Introduction

In Poland, it is my babcia’s 80th birthday, but she did not know it herself because of how much her dementia had progressed. She sat at the head of the table with a confused pout on her face and her head down. Her head was down as she fumbled with a small napkin on her lap, its surface patterned with two colorful flowers. She would nervously fold the napkin and unfold it and fold it again with shaky hands as if she was trying to fix it. Then she would trace the flower’s shape with her finger as if it were the only thing that was real to her, the only thing she understood at a birthday table surrounded by her family.  She needed something to distract her as we spoke around her. Then, on the radio, an old 60’s Polish song starts playing, called “Mamo moja jada goscie,” a song she would sing all the time as a child growing up in the traditional part of Poland called Kurpie. She stops fiddling with the tiny paper and looks up and smiles, then rocking back and forth, she sings “la” along to the song. Her voice followed the song as if it never left her, and she tapped her hand to the beat. She finally seemed present, and the whole family joined alongside her. After being isolated the whole dinner, we found a way to show my babcia how much love surrounded her on her special day. By the end of the song, her sister goes to hug her, and she hugs back and kisses her on the cheek. She knew it was her.

These experiences with my grandmother inspired me to learn more about her impairment. Cognitive impairment can take away a skill and take away a person’s sense of who they are. However, such impairment should not have to mean being isolated or socially disappeared. Because music operates through subcortical circuits that remain functional, even when explicit language, motor, or memory processing is damaged or overridden, music can bypass that impairment and reach the parts of a person’s brain that are still intact, restoring not only function but also personhood. Understanding this function on paper was not enough for me — I needed to see it for myself.  This particular power led me to explore this possibility during my internship at Mount Sinai’s Louis Armstrong Center for Music & Medicine, as I worked alongside music therapists like Kristen and Dr. Rossetti, and researchers like Tammy.

The Power of Music, Broadly Defined

Music profoundly influences us. It has lived with and within us for as long as humans have existed. Music serves many different purposes, including emotional, physical, symbolic, and social ones, for a diverse range of groups of people.

The power of music is shown in how it can physically reshape your brain. When music interacts with the brain, all parts of the brain are active. Perception, movement, memory, and emotion are all being exercised in a way an isolated task never would. That whole-network engagement is what builds plasticity, and plasticity is what eventually allows music to do something no other stimulus reliably can: reach around damage instead of through it. This is monumental because the brain is connected to the body, and the body functions through the signals it sends. So ultimately, when exercising a part of the brain to improve it, the bodily function that part of the brain controls will also improve, which is exactly what opens the door to bypassing impairment in the first place. Hallam and Himonides state that “music has a multiplicity of functions which operate at several levels: that of the individual, the social group and society in general” (Hallam and Himonides 4), showing that music can not be reduced to a singular function and its power is plural, plasticity only being the first piece of it.

A person’s emotions are among the most complex concepts a person holds, and the hardest part of a person to access directly. You can be the most articulate person, but states like grief, love, longing, and fear can be hard to put into words fully. However, music does not have that limitation. It can carry the shape of an emotion in a way language cannot. That is why someone can hear a song and break into tears without knowing why. The emotional power of music lies in the fact that it is not just a sound to enjoy, but an access point. Music serves as “a vehicle for emotional expression, conveying ideas and emotions which might be difficult to communicate in ordinary verbal interchanges” (Hallam and Himonides 5), reaching feelings that language cannot form. This concept will be important later in this paper because I will address how it influences a person who loses language altogether.

As strong as music is for its effect on the individual listener, it also holds tremendous social power. When music shifts from an individual personal experience to a shared experience, it takes on new meaning. Making music together creates a synchronized experience that’s built in real time. This synchrony does not just feel like connection — it becomes connection, at the level of brain chemistry, because it “creates and strengthens social bonds amongst interacting group members through endorphins, which are released during synchronized exertive movements in singing or playing together” (Hallam and Himonides 6). Shared music-making requires something of people that listening alone does not. It forces people to be vulnerable with their voice, timing, and imperfect participation. For someone with a cognitive impairment or mental illness, shared music experiences can offer a comfortable way to be seen without judgment and to stop being isolated and engage in the present moment. This is why “music fosters prosocial behavior, a shared sense of success, physical coordination, shared attention, shared motivation and group identity” (Hallam and Himonides 6) because it gives people a reason to lower their guard together. When music is shared, it does not just shape an individual and their emotions; it also shapes who “we” are and forms a group’s identity. This is similar to what sociologist Émile Durkheim calls “collective effervescence,” the heightened, almost electric sense of unity that arises when a group moves and feels something together, dissolving the boundary between individual and collective in the process. Durkheim was describing religious ritual, but the mechanism he described is the same one at work when a room full of strangers finds the same beat.

Beyond its power to connect people, music does something even more fundamental. Music does not just go through one ear and out the other; it physically alters your brain. Hallam and Himonides state that making music “draws on many brain functions, including those related to perception, action, cognition, emotion, learning and memory” (Hallam and Himonides 16). In other words, it moves through the whole system at once and is not confined to a single narrow pathway, as most single tasks are. This engagement with music is not short-lived. Over time, “extensive active engagement with music induces cortical reorganization, producing functional changes in how the brain processes information” (Hallam and Himonides 18). The brain is altering itself in a way that lasts and not just responding to music. Some clinical research suggests that music’s neurological power does not stop at the level of conscious thought.

According to Stephen Porges, the neuroscientist behind Polyvagal Theory, music also communicates directly with the autonomic nervous system, the part of the nervous system that regulates safety and threat, and operates completely outside conscious control. Andrew Rossetti, a music therapist who directs oncology music therapy at Mount Sinai, draws directly on Porges’ work. He explains that music “supports connectedness and co-regulation” and “communicates cues of safety to our nervous system,” which “down-regulate defense and optimize homeostatic processes” (Rossetti, ‘Environmental Music Therapy’ 135). This is not just theoretical and actually holds up under clinical testing. In a randomized clinical trial testing this mechanism in a radiation oncology waiting room, patients who received live, therapeutic music showed a significant drop in anxiety. Their anxiety had a median decrease of 16.6 points on a standard anxiety scale, compared to an increase in the control group (Rossetti et al., 2023, ‘A Clinical Pilot Study’ 58). If Porges’ theory explains why music can calm a nervous system that it never consciously reaches, this trial proves that it actually does. Music has been shown to interact with the brain on a whole other, unconscious level.

This unconscious quality of music is not a new revelation either; it is something researchers have speculated about for over a century. The philosopher Friedrich Nietzsche, who devoted himself to music and philosophy, put it, “we listen to music with our muscles” — a line the neurologist Oliver Sacks returns to in his own writing on music and the brain (qtd. in Sacks 2528). Kristen, another music therapist I worked alongside during my internship at Mount Sinai, echoed the same idea, saying, “music moves the muscles.” With Porges’ theory and Rossetti’s data, we can see that this is not just speculation. Music actually engages the body and brain as a single system, which is what makes listening to music such a distinct experience. 

If music’s neurological power lies in its ability to engage the brain and body as a connected system, then its critical significance lies in what happens when part of that system is damaged. For example, language relies heavily on specific and fragile brain regions responsible for grammar, word retrieval, and speech production, concentrated mostly in the left hemisphere. Music, on the other hand, draws on a much wider, more redundant network involving rhythm, pitch, and melody, which is processed in both the right and left hemispheres, in areas associated with movement, memory, and emotion. The two systems intersect at points, but they are not built on the same foundation, which means an injury precise enough to knock out language can still leave music’s broader network largely intact. Hallam and Himonides second this, saying, “clinical studies of those with brain damage revealed separate deficits in music and language” (Hallam and Himonides 46). In other words, a person can lose the ability to comprehend speech or to speak while their capacity for music remains completely untouched, and vice versa. This is what allows music to reach certain pathways and reach a person when language cannot, or they are impaired.

The Bypass Mechanism

This is exactly what happened to my babcia at our own dinner table. She sat in a wordless state due to her dementia, taking almost all speech away– until the melody of  “Mamo moja jada goscie” reached her.   Something inside her answered back. Looking at this mechanism more closely, I see that this separation between music and language is not something I noticed by chance. It has a name and a direct clinical application: melodic intonation therapy. For example, rather than asking a patient to speak, therapists sing sentences to them in an exaggerated, musical version of normal speech until it resembles a song. As Hallam and Himonides explain, this technique, developed by “Sparks and colleagues (1974)”, works by using “sung intonation of propositional sentences in such a way that the intoned pattern is similar to the natural prosodic pattern of the sentence when it is spoken” (74). The patients Sparks studied were not easy fixes. They were “eight severely, but not globally, impaired right-handed aphasic subjects with left hemisphere damage,” each of whom “had shown no improvement in verbal expression for at least six months” of standard language therapy (Hallam and Himonides 74-75).

This is the idea behind bypassing cognitive impairment: the therapy works not by forcing language back in through the original damaged pathway, but by rerouting it through music instead. My babcia was never enrolled in a clinical trial, but she is living proof of the same mechanism at work. Why is music able to bypass so many different types of damage, such as those affecting language, hearing, or memory? Part of the explanation goes deeper than any single neural pathway, reaching into the brain’s most ancient reward systems. The pleasure we get from music stimulates what neuroscientist Stefan Koelsch describes as “a phylogenetically old reward network that functions to ensure the survival of the individual and the species” (Koelsch 170). In other words, music does not depend on the same evolutionarily more recent circuits that language relies on. Instead, it has its own much older route into the brain, one that can remain intact even when more recent systems break down.

Kristen shared something a woman with Alzheimer’s said to her during a session: “I feel like I have forgotten more than I have ever known.” This is what daily pain is like with Alzheimer’s. It is not one dramatic loss but a subtle, contrasting awareness of disappearing until it has all gone. That is what a disease like dementia takes away from someone: not just words, but the certainty of who you were before you lost them. Music therapy cannot bring back everything that is gone, but it can reach and bring out the person that is underneath all that forgetting.

This idea of neurological bypassing can apply to any compromised system, and the effectiveness of music therapy in accomplishing this is supported by Hallam and Himonides, who summarize a study by Good and colleagues (2017) on children with cochlear implants. The children who received music training showed improved discrimination of melodic contour and rhythm, incidental memory for melodies, and emotional speech prosody perception, whereas a matched group given painting lessons showed no such improvements (Hallam and Himonides 74). This means the benefit was specific to music, not simply structured attention or care.

Work like this is also implemented in the Newborn Intensive Care Unit for premature infants. During my volunteer work at Mount Sinai, I observed music therapy in the Level IV neonatal intensive care unit, the Jo Carol and Ronald S. Lauder NICU. My mentor, Tammy, was studying how entrainment — matching the tempo of live singing to a baby’s breathing and heartbeat — affects oxygen and respiratory stability in infants born with conditions like Respiratory Distress Syndrome (RDS). While we do not yet have research findings, I observed it in practice at the hospital. I observed a baby with a small adhesive sensor strip on his forehead, connected to a near-infrared spectroscopy (NIRS) machine that tracked his fractional tissue oxygen extraction — a measure of how well the brain is receiving oxygen. As Tammy sang a soft jazz tune, matching her tempo to his breathing, he drifted off to sleep, and his vital signs remained stable throughout. This mirrors what Virtala and Partanen found in older infants: that ‘music-making and parental singing prompted infants’ early language development and auditory neural processing’ (Hallam and Himonides 74). Here, “bypass” is not the right word because there is not yet a damaged language pathway for music to route around. Instead, music arrives first to stabilize the nervous system before language has even begun to form, so that when language does emerge, it has a steadier foundation to build on.

