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Many of us struggle with anxiety in our daily lives, whether it’s due to work stress, personal challenges, or just the general chaos of the world around us. However, there are strategies we can use to cope with anxiety and keep it from overwhelming us. Enter: the 3-3-3 rule.

The 3-3-3 rule is a super simple technique that can help you regain control and calm your mind. It essentially requires you to identify three things you can see, three things you can hear, and three ways you can move your body.

“It’s basically a way of distracting yourself from your anxiety by shifting your attention to your senses,” says Aimee Daramus, PsyD, a clinical psychologist at Clarity Clinic, Chicago. “By redirecting your focus away from anxious thoughts, it grounds you in the present moment,” says Leigh McInnis, LPC, executive director of Newport Healthcare in Virginia.

In this article, we’ll explore what the 3-3-3 rule is, how it works, and why it can be a game-changer for anyone looking to manage their anxiety more effectively.

How to Use the 3-3-3 Rule for Anxiety

If you find yourself getting caught up in anxious thoughts, you can use the 3-3-3 technique to bring your attention back to the present moment.

Here’s how to do it:

• Look around: Identify three things you can see. Take a moment to really observe these objects, noting their details, colors, and shapes. “This process helps to shift your focus from internal anxiety to your external environment,” says McInnis.
• Listen closely: Find three sounds you can hear. These could be as loud as a blaring siren or as subtle as the hum of an air conditioner. 
• Move your body: Move three parts of your body. It could be as simple as rolling your shoulders, wiggling your toes, or turning your head. Pay attention to the sensations caused by each movement.

The beauty of the 3-3-3 rule lies in its simplicity and accessibility—it’s a technique you can use anywhere and anytime. What’s more, you can repeat it as many times as needed, until you feel more calm and collected.

Scientific Basis of the 3-3-3 Rule

The 3-3-3 rule is a grounding technique. By engaging our body and our physical senses, grounding techniques interrupt the flow of anxious thoughts and bring our focus back to the present moment.

Let’s unpack how this technique works:

• Engages the senses: Anxiety often has us ruminating over stressful or negative thoughts. The 3-3-3 rule forces us to shift our attention away from those thoughts and focus on our sensory experiences. Engaging the senses diffuses the hyper-alert state we’re in, says McInnis.
• Promotes mindfulness: The 3-3-3 rule encourages mindfulness by directing our attention to our surroundings (things we see and hear) and our body (our movements). This helps to redirect our focus away from anxious thoughts and grounds us in the present moment, McInnis explains.
• Calms the stress response: Anxiety often triggers the body’s stress response, leading to physical symptoms like increased heart rate and muscle tension. Grounding exercises, like the 3-3-3 technique, activate the parasympathetic nervous system, which counteracts the stress response and relaxes the body.
• Disables triggers: The 3-3-3 rule helps redirect our attention from internal anxiety triggers to external, non-threatening stimuli. This can help reduce the power of the trigger.
• Relieves muscle tension: Physical movement relieves muscle tension, a common symptom of anxiety, and promotes a sense of control over the body, further anchoring us in the present.

Other Coping Strategies for Anxiety

There are several techniques that can help us manage anxiety. What works for one person may not always work for another, so it can be helpful to try different methods to find what works best for you.

These are some coping strategies that may be helpful:

