, while female peripheral vision is more acute--the better to patrol territory and see who's sneaking up on the brood--men have the vision of survivalist killing machines. "Men are target-hitters," says Pease. "They have extraordinary tunnel vision to target and kill distant prey." Got a girl? Buy her some blinders.

SENSE OF HEARING

This is important, guys: "Women generally have a better sense of hearing," says Blum. "Historically, they are always listening for children. Men, on the other hand, are more likely to be sexually aroused by sounds." But take heart: The sound of your voice is absolutely essential for putting her in the mood. "Women like to hear more verbalizing before sex and are more attuned to language," says Zoldbrod. "For men, the fact that a woman wants to make love with them is enough. Women take it for granted you want to sleep with them. They want to know that you appreciate them. They want to hear that they're beautiful, that they're fun, and that you're willing to deal with a relationship, not just a sexual partner."

Uh, sorry, we weren't listening--can you repeat that?

Freelance writer Jeff Ousborne understands his wife completely.

A brain fog anxiety cure would bring welcome relief for people who suffer from brain fog due to anxiety. Regarding a true cure for brain fog with anxiety, there’s both good news and bad news. Unfortunately, there isn’t a cure because brain fog isn’t a diagnosable condition in and of itself but is indicative that something else is going wrong. The good news, however, is that the symptoms of brain fog can be treated and the causes addressed and fixed. You can heal both brain fog and anxiety, which is very close to a brain fog anxiety cure.

Understanding brain fog, anxiety, and the connection between them can help you know how to treat both. Causes and symptoms interact with each other to create a state of brain fog and anxiety.

To Find Treatment, a Cure for Brain Fog Due to Anxiety, Understand Both

Anxiety is a state of mind involving constant (as in day and night, no matter what you’re doing) thinking: worries, fears, what-ifs and worst-case scenarios take control of thoughts. This leads to negative thoughts that won’t stop.

Anxious thinking can be caused by stress, cause stress, increase existing stress, and make dealing with daily stressors feel daunting. Stress hormones pump through the body. The brain goes into fight-or-flight mode, and brain functioning changes. Operations shift from the cortex and hippocampus (areas responsible for things like rational thinking and memories) to structures like the amygdala so you stay hypervigilant for problems. Over time, the brain becomes fatigued.

When the brain is exhausted from anxiety, brain fog can set in. Signs and symptoms of brain fog due to anxiety include, but aren’t limited to:

• A sense of being separated from the world by thick fog or even quicksand
• Feeling that thoughts or responses are there but you’re unable to grasp them
• Difficulty focusing, concentrating and thinking clearly
• Problems reasoning
• Memory problems

Anxiety and brain fog are complex experiences that negatively impact lives, often severely. If you experience symptoms of both anxiety and brain fog, know that you don’t have to resign yourself to a life of misery. You can approach a cure for brain fog from anxiety.

Technically and medically, brain fog isn’t a condition with a cure, but it is an experience that comes from something specific, in this case, anxiety. Therefore, there’s a way to treat it and minimize it. The key is to treat its cause: anxiety and stress.

Ways to Treat Brain Fog Due to Anxiety

The key concepts involved in treating brain fog from anxiety are deceptively simple:

• Manage stress
• Decrease anxiety
• Uncover and address what causes your anxiety
• Change behaviors that maintain anxiety and brain fog

These four treatment components are spot-on and will lead to a near cure for brain fog due to anxiety as well as the anxiety itself. The below list provides ideas for managing stress and anxiety. Think of these strategies as tools for a quality life, one without anxiety and brain fog.

Tools to use to begin to treat and cure brain fog and anxiety:

• Mindfulness to help you focus on the moment
• Take short, frequent breaks to reset
• Exercise to reduce symptoms of both brain fog and anxiety
• Practice yoga or Tai Chi to
• Deep breathing
• Discovering passions and hobbies
• Get to the root of what’s causing anxiety—working with a therapist can help
• Increase the number of healthy foods you eat (your brain needs proper nutrition)
• Decrease the amount of junk food and sugary, caffeinated drinks you consume
• Drink lots of water to hydrate your brain properly
• Journal to empty your mind and develop life goals
• Color without thinking too much about the outcome
• See a doctor to discuss starting, changing, or stopping anxiety medication

One strategy deserves elaboration: meditation (mindfulness fits here, too). Meditation involves gently quieting the mind to let it rest and rejuvenate. With brain fog from anxiety, the brain is overstimulated. It has a hard time filtering out unnecessary stimuli because it is very busy overthinking, having negative thoughts, and being in a constant state of alert. The exhaustion that comes from this isn’t restful. To reduce brain fog, help your brain be still.