The bypass also extends to motor impairment. Earlier this year, I heard this principle explained directly by David Leventhal, founding teacher of Dance for PD, in a talk at a conference on music and medicine called “Mechanism of Pain and Music.” Leventhal described the patients who arrived rigid, frozen, sometimes barely able to initiate a single step, and the patients who left moving with fluidity and grace once music and rhythm entered the room — the same body transformed by an external beat. There is a real mechanism behind this happening. Parkinson’s disease damages the brain’s internal timing system, the one responsible for cueing smooth, sequenced movement. Researchers explain “PD is associated with a loss of internal cueing systems, affecting rhythmic motor tasks such as walking,” but that “music and dance encourage spontaneous rhythmic coupling between sensory and motor systems” (Krotinger and Loui). The mechanism, they argue, works because rhythmic training can strengthen “neural pathways involved in motor control, auditory-motor entrainment, action observation, and/or kinesthetic or proprioceptive feedback mechanisms that could then be utilized as an alternative to impaired motor areas” (Krotinger and Loui). This means that rhythmic training builds alternative neural pathways that can substitute for the internal timing system the disease has damaged.

Leventhal described people in his dance classes learning to forget that movements are commands sent from their brains to their bodies, and to use music and rhythm to shift what they do from a common action to something they create. I think of it like this: instead of thinking of walking as moving your feet in front of each other, one at a time, you use the rhythm of the music to make it an action of moving from stone to stone across a calm river. Then, soon after creating these new scenarios, people who could take a step learn to create these full dances. The body is not relearning how to move. It is borrowing a rhythm it can no longer generate on its own.

What struck me most, though, was not the mechanism – it was what Leventhal said about identity. Parkinson’s, he explained, “affects every aspect of a person’s sense of self.” But in his classes, patients are given “a new identity — that of dancer, instead of just patient” (“David Leventhal”). That distinction is not small. It is, in miniature, the entire argument of this paper: the bypass is not just of a damaged motor pathway, but of an erased identity.

So far, every population in this section has had a body or brain system that was physically compromised. PTSD complicates that picture — the injury is not structural, but the isolation it produces looks remarkably similar. Combat-related PTSD often produces ‘feelings of loneliness and isolation from society, intrusive memories, outbursts of anger and generalized feelings of helplessness’ (Bensimon, Amir, and Wolf 34). Traumatic memories resist the kind of verbal processing ordinary memories allow — they are stored as raw sensory fragments, leaving many survivors unable to translate what happened into words at all. This is often called “the unspeakable,” however, I would push back slightly on where the block actually sits. It may also be that people around them cannot bear to listen to it, and that unwillingness closes a door that survivors might otherwise have tried to open. Music offers a route around that block: because music and trauma are both “sensory mediated,” music therapy can function “as a means of sensory approach to traumatic memories as a detour of linguistic and logical mediation” (Bensimon, Amir, and Wolf 40)—a way to reach a survivor without requiring either side of that broken exchange to work first.

In a study of six soldiers diagnosed with combat- or terror-related PTSD, group drumming produced measurable “increased sense of openness, togetherness, belonging, sharing, closeness, connectedness and intimacy” (Bensimon, Amir, and Wolf 34). One participant described the effect directly: “Once you beat the drum, although you don’t know anyone, it gives a feeling of togetherness which makes it possible for you to share everything with the group. It’s as if you’ll go naked in front of them. . . If something facilitated intimacy above all the instruments, it was the drums” (Bensimon, Amir, and Wolf 38). These soldiers were already receiving individual psychotherapy alongside the drumming session, yet it was the drumming, specifically, that participants pointed to when describing this particular kind of openness. That distinction matters. It shows that rhythm reached something in these men that conversation, on its own, had not yet reached.  

Mania presents a different kind of impairment altogether– not a damaged pathway, but a mind in crisis. A recent randomized study of 102 inpatients hospitalized for manic episodes found that those who received group therapy alongside routine nursing care showed significantly lower mania severity scores and significantly higher emotional stability scores than those who received routine care alone. This shows that the intervention “significantly enhances emotional stability and satisfaction among hospitalized manic patients” (“Effect of Group Music Therapy” e46082). Here, the damage was to the mind’s instability in general and not to a single damaged circuit that needs to be routed around. And still, music reached something that routine clinical care alone did not.

As I explain later in this paper, I would witness this effect firsthand in a room full of patients diagnosed with schizophrenia, bipolar disorder, and psychosis.

Wholeness as the Goal, Not Just Function

Bypassing impairment at the level of the brain is only half the picture. For many patients, the deeper impairment is not neurological at all but the isolation that the illness produces, and reaching a person there requires more than rerouting a damaged circuit. It requires community. Music therapy and community music are not quite the same thing, and the distinction matters here. As MacGlone and colleagues explain, “community music interventions are distinct as they may have positive therapeutic outcomes, but these are secondary to the realization of an enjoyable, sociable experience for participants” (MacGlone et al. 2). In other words, community music does not set out to fix anything. It sets out to include someone, and healing comes as a byproduct of that inclusion rather than the goal. This reframes the word “treatment” from correcting something to restoring someone’s wholeness.

That reframing matters because isolation is not a side effect of illness — it is often part of the injury itself. “Isolation due to social exclusion is a key contributing factor to such mental health impacts” (MacGlone et al. 2), and the reverse is just as true: reducing isolation can itself be a form of treatment, not just a pleasant side benefit of one. Nowhere is this clearer than in the case of Jack, a young man with a disability who took part in a community music program studied by researchers at the University of Edinburgh. In the year before the program began, his mother had watched him steadily withdraw, losing interest in things that once brought him joy. A month of medical investigation turned up no clear cause, though doctors suggested depression. Then the music workshops started. According to a staff member, Jack “came back to life,” joining with enthusiasm he had not shown in over a year, cracking jokes again, playing with expectations during the group’s songs the way he once had. His mother described it: “It’s like seeing the old Jack… they’ve just seen bits of him that’s like they used to see years ago, coming back.” (MacGlone et al. 8). What is striking about Jack’s case is what did not happen. Nothing about his underlying diagnosis changed. No pathway was repaired, no circuit rerouted. And yet something unmistakable had come back. That gap is the clearest possible illustration of what “wholeness” means in this paper. It is not the absence of impairment, but the presence of the person who was there all along, however hidden the impairment had made them.

This idea has a name, specifically in dementia care. Psychologist Tom Kitwood defined personhood as “a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being,” adding that it “implies recognition, respect and trust” (qtd. in Tieu and Matthews). I keep coming back to that word “bestowed.” Kitwood is not saying that personhood is something a person has, locked safely away, no matter what happens to them. He is saying it is something given continuously by the people around them, which means it can also be withheld. A caregiver, doctor, or distracted family member can fail to bestow it through impatience, talking over someone instead of listening, and by treating a diagnosis as the whole of who that person is. Doing this can erode a personhood that no brain scan would ever show as damaged. This reframes what happened to Jack, and what happens every time my babcia sings. Neither the community music workshop nor my babcia’s song repaired anything measurable. But both moments gave back something that had quietly gone missing. For Jack, that was a sense of self his withdrawal had taken from him, and for my babcia, that was a place in her own family’s conversation, which her dementia had left her locked out of. What came back in both cases was not a restored function but recognition finally being offered again.

One of the researchers behind Jack’s program, Kirsty Brown, who has a disability herself and worked as a lay researcher on the study, gave this phenomenon the name “voice”. She defined voice as a form of self- expression that does not have to be verbal at all — participants could “sing, speak, play instruments,” but just as often, their voice showed up as “increased eye contact with others, bodily movement or gesture” (MacGlone et al. 6). Voice, in other words, is not the same thing as speech. It is whatever a person still has left to offer those around them, in whatever form it takes.

My babcia’s voice, that night at the dinner table, was a single syllable repeated in place of words she could no longer find: “la, la, la,” pitched exactly where the lyrics should have been. It was enough to bring her back.

None of this is merely an observation, and it does not apply only to dementia and disabilities. A ten-year follow-up study of people living with first-episode psychosis found that rates of “personal recovery,” “life satisfaction,” and “pleasure” were all higher than rates of “clinical recovery” — the disappearance of symptoms (Simonsen et al. 2112). In fact, “personal recovery overlapped more with emotional wellbeing than with clinical recovery” (Simonsen et al. 2118). Sixty-eight percent of participants had achieved at least one positive outcome after ten years, leading the researchers to conclude that a “good life with psychosis” was possible (Simonsen et al. 2112). This is the finding, stated in the language of psychiatric research rather than music therapy, that this entire paper has been circling. Wholeness was never the same as the absence of impairment and does not require a cure; it requires only what Kitwood said it does: constant recognition, respect, and trust. Sometimes that comes through a clinical trial. Sometimes it comes through a drum circle, a dance class, or a single syllable, sung at a dinner table, by a woman who lost the words but not the voice. Comprehending all of this can be done through reading, but watching it happen in front of your eyes in a room is so much more than an article can convey.

“It Brings Me Life”

I entered the “inpatient adult and geriatric psychiatric service unit” on the hospital’s fourth floor. The space is intimidating because people roam freely, and this section of the hospital is where patients with serious mental illness reside. . . It is my first time working with patients in these conditions, so I don’t know how to act. Not because I don’t want to be there, but because I can be standing two feet away from someone and have no clue what is going through their mind or what’s real and what’s not for them.

Patients carry their droopy faces as they drift, pace, and prowl around freely without reason. One person approached and stood closely behind me. In the common area, sets of eyes stare blankly at a TV playing. The eyes are not even watching the screen; they are just fixed there, not blinking or moving away.

The therapy room is different from the hallways. It’s clean and simple with a little bookshelf in the corner for patients to use. The chairs are arranged in a circle, with tables in the center, creating a sense of both distance and connection. Patients trickle in slowly, and I watch them carefully as each of their eyes darts around the room, trying to find the chair in the circle they feel the safest in. A guy on my left aggressively scratches his head and fixates on things around the room while the girls across from him look down rapidly tapping their feet. Then there is an older man at the end, and he is sitting back in his chair with his hands under the table, folded in his lap, his attention on the instruments placed down the middle of the circle. Kristen told me he rarely stays for the full sessions, trying to remain in his comfort zone. The feeling in the room feels uncertain until Kristen, the facilitator, asks a simple question. “What do you like about music?” People around the circle answer one at a time, and the old man at the end says, “It brings me life.” Kristen slowly starts playing her guitar and singing “Waiting on the World to Change” softly, almost under her breath. The soft strums allow everyone to drift into the shared experience comfortably. The instruments laid out are simple, nothing too sharp-sounding or jarring, like maracas, shakers, and small hand drums. Most people start reaching for instruments to play, whether it’s just to have something to hold or to add to the sound. The room, once filled with silence, drifts into a mix of different sounds, so softly played together, and the instruments disappear to the beat of the song Kristen is now singing.

Kristen stops singing at some point, and more questions about change and pushing people out of their comfort zones follow. I have previously learned some of their diagnoses, like schizophrenia, psychosis, and bipolar disorder, but as they play together and answer Kristen’s questions, their diagnoses disappear, and they turn into more complex humans. The older man finally grabs a small drum and a stick and plays so softly under all the other music that you can barely make it out. But as the bridge comes, he smiles and starts to sing along with Kristen. He stays for the full session.

Why This Matters: The Cost of Calling Music Optional

Nothing in this article is new information. The evidence for music therapy’s power to bypass impairment and restore personhood is not new, not thin, and not controversial within the field. And yet music therapy remains, in practice, an afterthought. Music therapy is treated as something offered when there is room in the budget, rather than built into the structure of care itself. Part of the reason is that music therapy does not fit neatly into a healthcare system built around pharmaceuticals and procedures. These things can be billed, coded, and reimbursed on a predictable schedule. A pill has a price, and a scan has a code. A conversation between a music therapist and a patient, no matter how transforming, often does not have that role in the patient’s treatment plan. As one recent review of music therapy in healthcare puts it plainly, “in many healthcare facilities and community settings, music therapy remains inconsistently funded, often relying on charitable support or short-term grants” (Lan et al.). Charity and short-term grants are not what you build a system of care on. They are what you build a program on and can be cut when the budget needs to be tightened.

This is not a problem of ignorance. The same researchers note that even mainstream medicine has been forced to take non-pharmacological approaches seriously, precisely because of “the limited efficacy and certain adverse drug reactions (ADRs)” of the drugs doctors have relied on instead (Lan et al.). In other words, the medical system already knows the current model has real costs, measurable harm, and real limits. It has turned to music therapy anyway due to necessity and not out of conviction. Funding has not kept pace with the growing evidence.