• Deep breathing: Taking slow, deep breaths can help you relax and calm down. This is an easy exercise that you can do just about anywhere. All you have to do is start paying attention to your breath and the way the air fills up your lungs as you inhale and exhale. Keep your focus on your breath, bringing it back if it wanders, until you feel calmer.
• Progressive muscle relaxation (PMR): PMR is a relaxation technique that involves tensing and then slowly releasing different muscle groups in your body. You can start from your toes and work your way up to your head, tensing each muscle group for a few seconds before releasing it. This exercise is best performed when you’re lying down on your back, so you can relax completely.
• Visualization: Imagining peaceful scenes can help reduce your anxiety by distracting your mind from stressful thoughts. When you feel anxious, try to close your eyes and visualize a place where you feel safe and relaxed, such as a beach or a forest.
• Journaling: If you like, you can write down your thoughts and feelings in a journal, to help reduce anxiety. You can spend a few minutes each day writing down what’s on your mind or keeping a gratitude journal to focus on positive aspects of your life.
• Social support: Talking to friends, family, or a support group can be comforting. When you feel anxious, reach out to talk to someone you trust.
• Hobbies: Doing things you enjoy can distract your mind from anxious thoughts, while also providing a sense of happiness and accomplishment. Make time for your hobby, whether it’s reading, painting, gardening, or playing an instrument.
• Exercise: Physical activity reduces stress hormones and releases endorphins, which are natural mood lifters. Walking, running, dancing, swimming, and yoga are all great options.
• Therapy: If you’re having difficulty coping with anxiety, it can be helpful to reach out to a mental healthcare provider. A therapist can help you explore the causes of your anxiety, identify triggers, and develop healthier coping mechanisms.

Splitting is a term used in psychiatry to describe the inability to hold opposing thoughts, feelings, or beliefs. Some might say that a person who splits sees the world in terms of black or white—all or nothing. It’s a distorted way of thinking in which the positive or negative attributes of a person or event are neither weighed nor cohesive.

Common in those with borderline personality disorder (BPD), splitting is considered a defense mechanism by which people with BPD view others, events, or even themselves in all-or-nothing terms. Splitting allows them to readily discard things they have assigned as “bad” and to embrace things they consider “good,” even if those things are harmful or risky.

Effects of Splitting

Splitting can interfere with relationships and lead to intense and self-destructive behaviors. A person who splits will typically frame people or events in terms that are absolute, with no middle ground for discussion.

Examples

Examples of splitting behavior may include:

• Opportunities can either have “no risk” or be a “complete con”
• People can either be “evil” and “crooked” or “angels” and “perfect”
• Science, history, or news is either a “complete fact” or a “complete lie”
• Things are either “always” or “never”
• When things go wrong, a person will feel “cheated,” “ruined,” or “screwed”

What makes splitting all the more confusing is that the belief can sometimes be iron-clad or shift back and forth from one moment to the next. People who split are often seen to be overly dramatic or overwrought, especially when declaring that things have either “completely fallen apart” or “completely turned around.” Such behavior can be exhausting to those around them.

Symptoms

By itself, splitting may seem almost commonplace, a behavior easily attributed to any number of individuals we know and maybe even ourselves. However, splitting in BPD is considered a consistent and distorted behavior usually accompanied by other symptoms, such as:

• Acting out (acting without consideration to consequences)
• Denial (consciously ignoring a fact or reality)
• Emotional hypochondriasis (trying to get others to understand how severe your emotional pain is)
• Omnipotence (the belief that you possess superiority in intelligence or power)
• Passive aggression (an indirect expression of hostility)
• Projection (assigning an undesirable emotion to someone else)
• Projective identification (denying your own feelings, projecting them onto someone else, and then behaving toward that person in a way that forces them to respond to you with the feelings you projected onto them)

Diagnosis and Management

Understanding the process of diagnosis and the careful management of borderline personality disorder can be helpful in understanding behaviors like splitting that are associated with the condition.

Diagnosis

A BPD diagnosis can only be made by a qualified mental health specialist. To make the diagnosis, the doctor would need to confirm five of nine symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), including:

• A warped view of yourself that affects your emotions, values, moods, and relationships
• Anger issues, such as violent outbursts followed by extreme guilt and remorse
• Extreme attempts to avoid abandonment or extreme feelings of abandonment
• Extreme depression, anxiety, or irritability that can persist for hours and days
• Feeling dissociated from yourself, including paranoia and amnesia
• Feeling persistently empty or bored
• Impulsive behavior, such as abusing substances or driving recklessly
• Intense and stormy relationships that involve splitting
• Suicidal thoughts and/or self-harming behaviors

Caring and Management

There is no easy answer on how to deal with a loved one who has BPD, especially when symptoms are extreme. How you cope depends largely on the nature of your relationship and the impact your loved one’s symptoms are having on your family.