Meditation involves sitting comfortably and letting your thoughts come and go without fighting with them or holding onto them. Concentrate on your deep breaths, either counting them or just feeling them. When you have an anxious thought or are thinking that your brain fog isn’t letting you focus, just let those thoughts drift away. When they return, let them drift away again.

With all of these techniques, you are working to manage stress and anxiety. As you take back your life, you just might find that there is indeed a cure for brain fog due to anxiety and that you’ve done it.

article references

Brain fog with anxiety is a common experience that is often misunderstood. Brain fog is often associated with a slowing down of thinking and processing, while anxiety frequently is the opposite: racing thoughts can make people vigilant, and worries keep people awake, wired, and restless. How is it that anxiety and brain fog can occur together? The answer begins with an understanding of both brain fog and anxiety.

How Does Brain Fog with Anxiety Happen?

Brain fog isn’t a disorder but instead is an experience. It’s the sensation that something isn’t right, that you’re not functioning as sharply as usual. With brain fog, you feel off. Anxiety involves such things as excessive worry, overthinking, imagining negative outcomes, and fear.

Feeling brain fog with anxiety happens because the symptoms of one can cause the symptoms of the other. This, of course, worsens both conditions. It can become an infinite loop:

• Anxiety involves “what-ifs,” ruminations, and negative thinking
• This leads to mental exhaustion
• Fatigue can lead to the development of brain fog
• Brain fog can increase anxiety because it feels frightening, worrisome
• Heightened anxiety causes this cycle to repeat, seemingly endlessly

The occurrence of anxiety and brain fog varies from person to person. Some people experience it often, while others are struck with it less frequently. It can come and go quickly, or it can last for days, weeks, and even months.

Both experiences are frustrating. Examining brain fog symptoms and causes of brain fog and anxiety will yield insights that can be used to treat them.

Symptoms of Brain Fog with Anxiety

If the symptoms of these mental health challenges had to be described in just a single word, that word would be “fatigue.” Brain fog, anxiety, and fatigue have an enmeshed relationship. Without a doubt, fatigue is at the heart of brain fog with anxiety.

Anxiety seems to overtake our entire brain and usurps thoughts, emotions, and behaviors. Living in a state of anxiety is exhausting. Additionally, anxiety can cause sleep problems. Fatigue can lead directly to brain fog. Symptoms of brain fog from anxiety include:

• Difficulty concentrating and focusing
• Muddled, unclear thoughts
• Short-term memory problems
• Difficulty reasoning logically
• Trouble processing, storing, and retrieving information
• Living in a fog that makes grasping comments, instructions, and conversations tough
• The vague sense that you just feel “off” but can’t do anything about it

The symptoms of brain fog with anxiety can be better understood in the context of the causes of anxiety and brain fog.

Causes of Brain Fog with Anxiety

The brain fog that can come with anxiety has several causes:

• The symptoms of anxiety (discussed above)
• The brain’s physical response to anxiety
• Stress and stress hormones

Understanding these causes can increase awareness of why brain fog and anxiety can co-occur.

The brain’s own reaction to anxiety can leave it feeling tired and foggy. The fight-or-flight response is an automatic fear response. The brain changes its activity in response to an extreme stressor in order to prepare to do what it takes to survive (either stay and fight or run away to safety).

• Activity in the cortex, the area of rational thinking, decreases, which leads to the inability to think that is a big part of brain fog
• Activity in the hippocampus, the area responsible for things like learning and memory, is suppressed, which explains the confusion, focus, and memory problems of brain fog
• Activity in the amygdala accelerates to keep you hypervigilant and ready to leap before you look, which is why brain fog is associated with a decline in rational thinking

The brain also orchestrates the production of hormones in reaction to stress and anxiety. Cortisol, adrenaline, and norepinephrine course through brain and body to keep you on alert and ready for action, but when these hormones are present for too long or in quantities that are too high, they overwhelm and exhaust the brain, leading to brain fog.

Treatment for Brain Fog and Anxiety

The best treatment for the brain fog that occurs with anxiety is to meet it at its source. Understand the symptoms of both brain fog and anxiety and take steps to reduce the symptoms you are experiencing. Further, know what is causing your symptoms so you can make positive changes to reduce them.

• Develop stress management strategies, and use them
• Take measures to increase the amount and quality of sleep you get nightly
• Address your anxiety, perhaps with a therapist
• Listen to your brain and body, and when your brain fog is intense, give your brain a break with things like meditation, mindfulness, exercise, and yoga

Brain fog and anxiety can team up to make life difficult. But by actively working on them, you can reduce both. Regain your brain and live well again.

article references

In the situation of wife battering, help is focused on removing the victim from harm's way, but batterer's interventions are possible as well. In a batterer intervention, treatment is focused on the domestic abuser. Batterer's interventions have several aims, depending on their underlying theory, but the main goal is to stop the batterer from committing violence.