The disparity is not evenly distributed, either. Music therapy “has been formally recognized as a professional field in numerous Western countries, such as the United States, Canada, the United Kingdom, and Australia; yet, in many low- and middle-income countries. . . There is a lack of standardized recognition and proper reimbursement mechanisms” (Lan et al.). Access to a person’s own personhood being restored should not have to depend on where that person happens to live and how much money goes into the healthcare system they are born into.

This concept is the most visible in long-term and nursing home care — the exact setting where Kitwood’s model of personhood was first developed, because it was in those settings that he saw personhood most routinely eroded. A resident in a facility built around cost containment is, structurally, a line item before they are a person — a bed to fill, a set of medications to administer on schedule, a body to keep alive as efficiently as possible. Bestowing personhood, Kitwood’s word (constant recognition, respect, trust), takes time, attention, and staff who are not stretched so thin they cannot give it. None of that shows up on a balance sheet as a cost saved. It shows up, if it shows up at all, as a resident who is easier to manage, calmer, and less likely to need intervention. These are all outcomes a spreadsheet can register, even when it cannot register the reason behind them.

The researchers behind this same review are unambiguous about what needs to change: “government, clinicians, insurers, and healthcare payers must recognize music therapy as a reimbursable health service. . . establishing reimbursement pathways or national funding frameworks would legitimize music therapy as a part of the formal, standard practice” (Lan et al.). This is not a radical claim, nor is it strictly about music. It is a claim about what a healthcare system chooses to count as a real treatment, and what it allows itself to treat as an option or just a nice, extra form of care. That extra form of care has reached people like no pill can.

My babcia is fortunate because she has family who can give her the music that she cares about. Not every patient with dementia, not every survivor of trauma, not every person losing themselves has that. Whether they do should not rely on what a hospital’s budget can absorb this year. It should depend on what we, as a system that claims to care for people and not just their symptoms, are willing to call essential.

Conclusion

I wanted to write a paper like this as soon as I saw my babcia reawakened from a 60-year-old song that found an opening into her being. I needed to know more about what I had witnessed. I found that what reached her was not a miracle, but a mechanism. Music and language are not the same communication modality, no matter how intertwined they are, and if one is damaged, the other is not. The same rerouting that allowed her to sing was the reason a man rigid with Parkinson’s moved again after hearing a rhythm his own brain could no longer generate, and why deaf children were able to learn to hear speech through rhythm. This bypass is more than strengthening an area of the brain to restore a daily function because it is actually able to reach people with issues that do not impact a function but take over their entire mental stability: people with trauma so severe they cannot put it into words have used music to overcome it. This is possible because music’s influence on the brain is older than language itself and foundational enough to remain after other parts of the brain have been compromised. However, on closer inspection, it is apparent that none of this is actually the point. A bypassed pathway is not the goal, but restoring the person is. What is actually happening when my babcia starts singing a song she once knew, when a shy man opens up to a group of strangers, every time Jack “comes back to life”, is closer to what Kitwood called bestowal. The quiet, repeated act of recognizing someone as a person, respecting them as one, and trusting that they are still there to be reached.

The larger argument of this paper is that music can help heal and that neurological impairment does not have to mean disappearance. Music is one of the most powerful ways we have found to meet a person where they are. It should not be a luxury or a grant-funded extra but a requirement. We are born with one heart and one body, so if there is a way to prevent impairment from taking who we are away from the one life we have, there should be no discussion.

My babcia still goes through every day with dementia, and there is no cure. However, knowing that we can achieve those little moments where my babcia and others are not lost forever restores hope — not that the disease like this one will stop taking, but that what they take can still, sometimes, be given back.

References

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About the author

Maya Nakahara

Maya Nakahara is a student in the Instrumental Music program at LaGuardia High School, where she plays piano and trumpet and has recently started learning guitar. Her academic interests sit at the intersection of music, neuroscience, and therapeutic application — an interest she has pursued through volunteer work at Mount Sinai’s Louis Armstrong Center for Music & Medicine. Outside the classroom, she plays volleyball for her school’s varsity team and for Brooklyn Elite Volleyball, a club team, and serves as the Event Manager for her school’s Mental Health Initiative.

The post How Can Music Bypass Impairment to Reach The Wholeness of a Person? appeared first on Exploratio Journal.

Abstract

This study examines whether teenagers use social media primarily for active communication or passive consumption. Screen time data from 29 teenagers revealed that 85.6% of usage was passive, compared to 14.4% active. Interviews indicated boredom and habit to be major factors in usage. These findings suggest that social media platforms originally designed for communication, are predominantly entertainment-oriented and signal a shift in how and why teenagers engage with social media.

Introduction

Social media began with SixDegrees in 1997, the first platform to combine user profiles, messaging, and friends lists: concepts still central to social media today. LinkedIn, Myspace, and Facebook followed, all focused on building personal or professional connections. But from 2005 to 2010, the platforms shifted: YouTube let anyone share videos, Instagram centered on photos, and in the 2010s Snapchat and TikTok introduced disappearing messages and algorithmic, infinite-scroll feeds. This is where the transition emerged: social media, originally designed to connect people, began to isolate them.

This shift shows up clearly in how much time teenagers now spend on these platforms. A 2023 survey found that U.S. teenagers spend an average of 4.8 hours per day on social media specifically (Gallup, 2023), and a separate study of teens and young adults found average daily screen time overall, across all apps, to be 6.54 hours (Gashaj, 2025).

TikTok’s structure was mirrored by other platforms, including Instagram Reels, Snapchat Spotlight, and YouTube Shorts, all converging on one consistent component: short-form content. A 2026 analytics review found TikTok’s 15-30 second videos have the highest engagement rate of any length bracket, 6.00% (Cucu, 2026), reflecting a decades-long trend of shrinking content length. Dopamine-scrolling, driven by mechanisms like suggestions, auto-play, pull-to-refresh, and infinite scrolling, keeps users continuously moving through a personalized feed to trigger dopamine releases. This endless scrolling has been linked to anxiety, depression, and lower self-esteem (one quasi-experimental study of Facebook’s staggered college rollout found it caused roughly 300,000 additional depression cases among 17 million U.S. college students, Doucleff, 2023), and can interfere with sleep schedules, compounding these effects. Yet social media has possible benefits too: 81% of teens feel more connected to friends’ lives, and roughly two-thirds feel they have people who support them through tough times (Pew Research Center, 2018). Rather than investigating these psychological effects directly, this study examines how teenagers actually use social media, specifically whether their time is spent on active social interaction or passive content consumption.

Therefore, this experiment isolates more than social media usage as a whole, but how social media is being used specifically. There are two major types of social media use, categorized as active and passive use. Active use involves communicating, commenting, and interacting with others. Passive use involves scrolling and viewing profiles without interacting. The Uses & Gratifications (U&G) Theory claims that users are actively selecting and using media based on their specific preferences and needs. The users choose the form of media that will serve their desired purpose (e.g., information, relaxation, communication). This perspective brings forth the idea that all forms of social media are somewhat active. For the purpose of this study, active use is used as a proxy for “social” interaction, while passive use is used as a proxy for “non-social” content consumption.

The background of our research lies in the significant alterations to social media platforms. Platforms that were solely used for connection now have extensive features that facilitate isolation. So the question that underlies the hypothesis is, “Is social media still social?” The question is aimed primarily at teenagers because they consume significant amounts of content through scrolling: 61% of teens use TikTok daily, compared with just 24% of all U.S. adults (Pew Research Center, 2025a, 2025b). Our hypothesis is that social media has become more of an entertainment platform than a connective one, with teenagers spending more time consuming content passively than interacting actively with others.

Previous research suggests that active use may provide more benefits, such as increased social connection, whereas passive use may be associated with negative effects such as isolation, depression, anxiety, and body dysmorphia.

Literature Review

The Dopamine Mechanism Behind Scrolling

A 2025 review in Cureus outlines the dopamine-driven feedback loop behind social media addiction (De et al., 2025). Peer influence and the pursuit of validation draw teenagers deeper into social media, where infinite-scrolling and algorithmically driven content take over. The mechanism runs through the mesolimbic system, the brain’s reward pathway: dopamine release makes scrolling feel rewarding, though it isn’t true happiness, just a chemical shortcut. As users build tolerance, they need more stimulation to feel the same reward, and personalized feeds are built to supply it: every like, follow, and swipe teaches the algorithm what will hold that user’s attention longest. This context-switching carries a measurable cost: short-form video specifically, unlike longer platforms like YouTube, has been shown to impair people’s ability to remember and follow through on their own intentions (Chiossi et al., 2023).

The Godard & Holtzman (2024) Meta-Analysis

A meta-analysis was conducted in 2024 (Godard and Holtzman, 2024) of 141 studies, in which they attempted to determine whether ASMU and PSMU had differing effects on users. The majority of effects were lower than the researchers’ threshold for a meaningful effect. However, one significant and consistent effect was that active use led to online social support (r = .34), with roughly 97% of the studies concurring. Despite most PSMU effects being below the threshold, some were worthy of note. Social anxiety symptoms (r = .29) were more prevalent due to PSMU. However, the data for social anxiety symptoms was gathered from only 3 of the 141 studies. PSMU was also found to be linked to greater illbeing, though the association was rather weak (r = .11).

This meta-analysis found adolescents and emerging adults show more negative passive-use associations than adults, which is why we chose to study the 16-18 age range specifically.

Research Question

To what extent do teenagers use social media for active social interaction compared to passive content consumption?

This paper investigates beyond total screen time: we gather screen time data, isolate social media usage, and break it into two categories, active and passive. Messaging others, including sending videos or photos directly to a friend, is recorded as active use, a deliberate act of communication directed at a specific person. Scrolling or viewing profiles without interacting is recorded as passive use. We record data for Instagram, TikTok, and Snapchat, three of the most-used platforms among teenagers. YouTube is excluded because most teenagers use it for longer videos rather than messaging.

Procedure

Data collection had two parts: a quantitative phase for every participant (n=29), and an optional interview (n=21). In the quantitative phase, after consent, each participant reported gender, age, and state, then opened their phone’s Screen Time tool so we could record total phone and social media time. We then navigated to their TikTok and/or Instagram and manually counted messages to record as active, with their permission. We asked whether each subject used Snapchat Spotlight, Snapchat’s scrolling feature, since Snapchat was otherwise coded as active.

We assumed each message or video took approximately 30 seconds to send, a figure chosen after timing one person reading and typing a 9-word reply (5-60 seconds). This 30 second estimate is likely a slight overestimate, since videos are often sent without opening the thread, but the difference is marginal and there’s no way to pin down a fully consistent messaging time. We used the previous day’s data throughout, to stay consistent with the daily figures gathered earlier.

But some willing participants contributed further by consenting to a recorded interview process. Questions varied slightly between conversations but they centered around the participants’ feelings regarding their social media usage. Not every participant was explicitly asked each question, as some were answered through previous answers. The core questions asked were:

1. Looking at your Screen Time numbers, is this about what you expected? What, if anything, surprises you?
2. If we pulled the same numbers from about three years ago, what do you think they would have looked like in comparison?
3. When you first started using your main social media platform, what did you mostly use it for, and do you think that use has changed since then?
4. How do you feel about the amount of time you spend on social media overall?
5. When do you think you use social media the most?
6. How do you usually feel after using social media?
7. Do you procrastinate, and if so, do you think social media plays a role in it?
8. What do you think you would do more of if social media did not exist?

Results & Discussion

Overall Usage

From the data, there was a large and consistent gap between passive and active usage of social media, with passive usage far exceeding active in time spent. Interviews also revealed that people don’t go on social media for a reason: most describe a trigger rather than a purpose.

As referenced in the intro, a recent study found the average daily screen time in adolescents to be 6.54 hours (Gashaj, 2025), and another study found the average adolescent daily social media time to be 4.8 hours (Gallup, 2023).

This study found similar results: average screen time across all 29 participants was 6h 31m (SD 2.62), and average social media time was 3h 22m (SD 1.45), likely lower than Gashaj’s figure because this study excludes YouTube, counting only Instagram, TikTok, and Snapchat.