However, there are some guiding principles that may help, including:

• Cultivate empathy. Start by reminding yourself that splitting is part of the disorder. While certain actions may seem intentional and manipulative, your loved one is not doing any of this to gain satisfaction. These are simply defense mechanisms they turn to whenever they feel defenseless.
• Encourage and support treatment. Your loved one can live a better life with treatment, which may include medication and/or talk therapy, most likely dialectical behavior therapy (DBT). Encourage them to start or continue with treatment, and learn everything you can about what they are going through. If needed, participate in therapy with your loved one.
• Maintain lines of communication. Discussing a situation when it happens allows you to isolate that event rather than piling one situation on top of the next. Failure to communicate only serves to fuel your loved one’s rejection anxiety.
• Remind your loved one that you care. People with BPD are often terrified of being rejected or abandoned. Knowing that someone cares often helps reduce the splitting behavior.
• Set boundaries. Dealing with the challenges of BPD is one thing; becoming the object of abuse is another. Always set limits with a loved one who has BPD. If that line is ever crossed, explain why you are backing away, and try to do so dispassionately. Setting boundaries helps preserve the relationship rather than challenging it.
• Take care of yourself. This may include finding your own therapist to help you balance your needs along with those of your loved one.
• Try to manage your response. If your loved one has BPD, keep in mind that you are in a better position to control your temper. Yelling or engaging in hostility will only serve to make the situation even worse.

Safety

There may be times where you will need to take more drastic action. In the event that the relationship is harming your family, your work, and your sense of well-being, you may be faced with the reality that the relationship cannot continue.

While this is an incredibly painful choice for everyone involved, it can also be the healthiest one in some cases. If needed, this decision should be made with the help of a qualified mental health professional.

Ghosting is a relatively new colloquial dating term that refers to abruptly cutting off contact with someone without giving that person any warning or explanation for doing so.

Even when the person being ghosted reaches out to re-initiate contact or gain closure, they’re met with silence. As you can see, it’s called ghosting because it involves someone essentially “vanishing” into thin air as if they were a ghost.

Signs of Ghosting

Ghosting is often obvious, but it can also be a gradual process. The other person might start by ‘soft ghosting,’ where they progressively minimize contact over a period of time. Some early signs that someone might be ghosting you include:

• They regularly bail out on plans to get together
• They struggle to make commitments
• They don’t like to share personal information
• They don’t want you to meet their friends or family
• They disappear from social media
• They rarely respond to your texts or calls
• Your conversations with them lack depth, and they seem disinterested

Ghosting can also occur on social media. It involves cutting off all social media contact with another person without explanation. The other person may unfriend, unfollow, or even block you on all social media platforms. They may even go so far as to deactivate or delete their social accounts to prevent all contact.

The History of Ghosting

The term “ghosting” became mainstream about seven years ago alongside the surge in online dating; it became an official entry in the Merriam-Webster dictionary in 2017. Interestingly, though, the term was actually used as far back as the 1990s. Some pop culture writers and scholars have even used the term to describe ghostwriting in hip-hop music.

Though a new term, the act of ghosting existed well before the digital age. “I think references of ‘going for a loaf of bread and never coming back’ are examples of ghosting,” says Bree Jenkins, LMFT, a dating coach in Los Angeles, Calif. “Ghosting used to be leaving a person and moving away or not leaving [them with] your contact information—its earlier origins are even the simple act of leaving a party or social gathering without notice and goodbyes.” 

How the Term Became Popular

So why did the term “ghosting” become mainstream just within the last decade? The argument is that online dating has simply made it way easier to ghost people.

With the higher frequency of ghosting instances, and with more people who could relate/understand being ghosted or doing the ghosting, the term was widely adopted.

Why Do Some People Choose to Ghost?

Ghosting is often seen as an immature or passive-aggressive way to end a relationship. In other instances, it may even be a form of emotional abuse.

There are two primary reasons why a person ghosts another, and often it’s a combination of the two.

It’s the Easy Route

The first is that some find it’s way easier (in the short-term, anyway) to ghost someone than to have an awkward, uncomfortable heart-to-heart about why you’re not interested in maintaining contact.

