Smart and Anxious

      By: Janie Hong, Ph. D.      

 The San Francisco Bay Area is home to some of the most brilliant minds.  One curious consequence is the large bubble of individuals who have a history of being labeled as “gifted” AND also suffer from high anxiety.  Why is that? What has become apparent to me- from both my practice and a review of the research on gifted individuals- is the very intelligence that has led to their success is also the cause of much of their suffering. 

Individuals are identified as intellectually gifted when their IQ scores are at least 30 points higher than the average score of 100. At an IQ of 130, that person has a score that is higher than 98% of the population.  The higher the IQ, the further the person is from experiencing and understanding the world like his or her peers, and is more likely to feel like an outsider.  What is even more isolating for gifted adults (and children) is the bias that comes from others who see high IQ scores as something to only be celebrated.  They are judged negatively if they share any aspects of their giftedness that is either positive (e.g., “What makes her think she’s so great?” “He doesn’t seem that smart to me”) or negative (e.g., “He’s seeking attention”; “He has nothing to complain about”) so that they quickly learn to closet their high intelligence.

Gifted individuals start life with a mental age that is higher than their chronological age.  The higher an IQ score is, the greater the discrepancy between a person’s mental and actual age. Starting in early childhood, gifted kids will become aware of emotional consequences and possible dangers that their emotional system and experience level is not yet equipped to handle. For example, consider a 4 year-old gifted child whose mom reads a story where the main character is living with her stepmother because her mother died. Rather than glossing over the fact as “just part of the story”, that 4 year old is horrified. He emotionally grasps the loss that comes with the death of a parent, infers what the character may have felt because of the loss, and then considers how a similar loss would feel if he lost the very parent who is reading him the story. Along with this awareness, is his poorly equipped 4 year old emotion system. He has never had discussions with others about these ideas, nor has he developed emotional skills to manage such an overwhelming possibility. To him, this aspect of the story is shocking and creates a full-stop emotionally that cannot be undone. 

The above type of story is common among my clients who have a history of intellectual giftedness. Their childhood is riddled with events where their cognitive awareness and empathy caused them to feel intense emotions by seemingly minor events. Anxiety happens when we do not feel safe. If someone experiences a sudden, intense rush of emotions without a clear reason why, or without a clear way to manage them, that person will feel unsafe and scared. 

One of the ways we manage anxiety is when we are able to reference past experiences of safety or use skills to soothe and effectively solve the problem.  When anxious, children may seek out rules for how to behave (or even made up their own magical rules) to help create a sense of predictability, or rely on being perfect to prevent unwanted consequences, or attempt to avoid any situation that may trigger high anxiety. These strategies can continue to adulthood and solidify into patterns of avoidance, rigidity, emotional numbing, and chronic worry.  Of course, a person need not be gifted to develop such a trajectory of anxious problems, but being “gifted” can set a person down a path where high anxiety is more the rule than the exception.

The gifted mind is by definition a lonely one. There are few who are intellectual peers and many who judge the suffering of those who are gifted. With the large (albeit artificial) bubble of gifted minds in the Bay Area, there is an opportunity for like-minds to find community and understanding that normally would not be possible.  Despite this opportunity, the loneliness and gifted closeting persists.

My hope is greater awareness of the difficulties that come with being gifted will give people the courage to come out of their closets to find their community. I also hope there will be greater willingness to see giftedness as part of the struggles they may be experiencing, and seek help if they need it. Being intellectually gifted means experiencing the world in a way that is “not normal” and is not always something to be celebrated.


New Paper on Social Network Quality and Treatment Outcome Published

By: Polina Eidelman, Ph.D.

A paper I co-authored with Dr. Lance Rappaport and Alexandra Jensen has been accepted for publication in Cognitive Behaviour Therapy. This paper discusses the relationship between negative and positive aspects of individuals' social relationships prior to treatment and the pattern of symptom change they subsequently experienced in therapy.

You can access the full paper here: 

You can also read more at:

We thank all of the patients who generously consented to have their deidentified data used for this and other research we do at our Center. Thank you also to Dr. Janie Hong and Dr. Jacqueline Persons who, along with Dr. Polina Eidelman, treated the patients whose data were included in our paper.

Eidelman, P.Jensen, A., & Rappaport, L. (In Press). Social Support, Negative Social Exchange, and Response to Case Formulation Based Cognitive Behavior Therapy. Cognitive Behaviour Therapy. 