Active vs. Passive: The Core Finding

Results show a consistent gap between active and passive usage: 27 of 29 (93.1%) participants’ majority SMU was passive, and only 2 of 29 (6.9%) were majority active, meaning they spent more time messaging than scrolling. The mean per participant was 14.4% active, 85.6% passive.

Passive usage is closer to consumption, like watching TV, than interaction; even liking and following are shallow, one-sided gestures. As established in the Introduction, we treat active use as “social” and passive use as “isolated” (proxies for answering our research question). Under that framing, social media is only 13.37% “social”: of 684.5 total hours collected, just 91.5 were spent actively messaging or sharing. Whether measured in pooled hours or per-person average (14.4%), the answer is largely the same: social media is not very social.

Figure 2. The same split, person by person rather than pooled, showing this isn’t a few heavy users skewing the average. Median is 89.7% passive, and only 2 of 29 participants are majority-active.

The Two Active Outliers

P15 and P10 are the only two participants whose majority SMU was active (59.0% and 54.6%, respectively), both because Snapchat, not TikTok, is their top app, and this study codes all Snapchat time as active by default. Neither sent an unusually high number of messages that week (P10: 5, P15: 6, both below average).

P15 describes a deliberate shift toward calling and texting friends instead of passively scrolling, consistent with his data. P10 describes a self-imposed screen time limit and his total usage is the lowest in the sample (849 minutes/week).

Because both outliers depend on Snapchat being counted as 100% active, Figure 3 tests how the sample’s active share shifts under three more conservative assumptions (90%, 80%, 60% active).

Platform Breakdown

This Screen Time data breaks down social media use per app. There are a few patterns worth noting regarding the different apps. TikTok dominates overall with 56.1% of all social media time across the sample. Instagram has 30.8% of the time and Snapchat has 13.1%. TikTok holds as the primary “top” or most-used social media app for 20 of 29 participants (69.0%).

The Boredom / Gap-Filling Trigger

Of the 20 interviewed participants who answered when they use social media most, all 20 (100%) described an empty or unoccupied moment: boredom, a gap between tasks, or routine downtime before bed, with nighttime the single most common trigger (40%). Separately, 33% (7 of 21) used the word “bored” themselves, unprompted. This pattern corroborates that social media is replacing boredom and empty space.

This presents an interesting perspective on the U&G theory discussed in the Introduction. U&G claims that people have a specific desire when they use media; however, this repeated use in gaps and empty space suggests otherwise.

It seems that most participants didn’t think they had a reason for scrolling on social media; it was more accurately a force of habit. This illustrates a weakness in the U&G theory: habitual use can erode the autonomy people are assumed to have over their own media use, since habits are automatic behaviors rather than deliberate choices (LaRose, 2010).

This interpretation of the theory posits that social media is far more passive than previously believed.

Procrastination and Displaced Activity

Of 13 participants asked whether social media plays a role in their procrastination, 11 said they procrastinate, and 9 of those directly blamed social media.

Separately, 19 participants named what they’d do more of without social media: reading was most common (5 of 19), followed by studying (4) and outdoor activity (3). No one said the time would simply sit empty: every answer named a specific, often more effortful activity, suggesting social media displaces effortful activity with a low-effort default. This only partly matches experimental displacement research: when people are actually deprived of social media, free time shifts toward browsing, chores, and work, not the more aspirational activities people predict for themselves (Hall, Johnson, and Ross, 2019).

Limitations

This study’s sample skews toward 17-year-olds: of all 29 participants, 79.3% were 17, 17.2% were 16, and 3.4% were 18, so it may not generalize evenly across the 16-18 range, even though every participant falls within it.

Some interview questions relied on retrospective self-report and recall, for example, “If we’d pulled these same numbers three years ago, what do you think they’d have looked like?”

This study also has three broader design limitations. The sample is a convenience sample, drawn significantly from one school and one state, not randomly selected, so it may not represent teenagers more broadly. The design is correlational: it can show that passive use and certain outcomes move together, but it cannot establish that one causes the other. And the screen-time data covers a single week per participant, which may not reflect a typical week, since school breaks, exams, or other unusual circumstances could skew an individual week’s numbers.

Because 0% of participants reported using Snapchat Spotlight (its scrolling feature), Snapchat was coded as 100% active, though some Snapchat use (swiping through Stories) is really passive and wasn’t easily separable in this study. This matters: if Snapchat were 80% active, no participants would have had majority ASMU, and at 60% active, the study’s overall active share would drop from 13.4% to 8.1% (see Figure 3).

This study also excludes YouTube, the fourth most-used platform among teenagers: in a February 2026 trial, YouTube’s own attorney argued it “isn’t a social media app… but rather a streaming channel, like Netflix or Disney+” (Aron, 2026). YouTube is almost entirely passive, so including it would likely only raise the passive share found here: a 2019 Pew analysis found the average YouTube video was about 12 minutes long, with only 3% exceeding an hour (Pew Research Center, 2019).

Conclusion

This study intended to answer the question of whether “social media is still social”. Overall, the findings in this study show that the answer is mostly no. Social media usage among teenagers is primarily a passive activity, with consumption greatly outweighing communication. This data is interpreted to mean that social media itself is more isolated than social. Furthermore, this study records 95% (20 of 21) of interviewed participants attributing their SMU to boredom, or a gap with nothing else to do. Participants described reaching for social media out of boredom or routine, not a specific communicative purpose, which weakens the assumption at the center of Uses and Gratifications Theory that media use is a deliberate, need-driven choice. Once that choice becomes a habit, it stops functioning as a choice at all (LaRose, 2010).

These results lead to the next research question, which is whether the action of using social media itself is an active choice anymore. Recent legal developments have indicated that the design of social media platforms is addictive (NPR, 2026). With the erosion of choice, and the addictive power of social media, it brings into question how active of a choice it is to use social media; whether it is autonomous or automatic.

References

Aron, Hillel. “‘It’s Not an Addiction’: YouTube Pushes Back in Landmark Social Media Trial.” Courthouse News Service, 10 Feb. 2026, www.courthousenews.com/its-not-an-addiction-youtube-pushes-back-in-landmark-social-media-trial/.

Chiossi, Francesco, Luke Haliburton, Changkun Ou, Andreas Butz, and Albrecht Schmidt. “Short-Form Videos Degrade Our Capacity to Retain Intentions: Effect of Context Switching on Prospective Memory.” Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems, 2023, article 253, doi:10.1145/3544548.3580778.

Cucu, Elena. “Best TikTok Video Length in 2026: What the Data Shows.” Socialinsider, 10 Jul. 2026 (updated 21 Jul. 2026), www.socialinsider.io/blog/how-long-are-tiktok-videos/.

De, Debasmita, Mazen El Jamal, Eda Aydemir, and Anika Khera. “Social Media Algorithms and Teen Addiction: Neurophysiological Impact and Ethical Considerations.” Cureus, vol. 17, no. 1, 8 Jan. 2025, e77145, doi:10.7759/cureus.77145.

Doucleff, Michaeleen. “The Truth About Teens, Social Media and the Mental Health Crisis.” NPR, 25 Apr. 2023, www.npr.org/sections/health-shots/2023/04/25/1171773181/social-media-teens-mental-health.

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Gashaj, Ariela. “Analysis of Social Media Addiction in Teens and Young Adults: A Recommendation Report.” Undergraduate Journal of Public Health, vol. 9, 2025, doi:10.3998/ujph.7607.

Godard, Rebecca, and Susan Holtzman. “Are Active and Passive Social Media Use Related to Mental Health, Wellbeing, and Social Support Outcomes? A Meta-Analysis of 141 Studies.” Journal of Computer-Mediated Communication, vol. 29, no. 1, 2024, article zmad055, doi:10.1093/jcmc/zmad055.

Hall, Jeffrey A., Rebecca M. Johnson, and Elaina M. Ross. “Where Does the Time Go? An Experimental Test of What Social Media Displaces and Displaced Activities’ Associations with Affective Well-Being and Quality of Day.” New Media & Society, vol. 21, no. 3, 2019, pp. 674-692, doi:10.1177/1461444818804775.

LaRose, Robert. “The Problem of Media Habits.” Communication Theory, vol. 20, no. 2, 2010, pp. 194-222, doi:10.1111/j.1468-2885.2010.01360.x.

NPR. “Jury Finds Meta and Google Negligent in Social Media Harms Trial.” NPR, 25 Mar. 2026, www.npr.org/2026/03/25/nx-s1-5746125/meta-youtube-social-media-trial-verdict.

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About the author

Bodie Jenkins

Bodie Jenkins is a high school senior from Culver City, California. He is deeply involved in Model Government and promoting civic engagement and has spent time debating on a statewide and national level, representing California at conferences.

This research paper was inspired by a topic Bodie debated during a statewide campaign for Youth Governor of California Youth and Government. The question regarded the regulation of algorithms in social media for youth. This debate propelled him to start a podcast Public Hearing with Bodie Jenkins to evaluate the positive and negative effects of social media, and the legal rulings surrounding it.

Following his research, Bodie couldn’t help but notice how much time his peers, and even he, spent on social media. Additionally, following the COVID-19 pandemic, Bodie began noticing what seemed to be increased social anxiety and discomfort in face-to-face interactions among his peers. These observations led Bodie to question whether social media, despite its promise of connection, might also contribute to feelings of social isolation. This question ultimately inspired his research project.

The post Is Social Media Still Social? Active vs. Passive Social Media Use Among Teenagers appeared first on Exploratio Journal.

Abstract

This paper will explore the psychology of interruptions. It will explore the difference between internal and external interruptions and how they impact us. Although interruptions are an unavoidable part of modern life, the combination of external technological distractions and internally generated self-interruptions can fragment attention, increase stress, and reduce performance; understanding how these two forms of interruption interact can help individuals protect their ability to engage in deep, sustained attention

From Notification to Self-interruption: Understanding Modern Distraction

Do you ever feel a phantom vibration in your pocket, pull out your phone, and realize the screen is completely dark? Soon after you find yourself to have opened an app without even remembering opening it. You sit there scrolling for an hour, but to you it feels like 10 minutes. You keep refreshing your social media feed to monitor your “like” count, with absolutely no memory of making a conscious effort to do so. This is the new psychological battle that we are all facing every single day. The new workspace is no longer just threatened by external disruptions, such as a parent calling to check in or a colleague walking in during an important task. Instead, the combined efforts of external and internal distractions are undermining our cognitive capacity. We as humans are capable of so much, but we are constantly distracted. Because of this our full capacities are hindered by a continuous loop of environmental triggers and psychological impulses. To understand how this process has changed and affected so many people, a distinction needs to be made between the two forces constantly competing with our mental energy, external distractions, and internal distractions, or what are sometimes called self-interruptions.

External Distractions

External, or what psychologists formally classify as exogenous, distractions are environmental triggers that hinder what you are currently focused on. If you look back at how traditional workplaces and classrooms used to be operated, the external distractions were pretty simple and under control. Back then, an external distraction was almost always something physical or in immediate proximity to the person that is being distracted. It was a classmate walking around asking questions, a coworker physically popping their head over a cubicle wall, or a landline ringing in the background. Because these disruptions required people to be in a place at the right time, they were easier to avoid. Workers could close an office door, move to a quieter space, or simply leave the workplace altogether. Once people returned home, many of these distractions disappeared completely. This allowed people to experience hours of uninterrupted time.

Before distractions became so complex, they still posed a significant challenge to human attention. Even when someone is simply distracted by someone talking on the phone in another room, their attention is still grabbed. They are no longer focused on their important task at hand, but are now focused on a random call. Gloria Mark, a Chancellor’s Professor of Informatics at the University of California, Irvine, did one of the most profound research projects on external and internal interruptions. Through her research, she found that after an interruption, workers could take an average of 23 minutes and 15 seconds to return to their original task. The reason it takes this long is not necessarily because the brain is completely frozen. Instead, workers typically iterate through two intervening tasks before navigating back to their original project. On average when someone is interrupted, they focus on that interruption for ten and a half minutes. Soon, this person is distracted by something else and they are focused on that for ten and a half minutes. Then they find their way back to the original interrupted project. This process may seem insignificant, but its effects pile up over time. Our brains alter our mental framework to fit this “new” stimulus. Next, our brains must reconstruct that mental framework that existed before the distraction occurred. When this happens, important details can be forgotten, progress gets slower, and mistakes become more likely.