The person doing the ghosting often wants to avoid confrontation or dealing with someone else’s hurt feelings, so they simply cease all communication and hope the hint is delivered.

Option Overload and Fatigue

“With internet dating comes what may seem like infinite choices as opposed to walking into a bar and having limited options,” explains Margaret Seide, MD, a board-certified psychiatrist based in New York City.

“Because there are so many choices, online daters are quick to have the ‘OK, next’ or the ‘Yeah, but what else?’ mindset,” says Seide. “Sometimes the person is nice enough, but is juggling a few other people and that person just didn’t make the cut.”

How Ghosting Can Impact the Ghosted

As you can imagine (or know from personal experience), ghosting can have a real psychological impact on the person who’s being ghosted.

Jenkins adds, “Next, the feelings of depression [can] kick in along with feelings of poor self-esteem as you mentally reexamine your relationship and last conversation for possible warning signs.”

Ghosting is inherently ambiguous because there is a lack of explanation for why the relationship ended. For the person who has been ghosted, it can lead to significant feelings of rejection, guilt, grief, and shame.

A person who has been ghosted may be left wondering what this type of behavior says about them, but it is important to remember that ghosting says more about the person who cuts off contact than the person who is ghosted.

Working Through Grief After Being Ghosted

The grief cycle may not run that exact course, but being ghosted often triggers a flood of ranging emotions. Thoughts of ‘Not only did the person not want to date me, but I wasn’t even deserving of an explanation’ can make someone feel dehumanized and devalued.

It’s often more painful when it’s a relationship that’s marinated a bit, but the ghosted person can also feel this way if it was a new connection. It can take some time to work through the pain, but with acceptance the person being ghosted can move on.

How Ghosting Can Impact the Ghoster

Ghosting doesn’t just impact the ghosted; it also is a detriment to the ghoster. The bottom line here is that ghosting is either a passive aggressive way to end a relationship, or it is the “easy way out.” Either way, it’s not doing the ghoster any favors in their ability to communicate with others.

“Ghosting doesn’t take into account how you affect other people and it makes it easier for the person to dip out or disengage when things get uncomfortable. There’s no way to have a healthy, long-term relationship without being able to work through problems and use your communication skills,” says Jenkins.

Alternatives to Ghosting Someone

Avoiding the easy route of ghosting someone will benefit both parties. Meide says that the best thing you can do when ending a relationship, however long or short, is to treat the other person as you’d like to be treated.

“I usually suggest two spoons of sugar with the medicine in the middle for delivery,” Meide says. “It can sound something like ‘Hey, you seem like a really great catch, but I don’t feel it’s working between us. I respect your time and just wanted to be honest. Warm regards and take care.’

“Or, ‘Hi—it’s been cool getting to know you, but I’ve decided to take a break from dating and don’t want to waste your time or be dishonest. Best of luck with everything.’”

Is Ghosting Someone Ever OK?

In many cases, ghosting is considered a rude route to take when trying not to talk to someone anymore, or especially when ending a more serious or established relationship. However, there are most definitely exceptions—when further communication can be a bad thing or even potentially unsafe.

Situations in which ghosting can make sense is if you find out the person is married or in a relationship, participating in illegal or unsavory behaviors, or if they display toxic traits. In such cases, you do not owe that person an explanation for abruptly ending the relationship. 

If you feel your best interest would be to completely cut off contact with the person in question, don’t let your feelings of guilt keep you from doing what’s right for you and what will ultimately keep you safe.

Zoloft (sertraline), like many other serotonin reuptake inhibitors (SSRIs), is fairly well known for resulting in a discontinuation syndrome if you stop taking it suddenly. This is, in part, because Zoloft has a short half life. Your doctor can help you through the process of weaning off Zoloft as safely and comfortably as possible.

Discontinuation Syndrome

Because it leaves your body so quickly, weaning off Zoloft too quickly can cause discontinuation syndrome.

Discontinuation syndrome can occur for anyone, but it is most common in people who have been on Zoloft for many months or years. It can be unsettling because the symptoms might mimic those for which you sought treatment in the first place; in fact, you might even become concerned that your depression or anxiety symptoms are reappearing.