Batterer intervention programs may be psychoeducational classes, couples therapy or group process depending on the type of intervention. The three main types of batterer interventions are:¹

• Feminist
• Family systems
• Psychotherapeutic

However, in practice, theories are combined to provide a better overall outcome.

Feminist Batterer Interventions

Batterer intervention programs started in the early 1970s thanks to the aid of feminists bringing awareness to violence against women. Feminists feel that batterering relates to a gender analysis of power. Specifically, battering happens due to a patriarchal society in which men attempt to assert their supposed rightful dominance over women in the home. To a batterer, women are childlike and incapable.

In feminist batterer interventions, the "equality wheel" is taught. This is to produce an equal and democratic relationship. Ideas taught include:

• Conflict resolution – negotiation and fairness
• Nonthreatening behavior
• Respect
• Trust and support
• Honesty and accountability
• Responsible parenting
• Shared responsibilities
• Economic partnerships

While many batterer interventions attempt to change the participant's views of gender roles, this theory alone does not explain the many ways in which battering occurs, such as in same sex couples.

Family Systems Model Batterer Interventions

In the family systems model, domestic violence is considered to be a manifestation of a dysfunctional family unit rather than identifying an individual as the problem. This model advocates for family counselling, an understanding of how interactions can lead to conflict and a holding together of the family unit.

Family systems model batterer interventions teach:

• Conflict resolution and communication skills
• To locate the problem through interactions rather than through one individual
• To focus on solving the problem rather than on blaming a cause
• To accentuate the positive such as when violence was avoided

While many couples, even when battering occurs, wish to stay together, this batterer intervention has inherent problems and some feel may even cause violence if the victim truly expresses themselves during a couples counselling session.

Psychological Batterer Interventions

Several types of psychological batterer interventions are also available. Both psychoanalytic and cognitive behavioral therapy (CBT) batterer interventions exist and the two types are often combined.

In psychoanalytic batterer interventions, violence is seen as being caused by a personality disorder or a past trauma. The psychological source of battering may be due to growing up in an abusive home, not having childhood needs met or early rejection. These batterer interventions are either in individual or group settings, wherein the unconscious root of the problem is sought through psychoanalysis. The aim is to then deal with the problem consciously and remove the motive for aggression.

Cognitive behavioral therapy is also used in batterer interventions. This therapy focuses on the here and now of conscious thought and action. In CBT, men are thought to batter because:

• They are acting out examples of abuse they have seen or lived (such as in childhood)
• Abuse is rewarded
• It enables the batterer to get what he wants
• Abuse is reinforced through victim compliance and submission

CBT focuses on understanding belief systems and actions, building new psychological skills and changing "self-talk." CBT works to identify the chain of events that lead to battering.

Do Batterer Interventions Work?

There is no clear study that proves which batterer intervention is superior but most experts agree that the most effective batterer intervention program combines aspects of each model in an individual fit for each situation.

article references

• What is fentanyl?
• Street names of
• How is fentanyl takfentanylen?
• Effects of fentanyl
• Dangers of fentanyl
• Is fentanyl addictive?

What is fentanyl?

• Fentanyl is a pain reliever.
• It was first synthesized in the late 1950s and was introduced into medical practice in the 1960s as an intravenous anesthetic. Today, fentanyls are extensively used for anesthesia and pain relief.
• Fentanyls are used as a patch for chronic pain management, and are effective in treating pain in cancer patients.
• To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic.

Street Names

• "Apache", "China girl", "China white", "dance fever", "friend", "goodfella", "jackpot", "murder 8", "TNT", "Tango" and "Cash"

How is it taken?

• Fentanyl is most commonly injected, but can also be smoked or snorted.

What are the effects of fentanyl?

• The biological effects are indistinguishable from those of heroin.
• Fentanyl may be hundreds of times more potent than heroin.
• Can bring about a state of euphoria and drowsiness.

What are the dangers of fentanyl?

Dangers can include:

• Respiratory depression and arrest.
• Nausea.
• Confusion.
• Constipation.
• Sedation, unconsciousness and coma.

Is it addictive?

It is not considered an addictive drug like cocaine, heroin or alcohol because it does not produce the same compulsive drug-seeking behavior. However, like addictive drugs, fentanyl produces greater tolerance in some users who take the drug repeatedly. These users must take higher doses to achieve the same results as they have had in the past. This could be an extremely dangerous practice because of the unpredictability of the drug effect on an individual.