Researchers Meyer, Evans, and Rubinstein (2001) found that these frequent shifts in attention create what is known as a task-switching cost, a measurable decline in efficiency that occurs whenever an individual moves from one task to another. Meyer and the other researchers said that even a brief mental block that was created by an interruption or task switching can cost as much as 40 percent of someone’s productive time. These findings are important because it challenges the belief that interruptions only take up a few moments of our day. Every distraction makes our brain redirect attention and completely alter our mental framework. These minor external distractions are common, like someone talking next to them or knocking on a door. In Mark’s research she also finds that when someone is interrupted, they tend to try and work faster to compensate for lost time. This compensation comes at a cost though. It causes people to have higher levels of stress, frustration, perceived workload, and time pressure (Mark et al., 2008). Interruptions do more than reduce productivity; they also change how people feel while they work.

Mark, Gudith, and Klocke (2008) found that interrupted workers reported feeling considerably more stressed than workers that worked for a long period of time without interruptions. Researchers said that people that are becoming interrupted are stressed because they are constantly switching their mental framework. Our brains are getting confused and overstimulated, leading us to feel more stressed than we need to. Furthermore, interruptions increase frustration significantly. As people shift from one thing to another they are losing time at the real task at hand. This causes people to become overly stressed because all they are thinking about now is how they have to do too much in not enough time. Because people are anxious and feel that they have lost time, they will try and compensate and work at a faster rate. While this is good in the sense that the work gets done quicker and you can do other things within the time, overall this is not a well thought out strategy. According to Mark, when someone tries to make up for lost time it comes at a cost, a cost of feeling a greater workload, increased stress, and feeling more time pressure, and overall these people are exerting more effort. She also mentions that the work that is done is not done to its fullest potential.

Alan Keen, a behavioral scientist, believes that the stress and overload that comes from constantly expecting to multitask, the people that get interrupted all the time, is causing an “epidemic of rage” as Keen says. When people are constantly being interrupted by people talking or by background music, the task switching raises stress hormones and adrenaline, both things that make us more aggressive and impulsive.

In a controlled experiment involving fifty participants, Bailey, Konstan, and Carlis studied how interruptions affect both performance and emotional well being. Participants were told to complete tasks like reading comprehension, counting, and different problem solving activities. Some individuals were interrupted during the tasks and the others were interrupted only between tasks. The different ways the researchers measured the effects were completion time, error rate, annoyance, and anxiety. The participants ranked on a scale how much anxiety and how much annoyance they felt after completing the tasks. They found that although participants tried to complete the tasks as fast as they could, the ones interrupted in the middle of the task took between 3 to 27 percent longer. The interrupted participants also made twice the amount of errors, experienced 31 to 106 percent more annoyance, and reported twice the increase in anxiety (Bailey at al., 2006). The implications of this study go so much farther than just this laboratory. If even a single interruption can increase error, stress, annoyance, and so much more, the cumulative effect of dozens to hundreds of interruptions a day could substantially impair the performance and well-being of humans. These findings suggest that finding a place to not be interrupted is not just for the sake of our productivity, but also for our mental health. Together, these findings demonstrate that even a brief external distraction can reduce productivity while simultaneously increasing stress, frustration, and cognitive overload.

What Happens When the Source of the Interruption no Longer Has to be Physically Present?

Although these traditional external distractions were problematic, they were still limited by one important factor: physical presence. A coworker could only interrupt someone if they were nearby. A teacher could only be interrupted by a student who was physically in the classroom. Once an individual left school or work, many of these distractions disappeared. Social media and smartphones, however, completely transformed how people experience interruptions. External distractions are no longer confined to a specific place or time. Instead, they exist in a person’s pocket and follow them wherever they go. Today, the modern workspace is having to deal with notification after notification, such as Snapchat bings and Instagram alerts. The real problem here is that we bring these phones, laptops, and tablets with us 24 hours a day, 7 days a week, and we don’t even think about it. Your smartphone does not care if you are trying to write a research paper that will determine your whole grade for a class, analyze a complex data sheet, or sit through an important meeting; it is constantly blasting you with notifications, calls, and texts all day every day.

A research study was done on daily smartphone interactions, and one of the most important pieces of information found was that the average user now receives over 146 notifications every single day (Wheeler, 2025). This means that our concentration is not broken a few times a day, but on average, over hundred. These findings suggest that modern work environments are characterized by increasingly frequent shifts in attention. Research conducted by Gloria Mark further demonstrates how dramatically our attention spans have changed in the digital age. In 2004, Mark and other researchers at the University of California, Irvine, studied office workers to determine how long people remained focused on a single activity. When this study was first done, researchers physically shadowed participants and used stopwatches to record when people began and ended the activities. As technology advanced and became more and more common, the researchers used computer logging software that automatically tracked screen activity and had much greater precision than the stopwatches. In 2004, the average participant remained focused for two minutes and thirty seconds. However, in 2012, the average has fallen to about seventy-five seconds. In recent years it has dropped to forty-seven seconds. These findings suggest that as technology and society has grown, our attention spans have weakened. Humans are now constantly used to being able to shift their attention so quickly because of the addicting social media apps where people just aimlessly scroll. Our attention is also getting so much worse as phones just sit next to us, because we can always grab it and choose to do whatever it is that we feel like on them.

Although smartphones create unnecessary distractions, it is important to recognize that they can provide meaningful benefits as well. In many situations, phone notifications serve an important purpose. For example, a colleague could call someone in order to correct a mistake on an important project. In this case, the distraction was necessary and helped the worker in the long run. Phones also help people stay connected with family and friends and they also help keep people safe. Instead of just wondering where your kid is, you can just text them “Where are you?” and they can respond right back. A student may receive a message about a change in practice time, a parent may call with urgent news, or a teacher may send a reminder about an upcoming assignment. In these cases, the interruption provides a valuable piece of information that can improve communication and efficiency throughout someone’s day.

One could argue that every notification has the potential to be important because there is always a reason someone is getting a notification. Whether it is because their mom texts them, or because a brand is sending them a reminder on a sale, or they are just receiving a like on an instagram post, anyone could say that all of these are equally important. However, research suggests that the overwhelming majority of notifications are not urgent and can safely wait until a scheduled break. The challenge is not deciding whether that notification you go has value or more important than another, but whether or not that notification really needs an immediate response.

What Happens When the External Interruption Becomes Something we Begin to Create for Ourselves?

The growing number of notifications does more than interrupt people while they work. Over time, these repeated interruptions begin to shape behavior itself. Rather than simply responding to a notification when they appear, people gradually become conditioned to expect them. Eventually, checking a phone is no longer triggered by an external alert but by an internal urge. This shift marks the transition from external interruptions, which originate in the environment, to self interruptions, which originate within the individual.

Internal Distractions / Self-Interruptions

While external distractions force their way into your attention from the outside world, internal, or endogenous, distractions may be harmful because they come from inside your mind. An internal distraction happens when someone abandons what they are doing without seemingly anything from their environment prompting them to do so. Internal distractions can take form in many ways, like daydreaming, thinking about a future event, or just suddenly remembering an unrelated task. Because these interruptions come from our mind, they are harder to control and recognize when they are happening. A person may appear deeply focused on the outside, but on the inside they can be completely distracted.

Mark’s research into smartphone interaction indicates that people do not look at phone notifications randomly. Mark’s 2023 research identified three different patterns of which people self interrupt using a phone. One of the most common patterns is using a phone as a buffer before beginning a difficult task. Gloria Mark found through her research that people frequently turn to their phones immediately before starting the task at hand as a way of delaying the effort required to begin the task (Mark, 2023). Smartphones are also used for the complete opposite, a reward. People tend to look at their phone after they have completed a step on the task because they think they deserve it. Mark’s research also indicates that people go on their phones during or after tasks in order to self regulate their emotions and recover from the demanding tasks (Mark, 2023). Lastly, people use phones as a way of pacing and resting during extended periods of interrupted concentration. Research done by Kaplan indicates that intentional breaks can replenish cognitive resources and improve subsequent performance (Kaplan, 1995). However, these benefits only can be possible when the breaks are time limited. When interruptions become long, people’s attention can become fragmented and make it increasingly more difficult to return to deep work.

There are so many more distractions than there ever have been in the world, and it will only continue to go up from here. Not only are people getting 100 or more notifications a day, but they are also checking their phones when there isn’t even a ping or a call.

Internal distractions have changed dramatically since the invention of smartphones and technology. Our brains are trained to find something that stimulates it, so when we are bored, we want to do something. We used to be able to sit in silence and reflect deeply on life, or simply just daydream. Now when we are bored we just grab our phone and scroll. In fact, 89% of the time when someone interacts with their phone, it is just the user turning it on rather than prompted by a notification or call (Kelion, 2020). This internal, or what Dr. Marks refers to as self-interrupting, behavior is a direct result of how phones and notifications are altering how our brains’ respond to distractions. Every notification conditions our brains to expect another one in the future. Over time, checking our phones is becoming a habit, even when there isn’t that external stimulus. Eventually that external stimulus becomes internalized. Rather than technology demanding our attention like a notification or a call, we begin demanding it ourselves.

What Does Self-Interruption Actually Look Like in Everyday Life?

Self interrupting is the act of voluntarily abandoning a current task to shift focus to something else, without being prompted by an outside person or event. Researchers Jin and Dabbish studied self interruption and sorted it into seven specific categories.

The first is Inquiry, which is when someone pauses a task to actively seek information required to finish it. This is an example of how self-interrupting can affect us in a good way. For example, a student writing may look up a finding or statistic in order to continue with their paper. Although this interruption temporarily stopped the student from writing the paper or doing the task at hand, it ultimately supported the goal of the task. However, inquiry distractions can be problematic sometimes. When a quick search turns into unrelated browsing on the internet, it causes the person to spend far too much time on something unimportant.

The second category is recollections, which occurs when someone acts immediately on a sudden memory of another errand. While remembering an obligation is important, it often causes people to abandon their current work before officially completing it. For example, a student that is studying for their final exam, randomly remembers that they need to send an email to their professor. While this interruption is an important task, it causes the students attention to fragment and can actually make it harder to return to the original task or study for their final. Over time if this becomes a habit, constantly switching between activities will cause production to lower and time to be crammed. 

The third category is Routine Habit. This is when someone reverts to a deeply ingrained routine, such as refreshing an inbox on Instagram. Unlike the first two, habitual interruptions usually provide little to no value. This is simply pulling you away from doing what is important, just to do something random that has been engraved into your mind. This has grown ever since phones have become a thing. There are many more habits with phones like checking a text, refreshing an inbox, or even just checking your calendar. This is why self interrupting is becoming more and more common each and everyday.

The fourth category is Trigger interruptions. This happens as an unplanned stimulus causes someone to think of an unrelated thought, causing attention to drift away from the task at hand. For example, while working on homework, a student might hear a conversation in the background that suddenly makes them think of their friend, then they begin to think about their weekend plans, and then it just goes into a cycle of thinking of anything else but the task at hand. Although this shift may seem natural because the person thinks they are doing something related, it actually results in a loss of time and reduced productivity on the original task. Trigger interruptions show how easy it is for our mind to move from one thought to another, even when there is no external interruption telling us to do so.

The fifth category is Emotional interruption. This is when feelings such as stress, anxiety, and excitement can cause someone to stop working on the task at hand. These people then try to focus their attention on their emotions and why they are feeling the way they are feeling. Emotional interactions are specifically powerful because strong feelings demand immediate attention. For example, a student may be worrying about an upcoming test, and this causes them to not focus on the studying itself, only the emotion at hand. While it is good to deal with emotions, doing it can be detrimental to entering a deep focused state on an important task.