Symptoms When Weaning Off Zoloft

The symptoms of discontinuation syndrome may include:

• Fatigue
• Upset stomach
• Muscle pain
• Insomnia
• Anxiety
• Agitation
• Dizziness
• Hallucinations
• Blurred vision
• Irritability
• Tingling sensations
• Vivid dreams
• Sweating or electric shock sensations

Some people will experience only minor symptoms and may not make the connection with the changes in their medication regimen. For others, the symptoms are so debilitating that they feel they cannot stop their antidepressant for fear of how it will interfere with their lives.

Tapering to Prevent Discontinuation Syndrome

The best way to avoid or minimize these symptoms is to taper off Zoloft gradually. Consult your physician before attempting to taper.

There are not any hard and fast rules for tapering off Zoloft. One person may do it within a short time, while another may take longer. Some may even need to use liquid Zoloft or split their pills in half in order to taper in smaller increments.

A liquid formulation of Zoloft, which your doctor must prescribe, allows you to easily measure out smaller quantities of the medication than what is available in pill form. Pills can be split by obtaining an inexpensive device called a pill splitter from your local pharmacy.

Tips for Weaning Off Zoloft Comfortably

The best way to avoid severe discontinuation symptoms is to reduce your dose gradually under your doctor’s supervision. If your symptoms are severe, you might have to wean more slowly. The symptoms will pass in time as your brain adapts to the new dosage.

Work With Your Mental Health Professional

It may be tempting to quit your medication as soon as you start to feel better, but going off of it too soon can cause a relapse. In general, you should stay on your medication for at least four to nine months, and if you’ve struggled with depression three or more times, you should wait at least two years.

Talk to your mental health professional about whether or not it’s a good time to discontinue your medication and how to do it.

Follow the Plan

Make sure you taper off according to your doctor’s direction. It may take longer than you think it should, but it’s important to go slowly, so your brain has adequate time to adjust. It is OK to call your doctor and let them know that you wish to discontinue your medication more slowly if you are experiencing uncomfortable withdrawal symptoms.

Get Outside Support

Keep in touch with your mental health professional, especially if you are having withdrawal symptoms. Think about involving a close friend or family member as well, since this person can potentially see issues you may be having that you don’t notice.

Consider Psychotherapy

Therapy, particularly cognitive-behavioral therapy (CBT), can be extremely helpful in keeping depression symptoms at bay by helping you learn how to identify negative thought patterns and change them. Studies have also shown that psychotherapy decreases the likelihood of a relapse.

Stay Healthy

Eat nutritious, balanced meals and snacks, exercise regularly, get enough sleep, and participat in activities you enjoy. Exercise, in particular, can help increase serotonin levels, which in turn boosts mood. Just get that workout done at least several hours before bedtime, or the rush of adrenaline and endorphins you feel may interfere with your sleep.

Dementia is marked by a severe decline in cognitive functions, such as thinking, reasoning, and remembering, to the extent that it interferes with the person’s daily life.

Dementia typically affects older adults, but it is not a normal part of the aging process. While some amount of forgetfulness is normal with age, dementia is a severe disorder that can affect the person’s ability to function on a daily basis.

According to the National Institute on Aging, about one-third of all people above the age of 85 have some form of dementia. Dementia can stem from various causes, the most common being Alzheimer’s disease. Some of the other causes include Parkinson’s disease, Lewy body dementia, and frontotemporal dementia.

Dementia progresses in stages, ranging from mild to severe. In 1982, Dr. Barry Reisberg created the Global Deterioration Scale (GDS), which consists of seven stages, to help clinicians categorize the progression of dementia.

This article explores the seven stages of dementia so you know what to expect if you or a loved one has been diagnosed with it.

The stages are as follows:

1. No cognitive decline
2. Very mild cognitive decline
3. Mild cognitive decline
4. Moderate cognitive decline
5. Moderately severe cognitive decline
6. Severe cognitive decline
7. Very severe cognitive decline

Stages 1 to 3 are the pre-dementia stages, whereas stages 4 to 7 are the dementia stages. Clinicians typically compare the person’s symptoms to the criteria listed for each stage and use their judgment to determine which stage the patient is at.