Defining and treating premature ejaculation and delayed ejaculation

Rapid (or premature) Ejaculation

Rapid (or premature) ejaculation is the most common male sexual function concern. One-third of men feel they have rapid ejaculation. Contrary to popular myth, this remains stable across the age spectrum. Defining rapid ejaculation depends on each couple and their sexual interaction. For a heterosexual couple, does she have her orgasm with intercourse only, or is she orgasmic with "outercourse": manual, oral, self, or other non-intercourse stimulation? The length of time that intercourse lasts is between 4 - 7 minutes for the average couple. Independent of the length of time of intercourse, is she (and he) satisfied with their sexual activity?

Men with rapid ejaculation often ejaculate unintentionally before, or immediately after the moment of penetration. This can be very distressing for both the man, who wishes nothing more than to last longer; and his partner, who in their own frustration might blame him for intentionally not attending to her needs.

Treatment for Premature Ejaculation

Traditional treatment, the "stop-start" technique developed by Masters and Johnson, uses graduated masturbation exercises to help the man recognize the stage of ejaculatory inevitability and reduce the amount of stimulation to remain below this threshold. These exercises are detailed in Bernie Zilbergeld's book The New Male Sexuality.

While initially successful in 90% of men, longer term maintenance remains much lower than when traditional sex therapy methods are used alone.

While single men can be taught these exercises alone, they often have difficulties in generalizing gains in ejaculatory delay to their partners. Men who have difficulties in forming intimate relationships because of their anxiety about delayed ejaculation will often benefit more from assertiveness training before starting sex therapy.

Couple Therapy for Premature Ejaculation

Couple sex therapy involves helping the couple understand the physiological basis for rapid ejaculation, and that it is not something the man is doing intentionally to frustrate the partner. Acknowledging the partner's feelings (often of frustration, at times of anger), and dealing with these is a cornerstone of therapy. Expanding the couple's sexual repertoire beyond intercourse is a way for both to achieve pleasure and allows the negative pressures to abate. Then starting with the man self-pleasuring initially alone, he stimulates himself nearly to orgasm 3 times, before ejaculating the 4th time. Through practice, he gradually gains the ability to pull back from the point of ejaculatory inevitability. Once this is achieved, the partner can be introduced, initially with their dry hand, then with lubricant, and eventually with genital contact. Having the partner on top initially puts the least pressure to ejaculate on the man, but can be frustrating for the woman as she is asked to provide a "silent vagina" and not move to her own rhythms initially. Gradually both members of the couple can start to thrust, and eventually move to the male superior position, in which the man finds it most difficult to control ejaculation.

Antidepressants as Treatment for Rapid Ejaculation

The SSRI antidepressants cause significantly delayed ejaculation, often limiting compliance in depressed patients. Using this side-effect as a therapeutic tool has significantly improved the treatment of rapid ejaculation. Clomipramine (Anafranil) is slightly more effective than SSRI's, but causes more side-effects. Paroxetine (Paxil) and may be more effective than Fluoxetine (Prozac) or Fluvoxamine (Luvox). Most clinicians integrate low dose SSRI's with sex therapy. They can be used on an as-needed basis 2 - 4 hours before anticipated intercourse, or if this fails, then on a daily basis.

Delayed Ejaculation

Delayed ejaculation is rarer than rapid orgasm, with somewhat less than 1 in 10 men complaining of inability to ejaculate with a partner. A man who has never had an orgasm (through intercourse, masturbation or nocturnal emissions) requires a thorough evaluation for secondary causes. Perhaps the commonest cause of secondary delayed ejaculation is the use of SSRI's as mentioned above. Any new onset of delayed ejaculation necessitates a thorough medical and medication review.

Partners are often more frustrated with delayed ejaculation than the patient in feeling that they are somehow not attractive, or adept enough as lovers to help him ejaculate. Treatment involves helping the couple understand the physiology and psychology of delayed ejaculation. Consideration of medication changes if possible can be helpful. Cyproheptadine, both a histamine as well as serotonin antagonist, can act as an antidote.

Often couples with delayed ejaculation do not present for therapy until the issue of infertility arises. Many of these men can ejaculate on their own, but not with their partner present. Fertility can be achieved through the use of a 3-cc syringe to allow the couple to insert semen intra-vaginally on their own, or through intrauterine insemination in the physician's office. Men who have suffered a quad- or paraplegic injury can be stimulated with vibrators or mild electrical stimulation.