The sixth category is Environmental interruptions. Unlike external interruptions that force attention away, environmental self-interruptions are when someone voluntarily chooses to focus their attention on something in their surroundings. This is much more common than it used to be. One example of how it used to be seen was when someone was working on an important task and in the background they hear people talking in the distance, and they decided to go join in. Now, people do this all of the time because phones exist. Someone could just have their phone next to them, and then they decide to go on it. This is troublesome because, even when something is not directly interrupting us, we are interrupting ourselves with something around us.

The final category is Idle Time interruption. This occurs when people become bored and seek stimulation. Smartphones have made this type of self interruption especially common because entertainment is just at the palm of our hands. Instead of pushing through a difficult task, many people immediately reach for their phones and headphones, reinforcing a continuous cycle of distraction. Over time, constantly seeking stimulation can cause a person’s tolerance for boredom to reduce. Instead of dealing with an emotion, people are just distracting themselves by going on their phones. As a result, idle interruptions are limiting us from entering that deep attention and leading us to not be able to sit with boredom (Alder, 2013).

If so Many Self-Interruptions Can Happen Without an External Stimulus, How Much of Our Internal Distraction is Actually Being Created by the External World?

Although external and internal distractions are usually seen as separate things, they are very much intertwined. In many cases external distractions create habits that eventually become internal distractions. For example, when we are constantly getting bombarded with a text message or a notification from Instagram, our body starts to expect them. Sometimes people feel vibrations coming from their phone, when there was never actually a vibration to begin with. This is called a phantom vibration. It is technically classified by psychologists as a tactile hallucination, meaning your brain registers a physical sensation that does not exist in reality. This is actually incredibly common amongst humans. Research shows that 89% of smartphone users experience this at least once to twice a week (Travers, 2024). This happens to us because our brains deal with an overwhelming amount of sensory input. Our brains get confused sometimes and try to fill in the gaps with what it reckons is appropriate. Since our phones are constantly pinging, our brains start to learn to expect this, even when it is not happening.

Ramifications

But what Does this Constant Cycle of External and Internal Interruption Actually do to Us Over Time?

Frequent notifications train the brain to expect rapid shifts in attention. This is causing people to distract themselves even when the external distractions, like the phone pinging, is not present. People are constantly thinking “Did someone text me?” or “How many likes have I gotten on my Instagram post since I last checked?” These frequent notifications train the brain to remain an alert state and a fragmented focus state. Sadly, this is severely damaging many people’s mental health. When one is constantly bombarded with notifications our brain anticipates the notifications. This constant anticipation triggers the release of stress hormones like cortisol. When the body experiences prolonged or repeated stress, persistently elevated cortisol can contribute to negative health effects. This can contribute to inflammations and a weakened immune system (Cleveland Clinic, 2025). Having too much cortisol can also cause stretch marks, weight gain, and high blood pressure. Some ways to reduce your high cortisol levels are getting good quality sleep, moving your body, and practicing deep breathing experiences

Researchers have also found that self-interruptions leave behind what psychologist Sophie Leroy calls attention residue. When people stop working on one task before mentally finishing it, part of their attention remains focused on that unfinished task, even after they have switched to something new. As a result, people are unable to devote their full cognitive capacity to the next activity, making it harder to think clearly, solve problems, and maintain deep concentration. Every unnecessary self-interruption, such as checking a phone or social media feed, increases this attention residue and makes it more difficult to regain full focus on the original task (Leroy, 2009).

If our Brains are Constantly Being Trained to Shift Attention, what Happens to Our Ability to Sustain it?

Flow State

The answer becomes especially clear when looking at flow state, a condition in which attention becomes deeply focused and sustained. The problem arises when people are getting notifications too often and they are not necessary. Like a Snapchat or Instagram notification telling them that a person liked their post. While this could make a person happy in the moment, in the long run these social media notifications are the reason we can never reach flow state. What was originally intended as a tool to communicate with others, has turned into a device that continuously demands attention throughout the day.

Our minds are constantly searching for stimulation, and when it is not satisfied we try to find the closest external distraction. People actively seek out phone notifications right before starting something heavy or cognitively demanding just to delay the effort. People also check notifications immediately after a heavy task as a form of personal reward. For example, if you have a multiple step project, you might think that you can sit down and complete this all in one sitting, but that is not true. Most people will go on their phones before and after each step, causing our brains to not be able to reach “flow state.”

Flow state is a psychological condition of optimal consciousness where you become fully immersed, deeply focused, and completely absorbed in said activity. Mihály Csíkszentmihályi calls it being “in the zone “ (Csikszentmihalyi, 1990). This is when someone is so immersed in an activity that they lose track of time, consciousness reaches its best point, and performance peaks. If we are consistently prevented from reaching this state, we may struggle to perform at our highest potential. “Flow state” is something that someone can learn. When children learn to get into flow, it becomes a lifelong habit (Kamel, 2024). To help kids and also full-grown adults reach flow state, they need to be given uninterrupted time and clear goals. Whether it is reading a book, performing in a musical, or creating artwork, children will maintain their highest performance level when in a place where they are fully uninterrupted and engaged.

Mark’s research shows that after an interruption, people often complete two additional tasks before returning to their original task (Mark, 2023). While it is impossible to limit all interruption, it is not impossible to return right away to the task at hand right after being interrupted. While flow is temporarily broken in this case, it is not broken for as long as it would be if the person focused on two unrelated tasks. By doing this, the person will then limit the amount of attention residue, the cognitive cost of switching between tasks, and allow the brain to rebuild the mental framework needed for deep concentration.

However, phones and electronics are making people entering adulthood struggle to ever reach this crucial flow state in the first place. Because getting “in the zone” requires a long, uninterrupted stretch of time, the constant presence of modern technology acts as a barrier to get into the deep focus state. Instead of people reaching this state of mind where they are so immersed that they lose track of time and they are at their highest level of performance, phones are limiting people to only get into this shallow mental state where every single step of the project feels like an ongoing uphill battle.

When someone truly reaches flow, there are three different neurochemicals that are released, dopamine, endorphins, and norepinephrine (Kotler, 2015). These neurochemicals make hard work feel automatic and rewarding. They are the reason our best work comes from when we reach flow state. Without flow, you have to rely on raw willpower, which quickly depletes and makes the process feel like you can never catch up (Cherry, 2023). Because these neurochemicals act like feel good drugs, flow can be a highly addictive state (Kotler, 2015). Norepinephrine and dopamine lower the signal-noise ratio. When this happens our pattern recognition is heightened. (Kotler, 2015). 

Lastly, flow state can help us learn more quickly. When more neurochemicals are present during an experience, there is a better chance that the experience goes from short term to long term memory. Research shows that flow can cut the time to learn in half. This was proven when researchers at DARPA conducted an experiment with soldiers, and they measured how long it took them to learn how to reach an elite “expert” level of marksmanship. The researchers used noninvasive stimuli to have the experimental group reach flow state, and the control group did not receive these stimuli. They were then both set to learn how to reach an elite “expert” level of marksmanship. The experimental group, the one that was in flow state, reached elite expert-level marksmanship in exactly half the time it took the control group (Berka, 2003). This demonstrates that reaching a deep state of flow significantly increases the speed at which people learn and complete tasks.

Understanding flow state is important because it shows exactly what is being lost when interruptions become a normal part of everyday life. If interruptions continually prevent people from reaching deep concentration, then they are not simply just losing a few seconds every time they check a phone, but hours. They are losing the opportunity to reach a state where learning, creativity, and performance can reach their highest levels. This makes limiting unnecessary interruptions an important part of protecting deep attention.

Solutions

If Interruptions are Inevitable, how can we Protect our Ability to Reach Deep Attention Anyway?

Although interruptions always have and always will be a part of our life, research shows that their negative effects can be mitigated and reduced. Psychologists argue that eliminating distractions is unrealistic and almost impossible, so instead, individuals can find strategies to reduce the negative effects of interruptions and minimize unnecessary interruptions. Three particularly effective strategies include managing digital notifications, designing a workspace that supports deep work, and strengthening mindfulness skills.

Managing Notifications

The first strategy is managing smartphone notifications to the best of your abilities. While notifications can be important, like a parent or colleague texting you, there are many notifications that do not need to be dealt with right away, like social media notifications. Notifications that show when someone liked a post, posted a story, or commented on your photo are rarely a notification that needs an immediate response. Researchers Kushlev and Dunn conducted a study to see if limited social media notifications could increase well-being. In this study individuals either received notifications as usual or limited notification to scheduled times throughout the day. The researchers found that individuals who limited notifications to specific times throughout the day reported lower levels of stress and greater productivity compared to those who received notifications continuously (Kushlev et al., 2015). These findings suggest that people do not need to avoid notifications completely, but rather schedule times in their day to check these notifications and experience the benefits of them.

Limiting oneself to checking notifications right when you get them can decrease the harmful effects. Instead of choosing to answer or look at a notification right when it is delivered to you, a good strategy would be to check your phone’s notifications once every hour or after completing a major task. You can set your phone on Do Not Disturb for that hour and then allow yourself to check it after that hour is up. That way you are still responding and getting that dopamine rush, but you are also allowing yourself to enter deep concentration for much longer than before. While some people may worry that their relationships with people might be hindered because they are not responding right away, research shows that most messages are not urgent and can safely wait.

You might ask yourself why people don’t just turn off their notifications completely? There are many reasons for this. Without a sound or vibration to reassure the user, anxiety and stress is actually heightened (Saskovets et al., 2025). Notifications operate on what a psychologist calls a variable reward schedule. This is kind of like a slot machine. Because users never know if the next buzz is an emergency, a text from a loved one, or just junk, the brain becomes hooked on the anticipation. Also, responding quickly can signify that you like the person you are texting and doing so can create friendships and relationships. Because of this people worry that turning off notifications will alienate friends, make them look distant, or result in missing an emergency (Saskovets et al. 2022). Consequently, even though people realize that notifications are distracting and can affect them in so many ways, they may continue to keep them enabled because the psychological and social benefits often outweigh the perceived costs. But do they?

To maximize these interruptions and make them less harmful, we need to set a schedule for times to check devices. We also need to disable unnecessary notifications like social media. And lastly we need to work on our mindfulness and realize when it is appropriate to actually check our phones.

While this is a good strategy to not allow people to check their phones, research shows that the physical presence of a phone just on a desk, even if it is completely turned off and doesn’t have notifications, negatively impacts cognitive capacity and problem solving skills. The brain uses active energy just to resist checking it. The solution to this is leaving your phone in a separate room, so your brain is not constantly thinking about it and trying to resist it.

Adrian Ward and co authors conducted a research study with about 800 smartphone users in an attempt to measure how well people complete tasks when they have their phones nearby versus when they are not present at all. In the experiment people were instructed to sit at a computer and take a series of tests that required full concentration in order to score well. They were either told to place their smartphones on the desk face down, in their pocket or personal bag, or in a whole different room. All participants were told to put their phones on silent.

The research findings showed that participants that put their phones in a whole different room, completely outperformed those with their phones on their desk, and slightly outperformed those who put their phone in a pocket or bag (Ward et al., 2017). This evidence proves that even when a phone is just present our brains are constantly trying not to think about it and it is hindering our deep attention. It isn’t just the notifications but also the “mere presence” of a phone is enough to reduce cognitive capacity. To solve this, putting your phone in a different room when working or at least putting it in a bag or pocket can benefit your work product. When doing this, our brains feel like they are allowed to relax and focus on what is really important.

Creating an Environment That Makes Deep Attention Possible

The second strategy to minimizing distractions is designing a workplace that supports deep work. Research consistently shows that an environment that has constant interruptions significantly interferes with the ability to achieve flow. Because flow requires sustained concentrations, even brief distractions can force an individual to restart the process of becoming deeply engaged. Because most workspaces want people to collaborate, there are very limited spaces that people can go that limit these distractions.

Creating an environment that already helps limit distractions is what every workplace needs. While it may seem obvious that a quieter work space can help improve focus, there is research behind it that shows that a workspace has much more of an effect than most people think.

One study that demonstrates this was done by Hones, Marsh, and Hughes in 2012. The researchers wanted to determine how background noise and conversations affects a person’s ability to concentrate deeply.