The 7 Stages of Dementia

The seven stages of dementia are outlined below.

Stage 1: No Cognitive Decline

At this stage, the person can function normally and exhibits no signs of memory loss, confusion, or cognitive impairment.

However, the structure and functioning of their brain may have started to deteriorate as the neurons (nerve cells) in their brain start to lose connection with other brain cells and die.

Stage 2: Very Mild Cognitive Decline

The person starts to experience occasional lapses of memory, such as:

• Forgetting where they keep familiar everyday objects
• Forgetting names they once knew very well

At this stage, the symptoms are unlikely to affect the person’s work or social interactions. 

In fact, the symptoms may even be too mild to detect in a clinical interview with a healthcare provider, as the person may be able to adequately perform memory tests during the interview. 

Stage 3: Mild Cognitive Decline

This is the stage at which cognitive impairment starts to become more noticeable to the patient, their friends, family members, and colleagues.

The person may start to show symptoms such as:

• Getting lost while walking or driving, particularly in unfamiliar places
• Reading something and retaining very little of it
• Forgetting the names of people they’ve just met
• Losing items of importance or value
• Having trouble concentrating and performing complex tasks
• Experiencing increasing difficulty in social settings
• Frequently forgetting words and the names of loved ones
• Performing poorly at work to the extent that it becomes evident to colleagues

The person may start to feel anxious as their symptoms begin to become apparent and interfere with their ability to function. 

Stage 4: Moderate Cognitive Decline

In this stage, the person will exhibit a definitive decline in cognitive ability in a clinical interview.

Some of the symptoms of this stage may include:

• Lack of knowledge of current and recent events
• Difficulty remembering parts of their own personal history
• Trouble with organizing, planning, traveling, and managing finances

At this stage, the person will likely still be able to recognize loved ones’ names and faces and navigate familiar places. However, they may start to avoid challenging situations to prevent anxiety and hide their distress from others.

Stage 5: Moderately Severe Cognitive Decline

From this stage onward, the person may no longer be able to function without some assistance. 

These are some of the symptoms of this stage:

• Difficulty recalling a vital detail such as their address, phone number, or high school
• Disorientation in terms of place and time, such as confusion regarding the season, date, day of the week, or time of day
• Difficulty counting backward from 20 by 2s or from 40s by 4s (provided they are educated and were once able to do this calculation)
• Trouble with making decisions

In this stage, the person can likely still remember their own name and the names of their spouse and children, but they may struggle with recalling their grandchildren’s names. They may be able to eat and use the bathroom without assistance but may need help with tasks such as deciding what to wear.

Stage 6: Severe Cognitive Decline

At this stage, the person may require a high degree of care, as they may have symptoms such as:

• Difficulty remembering the names of their spouse, children, or primary caregivers
• Lack of awareness regarding all the recent events and experiences in their life
• Patchy or skewed recollection of their early life
• Difficulty counting backward or forward to 10
• Lack of awareness regarding their surroundings as well as the time and place
• Inability to travel alone without assistance
• Tendency to wander

The person is also likely to experience emotional and personality changes, such as:

• Paranoia, hallucinations, and delusional behavior, such as talking to themselves or believing their caregivers are trying to harm them
• Obsessive symptoms, such as repeatedly performing cleaning activities
• Agitation, anxiety, and even violent behavior
• Loss of willpower due to being unable to carry a thought long enough to complete the action

During this stage, the person is likely to still remember their name and distinguish between familiar and unfamiliar people in their environment. They will probably need assistance with daily living activities and may experience incontinence and sleep-related difficulties.

Stage 7: Very Severe Cognitive Decline

In the final stage, the brain appears to lose its connection to the body and becomes incapable of telling it what to do. 

The person is likely to progressively lose their motor skills and the ability to speak. They may only be able to utter unintelligible sounds or words, if at all. They will need assistance with all personal care tasks, such as eating, walking, and using the bathroom.