Therapy for delayed ejaculation focuses on increasing the pleasure of the process of lovemaking, rather than the anxiety-producing goal of ejaculation. This can then be linked to a behavioral process of stimulus intensification to allow the man to ejaculate initially in any way while in his partner's presence, and then gradually closer to their genitals.

Date rape and acquaintance rape are forms of sexual assault involving coercive sexual activities perpetrated by an acquaintance of the rape survivor. The perpetrator is almost always a man, and though both men and women can be raped, women are most often the targets of this violence. It is difficult, because of a lack of research on the subject and the tendency for rape survivors not to report attacks, to come up with precise statistics on male survivors. However, men are raped by other men and are also victims of sexual violence. Date and acquaintance rape can happen to or be perpetrated by anyone. Incidences are very high: they comprise from fifty to seventy-five percent of all reported rapes. However, even these figures are not reliable. According to conservative FBI statistics, only 3.5 - 10 percent of all forms of rape are even reported.

Date and acquaintance rape is quite prevalent on college campuses. One in four college women has been raped; that is, has been forced, physically or verbally, actively or implicitly, to engage in sexual activity. A 1985 study revealed that ninety percent of college rape survivors knew their attacker before the incident. Another survey found that one in fifteen college men admitted to having forced a woman into sex.

Some experts believe that one explanation for such high statistics is that young people, constrained for most of their lives by their parents and laws, are unprepared to act responsibly in a "free" environment. This "freedom" can lead to unrestrained drug and alcohol use, which then leads to sexually irresponsible acts, and then to rape.

Another theory portrays America, especially young America, as a rape culture. The values adopted by the dominant society dictate inherent differences between men and women. Women are expected to be passive, unassertive, and dependent. Similarly, men are constrained in their behavior. They are taught to be aggressive, even intimidating, strong, and relentless. They are taught not to take no for an answer. Men who accept or unwittingly exhibit this kind of behavior are likely to misinterpret a woman's communications. Typically, the man will decide that the woman is acting coy or hard to get in a sexual situation. He may believe that she really means yes, although she has been saying no.

Communication is the most important avenue to understanding another person's desires and needs -- often the rapist will ignore the woman's attempts at communication, will misinterpret them and continue his actions, or will realize what the woman is trying to say but will decide that she "really needs to get laid" and doesn't care. The bottom line is that yes means yes and no means no; if you want to play sadomasochistic games, make up a safe word like "pineapple" to use as a preordained signal to stop.

If a person says no and is still coerced or forced into having sex, then a rape has occurred.

Was it really rape?

Many times women or men who have been date- or acquaintance-raped do not view the assault as a rape. They may experience some or all of the symptoms of rape trauma stemming from the violation of the body and the betrayal of a friend, but still may not consider the incident rape. Some symptoms of rape trauma include sleep disturbances, eating pattern disturbances, mood swings, feelings of humiliation and self-blame, nightmares, anger, fear of sex, and difficulty in trusting others. Often, especially in a college situation, the rape survivor and the attacker live near each other or may see each other every day. This can be particularly stressful to the survivor because the man may see the rape as a conquest or "just a mistake." Bystanders and friends of both people may not view the incident as the rape it is and consequently will not lend the survivor the support needed. Friends of the survivor may misinterpret the incident and feel that somehow the rape was deserved or that the survivor "asked for it" by wearing a miniskirt or getting drunk. Some people may belittle the survivor's traumatic experience, saying things such as, "She liked the guy anyway, so what's the big deal?" These attitudes that blame the survivor, some say, are embedded in our culture and help to perpetuate violence against women and sexual violence such as date and acquaintance rape. Survivors, living and learning in this culture, may also accept "explanations" of "why it isn't rape," although they have been inwardly traumatized. The important thing to remember is that if there are feelings of violation, if a person's lifestyle and self-esteem are negatively affected by the incident, or survivors believe they have been raped, then it is rape.

Date and acquaintance rape is not only a woman's issue. Men must be actively aware of this issue, as they can help minimize rape by educating themselves and others. Lovers, neighbors, friends, co-workers, dates, and classmates -- these can all be perpetrators of date and acquaintance rape. Escort services, blue light phones, and van services are useless if the rapist lives in your home or dorm, is your date, drives you home from work, or is someone you have had reason to trust. In order for date and acquaintance rape to be minimized, men must stop "blaming the victim" and start taking responsibility for their own actions. We all must not allow rapists to use the "rape culture" as a means of silencing rape survivors, nor can we permit their friends to lie for them. And although it is always difficult, and admittedly, sometimes impossible to do, rape survivors and others must speak out and continue to speak out against rape.

There are many organizations which are designed especially to support rape survivors, give referrals, and talk about concerns they may have. All services are confidential.