To achieve this, participants were asked to complete memory and attention tasks while working under different sound conditions. Some were doing the tasks under the condition of no external noise, and others were doing the same activities and tests under the condition of irrelevant conversations played in the background. The study measured the participants’ accuracy, the number of errors they made, and how well they remembered information after completing the tasks and tests.

The results of this experiment showed that participants who worked while listening to background conversations performed significantly worse than those in silent work spaces. Even though they were instructed to ignore the voices in the background, the participants’ brains automatically processed the speech, which resulted in reduced attention.

This shows that workspaces and classrooms need specific spaces for quiet time. That way workers or classmates can enter that deep concentration level. While collaborative work is seen to help brainstorm ideas and make our minds more creative, work spaces need a specific time interval where quietness is enforced or at least encouraged so individuals can enter that deep concentration where flow is achieved.

Strengthening Our Ability to Control Where Our Attention Goes

The third strategy to control the negative effects of interruptions involves developing mindfulness skills to help reduce self interruptions. Unlike external distraction, self interruptions develop inside our mind which makes it harder to identify and control, but there are ways to control it.

Researchers wanted to determine if mindfulness helped with attention, not just helping people feel more relaxed. To test this, the researchers used students as their participants and randomly assigned them into one of two groups. One group did two weeks of mindfulness training. This included things like meditation, breathing exercise, and other activities that trained them to recognize when their mind wandered and gently redirect their attention to the present moment and what was actually important. The other group, which in this case was the control group, participated in an educational program so both groups were receiving some sort of education. The only difference was that one was specifically gaining deep attention skills. The researchers gave each group a set of tests before and after to see if their attention changed.

The results showed that students that completed the mindfulness training improved significantly in the working memory aspect, their reading comprehension scores went up substantially, and they had way less mind wandering than the control group (Mrazek et al., 2013). This shows that just two weeks of practicing mindfulness exercises can change how someone thinks. When one does this, the self interrupting goes down, meaning that all of the negative effects from self interrupting also go down. When someone learns mindfulness they can focus on where they want their attention to go, they become more aware of their own thoughts, and overall can enter flow so much easier.

Additional research supports these findings. Jha, Krompinger, and Baime found that individuals who participated in mindfulness training demonstrated significant improvements in sustained attention and working memory compared to those who did not receive the training (Jha et al., 2007). These findings suggest that mindfulness does more than simply reduce stress. It also strengthens the brain’s ability to maintain attention, making people less likely to engage in unnecessary self-interruptions and better able to redirect their focus after becoming distracted.

As people begin to realize when their attention is drifting, they can redirect themselves, so the interruption doesn’t turn into a lengthened self-interruption. Mindfulness gives an individual more control over their attention. When mindfulness becomes a habit is when concentration lasts longer, and self interruption becomes way less frequent.

The next time you feel a phantom vibration in your pocket, the most important thing may not be whether your phone actually went off. The more important question is whether you have control over where your attention goes. At the beginning of this paper, I described how easy it is to pick up a phone without even remembering why you opened it, only to spend an hour scrolling. This is what makes modern distraction so different from the interruptions of the past. The greatest threat is not just that our phones interrupt us from the outside, but that we learn to interrupt ourselves after becoming so connected to our phones. External notifications can become internal habits, and internal habits can make it increasingly difficult to sustain deep attention.

Learning to manage this cycle can give individuals an advantage in a world where attention is becoming increasingly more difficult to protect. If most people are constantly checking their phones, responding to notifications, and switching between tasks, the person who can remain focused on one difficult task for an extended period of time will have an advantage. They will be able to learn more deeply, complete work more efficiently, make fewer mistakes, and give more attention to the people and activities that actually matterin life. The ability to control our attention is a skill that can separate someone who is constantly reacting to their environment from someone who is intentionally deciding what deserves their attention.

The goal of managing distractions is not to reject smartphones or modern technology. Technology was created to make communication, work, and everyday life more efficient, and it can still do all of those things. A phone can allow someone to communicate with family instantly, receive important information, organize their schedule, and complete work that would have taken much longer in the past. The problem occurs when the tool designed to make our lives easier begins controlling where our attention goes. By managing notifications, creating environments that support deep attention, and strengthening our ability to recognize self-interruptions, we can begin to use technology for what it was intended to do rather than allowing it to use us.

Ultimately, mastering attention does not mean never getting distracted. Interruptions will always be a part of modern life whether we like it or not. Instead, it means becoming aware of when an interruption is actually important and when it is simply pulling us away from what matters. The person who can recognize the difference will be better prepared to learn, work, communicate, and create in a world filled with constant stimulationand interuptions. When we can put the phone down without feeling like we are missing something, return to a difficult task without immediately reaching for another distraction, and choose when technology deserves our attention, we are no longer fighting against technology. We are finally using it on our own terms.

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About the author

Kelsey Staszak

Kelsey is a high school senior at Oak Park River Forest High School. She has been doing club soccer ever since she was 10 years old. At school, she spends her time in clubs including Best Buddies, a club that helps kids with special needs feel included, Tau Gamma, a volunteer club, and Huskie Athletic Council, a club that helps the school sports teams with events.

Kelsey also started an out of school organization with her friend called, High Schoolers for Health. They aim to raise money for health equipment for underprivileged communities overseas. She aim to help my community always and make sure everyone feels included and welcomed.

The post From Notification to Self-interruption: Understanding Modern Distraction appeared first on Exploratio Journal.

Abstract      

Agitation, such as verbal outbursts and physical aggression, is one of the most challenging symptoms of dementia in patients with Alzheimer’s disease. Non-pharmacological interventions, such as pet therapy, have emerged as a potential treatment for agitation symptoms. This literature review evaluates the application of  pet therapy and its efficacy on mitigating agitation in patients with Alzheimer’s. Synthesizing clinical trials, this paper focuses on the physiological and neurobiological mechanisms through which Animal Assisted Interactions (AAI) can reduce agitated behaviors. Mechanically, this paper explores how through observable decreases in physical stress indicators like pacing and verbal outbursts, as well as increases in measured biomarkers like oxytocin, AAI shows itself as a promising non-pharmacological alternative to treating agitation in patients. That being said, methodological limitations across current literature such as brief intervention timelines highlight the need for larger and highly controlled randomized controlled trials to establish long-term clinical protocols.

Introduction

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that affects millions of individuals above the age of 40 globally and represents a major public health challenge. When most consider AD, cognitive decline is recognized as the hallmark symptom of the disorder. Despite this, it is often the non-cognitive manifestations—known as Behavioral and Psychological Symptoms of Dementia (BPSD)—that place the greatest burden on caregiving facilities and families of patients (Cerejeira, Lagarto, and Mukaetova-Ladinska 2012). Historically, agitation in AD patients has been managed through psychotropic medications; however, these pharmacological approaches carry significant risks, including sedative side effects and accelerated cognitive decline. Consequently, there is a clinical focus on identifying effective, non-pharmacological interventions (Cerejeira, Lagarto, and Mukaetova-Ladinska 2012).

 Animal-Assisted Interactions (AAI) have emerged as a compelling non-pharmacological therapy for use in geriatric care. AAI uses the human-animal bond to improve emotional, physiological, and social well-being (Filan and Llewellyn-Jones 2006). Therapy animals provide a non-verbal and non-judgmental companion whose contact with patients triggers a release of oxytocin along with a simultaneous decrease in cortisol levels and blood pressure (Kim et al. 2021).

Unfortunately, data on AAI for Alzheimer’s patients is severely hampered by methodological limitations, such as small sample sizes and insufficient follow-up tracking (Filan and Llewellyn-Jones 2006; Yakimicki et al. 2019).

Background

Alzheimer’s disease is a degenerative and irreversible neurological disorder that was first discovered in 1906 by German psychiatrist and neuropathologist Dr. Alois Alzheimer. It began when Dr. Alzheimer examined a middle-aged female patient, August Deter, who was exhibiting extreme and abnormal paranoia, memory loss, and agitation. Unable to prevent Deter’s death, Dr. Alzheimer performed a post-mortem histological examination hoping to find the cause for the observed deterioration of Deter’s physical, cognitive, and behavioral functions. Upon the examination, Dr. Alzheimer discovered the now hallmark signs of Alzheimer’s disease such as amyloid plaques and neurofibrillary tangles of brain fibers (Alzheimer 1907; Graeber and Mehraein 1999). These findings were presented to Dr. Alzheimer’s colleagues and the disease was coined “Alzheimer’s disease” nearly 4 years later in 1910 by Dr. Emil Kraepelin in his textbook Psychiatrie (Kraepelin 1910). At first, Alzheimer’s disease was believed to be a rare condition with an age barrier dictated by Deter who had developed the disease in her fifties (Graeber and Mehraein 1999; Kraepelin 1910). However, around the 1960s and 70s, what was originally thought to be “senile dementia” (cognitive decline that came with age) was found to be pathologically identical to Alzheimer’s disease (Blessed, Tomlinson, and Roth 1968). This discovery led to Alzheimer’s disease and dementia being interchangeable names for this cognitive condition that affects an overall population of around 55 million people worldwide (World Health Organization 2023) including an estimated 7.4 million Americans (Alzheimer’s Association 2024). The disease can show symptoms as early as in the patient’s 40s in rare cases of early-onset. However, most cases see a typical late onset of Alzheimer’s disease on individuals 65 or older (Alzheimer’s Association 2024). These diagnoses were gathered through measuring a patient’s cognitive decline as well as an objective framework based on living biomarkers (Jack et al. 2018). As part of that framework, amyloid-beta testing (brain imaging) and tau pathology testing (blood or cerebrospinal fluid tests) are used to establish the existence of abnormal amyloid plaques and the spread of toxic neurofibrillary tangles, respectively. The presence of these signs and symptoms are required to establish an Alzheimer’s diagnosis (Jack et al. 2018; Hansson et al. 2021).

Pharmacological intervention has been used for many years in an attempt to combat Alzheimer’s disease. Medicinal drugs, while impermanent, hold many benefits for patients (Cummings et al. 2022; Birks and Harvey 2018). Along with boosting neurotransmitters and managing behavior, some medicines can provide a temporary stabilization for Alzheimer’s patients that can help reduce caregiver burnout (Cummings et al. 2022; Birks and Harvey 2018). Even so, pharmacological limitations continued to halt scientists and doctors in developing a cure for Alzheimer’s (Cummings et al. 2022). Furthermore, pharmacological treatment can have adverse side effects such as gastrointestinal (GI) distress and increased risk of falling (Birks and Harvey 2018). Most of all, regular use of Alzheimer’s medication reduces its efficacy over time as more neurons die off (Cummings et al. 2022; Birks and Harvey 2018). As a result, modern medicine bifurcated its approach to the disease into two distinct focuses (Winblad et al. 2016). One track being long-term prevention and early detection of Alzheimer’s and the other being a focus on the management and comfort of patients already suffering from the disease (Winblad et al. 2016). With how progressive Alzheimer’s disease is, it became important to identify the warning signs of cognitive impairment before it developed into a near complete incapability of self-regulation (Jack et al. 2018, 535; Winblad et al. 2016). For those with Alzheimer’s disease, the primary clinical target of dementia care is quality of life (Winblad et al. 2016; Gitlin et al. 2012).

As such, there have been a wide variety of methods attempted ranging from pharmacological interventions to familial and personal caregivers (Gitlin et al. 2012, 2020). And while there are pharmaceutical treatments that manage to slightly slow cognitive decline, they often come with side effects and limited efficacy for behavioral symptoms (Cummings et al. 2022; Birks and Harvey 2018). This has prompted researchers to look for non-pharmacological therapies (Gitlin et al. 2012; Park et al. 2020). One such method that has recently gained more traction is pet therapy or animal assisted therapy (AAI) (Park et al. 2020). Pet therapy has already been proven to be effective in treating general mental health conditions like anxiety and depression (Charry-Sánchez et al. 2018). The presence of an animal companion helps many individuals with such afflictions to feel more grounded and calmer; and in hope of seeing a similar effect in patients with Alzheimer’s disease, pet therapy has gradually been introduced as a possible option for maintaining a reasonably high quality of life for individuals with Alzheimer’s (Park et al. 2020; Charry-Sánchez et al. 2018).