Spade and Bourdain - Making Sense of Tragedy

By: Polina Eidelman, Ph.D.

In the past week, a great deal of press has been dedicated to covering the passing of Kate Spade and Anthony Bourdain, two celebrities whose deaths felt quite shocking to the public. These were individuals who seemed so original, creative, successful, intelligent, and inspiring to many of us, and they were a part of the lives of many people who had never met them. Perhaps we knew them from watching their adventures in the culinary world and found inspiration in their unapologetic and strong opinions. Or perhaps we interacted with their name on a daily basis when we used a favorite bag or wallet. Hearing about the passing of a celebrity who was as widely admired as Kate Spade or Anthony Bourdain can feel shocking - how, we ask, could a person who had so much going for them have felt so hopeless?

It is hard to know what to make of the suicide of someone we do not know, but perhaps it can serve as an opportunity to check in with ourselves to make sure that we are attuned to the difficulties anyone can have, no matter their level of privilege. Depression, hopelessness, and suicidal thoughts can make us loathe ourselves and make us think that we are not deserving of help - "I have so much", we might say, "how can I possibly justify asking for help when so many others out there have it so much worse?" We might feel a great deal of shame when we think of the luck we've had in our lives and find ourselves unable to justify feeling unhappy.

This is how the automatic thoughts that stem from depression feed on themselves. They make us feel wrong, ashamed, incompetent, unlovable, and they block us from asking for the very thing we need. These depressive thoughts reinforce themselves, making us feel more and more stuck in a loop of negative thinking, hopelessness and self-disgust, and then making us withdraw from the things or people that could help us feel even a little bit better. If there is anything useful that might come from learning about a beloved celebrity's death by suicide, perhaps it can be the idea that depression and suicide do not discriminate, and that economic or social privilege are not protectors against them.

If you are considering getting help, please know that there are many options available to you - cognitive behavior therapy, dialectic behavioral therapy, medications, and support groups, among other empirically supported options. If you are not yet ready to take a step to get treatment, please know that the National Suicide Prevention Lifeline is available 24 hours/day at 1-800-273-8255.

Depression and hopelessness can affect anyone, and every person who is struggling with despair or thoughts of self-harm is deserving of help.


Self-Care in Difficult Times

By: Polina Eidelman, Ph.D.

Lately, I have been particularly interested in how we respond to distress and the role our physical experiences of emotion play in difficult moments. I feel very lucky to get to work with patients who are very thoughtful, analytical, and intelligent. They tend to enjoy thinking deeply about many different things, including their experience of the world and their experience of distress. As you might imagine, this ability to engage intellectually with difficult experience can be a tremendous strength. At the same time, a person who tends to lean on analysis and cognitive strength in times of stress might actually miss a big part of the picture. They might put a lot of attention toward their thoughts, talk back to themselves, and try to fix/problem-solve the situation. Each of these strategies might be helpful or unhelpful, depending on the particulars of the situation, but in any case, the emotional and physical distress the person is experiencing goes ignored and unaddressed.  

Isn’t it interesting how we do this? Because we have access to high level cognitive functions, we can disconnect from our bodies in a very deep way. Many scientists, including Dr. Marsha Linehan (who developed Dialectical Behavior Therapy) and Dr. Kristen Neff (a pioneer in self-compassion research), among others, have done a great deal of research, thinking, and treatment development around this topic. I have found their work to be very helpful in guiding some of my clinical thinking. This means I often work with patients to help them learn to pay attention to how they are caring for their physical selves – Are they drinking enough water? Exercising? Making space in their day to wind down? These might seem like very simple questions, but their simplicity is one of the big reasons they often don’t get asked. We move quickly to analysis mode and we skip over attending to our basic physical needs.

I also often work with patients to find a way that is individual to them for physically self-soothing and comforting themselves in times of distress. For some, this means engaging in a high energy activity like a run; for others, this means finding a gesture that they can use as a signal of comfort to themselves, such as putting their hands on their heart or rubbing their upper arms with the opposite hands; and for others, this means looking for pleasurable sensations they can access in times of distress, like a nice scented candle or a particular tea they can drink while noticing the effect tapping into these senses has on their emotional and physical experience.

In each case, the ability and willingness to pay attention to our physical experience and ask the question “what do I need to help soothe myself?” can be a very useful skill. As I continue to think and learn about the mind-body connection, I hope to build up a menu of intervention options that might help even the most intellectually inclined of us feel able and willing to connect to how our bodies feel and what we need in times of struggle.