Effect of Pet Therapy on Agitation

The effectiveness of pet therapy in mitigating agitation is rooted in distinct psychological and physiological mechanisms. From a sensory perspective, the experience of stroking an animal’s fur returns the individual to the functions of the parasympathetic nervous system, increasing release of chemicals like acetylcholine and allowing calming hormones like oxytocin to take over. Furthermore, these positive interactions are associated with reduced production of the stress hormone cortisol, which was detected in saliva samples from patients (Sheikh et al., 2021). Additionally, what Sheikh’s literature review found that is especially promising about AAI is the bi-directional aspect that can be seen with pets such as dogs that dynamically react to human emotion — for example, when a dog holds eye contact with a human, or when a dog knows to lean into a person to help them feel accepted by the animal.

Managing the behavioral and psychological symptoms of dementia (BPSD)—particularly agitation, aggression, and late-afternoon distress known as sundowning—presents a profound clinical challenge in Alzheimer’s care for both the caregivers and those with Alzheimer’s. Clinical trials within high-stress medical settings demonstrate that the introduction of a trained therapy dog yields statistically significant, immediate reductions in patient agitation compared to standard care routines (Krüger et al., 2021). Kruger’s study was a systematic review of 51 studies concerning AAI with patients with Alzheimer’s disease. The study found that there was a correlation between animal intervention and a decrease in agitation, while oppositely finding no significant relationship between AAI and depression/quality of life.  Even so, this behavioral shift suggests that the physical presence of an animal provides a grounding, non-threatening stimulus capable of redirecting a patient’s attention away from environmental stressors or internal confusion.

Despite these positive outcomes, a comprehensive analysis of the literature reveals critical methodological limitations regarding the sustainability of these interventions. While the immediate de-escalation of agitation during a pet therapy session is well-documented, evidence tracking the long-term or residual effects after the animal leaves remains scarce and often low-certainty (Park et al. 2020). Park performed a systematic review of 9 randomized controlled trials published between 2000 and 2019. It was found that there is a statistically significant amount of evidence that AAI reduces depression in dementia patients. However, with broader outcomes like sustained agitation reduction and long-term behavioral changes, the overall evidence base was limited by small sample sizes and a lack of follow-up tracking. Additionally, individual patient histories must be considered; for individuals with pre-existing cynophobia (fear of dogs) or animal allergies, the introduction of a therapy animal can inadvertently exacerbate psychological distress rather than soothe it. Consequently, current research positions pet therapy as a highly potent, acute tool for situational agitation management, though further standardized, longitudinal studies are required to determine how to extend these calming effects into a patient’s broader daily routine.

Research Gaps 

Most studies concerning AAI in use for treating stress and agitation in dementia patients all share similar research limitations. Those limitations being that oftentimes the studies lack sufficient sample sizes or long-term follow-up for the realistic viability of using therapy animals in caregiving settings — to address this, prospective longitudinal studies should be conducted. Another variable these studies fail to capture is the maintenance aspect of using therapy animals to help treat dementia patients. The care for the therapy animals adds another layer of work to be done for patients that already require around the clock care. Even if there were to be specific people assigned to taking care of the therapy animals, it would require more people in the caregiving/nursing profession which is already short staffed.

Conclusion

The synthesis of current literature indicates that pet therapy can serve as a valuable non-pharmacological strategy for reducing agitation and behavioral distress in individuals living with Alzheimer’s disease. The presence of therapy animals consistently yields reductions in acute agitation, accompanied by increased positive emotional engagement. The physical presence provided by animals appears to mitigate anxiety without the adverse risks often associated with psychotropic medications.

However, while short-term behavioral benefits during active sessions are well-supported, long-term durability remains questionable. Future research should prioritize larger sample sizes and designs that allow researchers to follow up with patients from the sample long after the end of the initial experiment. In this way, the research on AAI with Alzheimer’s patients can hopefully be expanded and possibly conformed into a standardized protocol in caregiving facilities.

References

Alzheimer, Alois. 1907. “Über eine eigenartige Erkrankung der Hirnrinde.” Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtliche Medizin 64: 146–148.

Alzheimer’s Association. 2024. “2024 Alzheimer’s disease facts and figures.” Alzheimer’s & Dementia 20 (5): 3708–3821.

Birks, Jacqueline S., and Richard J. Harvey. 2018. “Donepezil for dementia due to Alzheimer’s disease.” Cochrane Database of Systematic Reviews, no. 6.

Blessed, G., B. E. Tomlinson, and M. Roth. 1968. “The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects.” The British Journal of Psychiatry 114 (512): 797–811.

Cerejeira, Joaquim, Luis Lagarto, and Elka B. Mukaetova-Ladinska. 2012. “Behavioral and psychological symptoms of dementia.” Frontiers in Neurology 3: 73. https://doi.org/10.3389/fneur.2012.00073.

Charry-Sánchez, Juan D., et al. 2018. “Animal-assisted therapy in adults: A systematic review.” Complementary Therapies in Clinical Practice 32: 169–180.

Cummings, Jeffrey, et al. 2022. “Alzheimer’s disease drug development pipeline: 2022.” Alzheimer’s & Dementia: Translational Research & Clinical Interventions 8 (1): e12295.

Filan, S. L., and R. H. Llewellyn-Jones. 2006. “Animal-assisted therapy for dementia: A review of the literature.” International Psychogeriatrics 18 (4): 597–611. https://doi.org/10.1017/s1041610206003322.

Gitlin, Laura N., et al. 2012. “Nonpharmacologic management of behavioral symptoms in dementia.” JAMA 308 (19): 2020–2029.

Graeber, Manuel B., and P. Mehraein. 1999. “Reanalysis of the first case of Alzheimer’s disease.” European Archives of Psychiatry and Clinical Neuroscience 249 (3): S10–S13.

Hansson, Oskar, et al. 2021. “The Alzheimer’s Association appropriate use recommendations for blood biomarkers in clinical practice.” Alzheimer’s & Dementia 17 (10): 1675–1693.

Jack, Clifford R., et al. 2018. “NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease.” Alzheimer’s & Dementia 14 (4): 535–562.

Kim, S., Y. Nam, M.-J. Ham, C. Park, M. Moon, and D.-H. Yoo. 2021. “Neurological mechanisms of animal-assisted intervention in Alzheimer’s disease: A hypothetical review.” Frontiers in Aging Neuroscience 13: 682308. https://doi.org/10.3389/fnagi.2021.682308.

Kraepelin, Emil. 1910. Psychiatrie: Ein Lehrbuch für Studierende und Ärzte. 8th ed. Johann Ambrosius Barth.

Kruger, Katelyn, et al. 2021. “Animal-Assisted Intervention in Dementia.” ResearchGate. https://www.researchgate.net/publication/315461366_Animal-Assisted_Intervention_in_Dementia. 

Park, A. L., et al. 2020. “Animal-assisted interventions for people with dementia: A systematic review and meta-analysis.” Journal of Clinical Nursing 29 (17-18): 3121–3133.

Sbrizzi, C., and W. Sapuppo. 2021. “Effects of pet therapy in elderly patients with neurocognitive disorders: A brief review.” Dementia and Geriatric Cognitive Disorders Extra 11 (3): 198–206. https://doi.org/10.1159/000518469.

Sheikh, Saba, et al. 2021. “Pet-Assisted Therapy for Delirium and Agitation in Hospitalized Patients with Neurocognitive Impairment: A Review of Literature.” Geriatrics 6 (4): 96. doi.org.

Winblad, Bengt, et al. 2016. “Defeating Alzheimer’s disease and other dementias: a priority for European science and society.” The Lancet Neurology 15 (5): 455–532.

World Health Organization. 2023. Dementia key facts. World Health Organization.

Yakimicki, Mary L., Nancy E. Edwards, Elizabeth Richards, and Alan Beck. 2019. “Animal-assisted intervention and dementia: A systematic review.” Clinical Nursing Research 28 (1): 9–29. https://doi.org/10.1177/1054773818756987.

About the author

Colin Weindel

Colin is a senior at Carmel High School who is hoping to pursue a career in veterinary medicine after graduating high school starting with attending university to major in Animal Science.

The post A Literature Review of the Effect of Animal-Assisted Therapy in Reducing Agitation in Patients with Alzheimer’s Disease appeared first on Exploratio Journal.

Abstract

Though the term was not coined until recent decades, scholars have written about individuals who fit the description of what we now call attention deficit hyperactivity disorder (ADHD) for centuries. The current paper reviews the history of ADHD, its diagnostic criteria, and reasons behind rising diagnosis rates. It then applies the evolutionary mismatch hypothesis to argue that ADHD traits, though challenging in modern settings, may have been adaptive in ancestral environments. Finally, it examines research linking ADHD to creativity, focusing on divergent thinking, real-world creative achievement, and mind wandering.

History of ADHD

Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the most common disorders that affects attention and behavior. Even though ADHD is widely known today, modern researchers have noted that earlier scholars have reported deficits in some children’ s abilities to pay attention, control their actions, and stay focused on tasks for hundreds of years (e.g., Lange et al., 2010; Martinez-Badia & Martinez-Raga, 2015). According to Lange and colleagues (2010), one of the earliest descriptions came from a Scottish doctor named Alexander Crichton in the late 1700s who wrote about people who seemed unable to keep their attention on one thing for very long. He observed that some individuals were easily distracted by things happening around them and found it difficult to maintain attention on tasks, which often interferes with learning and education (Lange et al., 2010). Additionally, Martinez-Badía & Martinez-Raga (2015) recount that in 1902 British doctor George Frederick Still described children who had difficulty controlling their behavior even though they were intelligent. It noted that these children were often aggressive, defiant, resistant to discipline, and also had difficulty in concentrating or learning from the consequences of their actions despite having normal intelligence (Martinez-Badía & Martinez-Raga, 2015). Today, many researchers believe that the children he described likely had ADHD (e.g., Lange et al., 2010; Martinez-Badía & Martinez-Raga, 2015; Taylor, 2011).

As doctors learned more about the brain, they started to look for medical explanations for behaviors that had previously been seen as problems with discipline or poor self-control. During the middle of the twentieth century, ADHD was often linked to problems in brain development that could affect behavior (Martinez-Badía & Martinez-Raga, 2015). Different names were used over time, including “Minimal Brain Dysfunction” and “Hyperkinetic Reaction of Childhood,” reflecting changing ideas about the condition. These terms focused mainly on hyperactivity, but they also helped shift attention away from blaming children for their behavior and toward medical explanations. As these ideas became more widely accepted, ADHD came to be recognized as a medical condition rather than simply bad behavior or poor discipline. Over time, the diagnosis and treatment of ADHD expanded beyond North America and became more common in many parts of the world. In 1980, the American Psychiatric Association introduced the term “Attention Deficit Disorder” (ADD) in the DSM-III, recognizing that difficulties with attention were a major part of the condition. Later editions changed the name to Attention-Deficit/Hyperactivity Disorder (ADHD), which is still used today. This process of treating ADHD as a medical condition contributed to the global acceptance of ADHD, and today it is considered one of the most common neurodevelopmental disorders, with studies estimating that about 5% of children and adolescents worldwide are affected by the condition (Conrad & Bergey, 2014). Although scientists did not fully understand ADHD during its early development, these changes helped shape the modern understanding of the disorder (Martinez-Badía & Martinez-Raga, 2015).

Common Characteristics and Diagnostic Criteria

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to diagnose ADHD. According to the DSM-5, symptoms must begin before the age of twelve. ADHD affects people in different ways, but most symptoms fall into two main groups: inattention and hyperactivity-impulsivity (American Psychiatric Association, 2022). Some people mainly struggle with attention, while others mainly struggle with hyperactivity and impulsive behavior. Many people experience a combination of both. Lange and colleagues (2010) reported that researchers as early as Crichton observed individual differences in these characteristics throughout the population. Modern researchers report that these two symptom types have differing impacts on the daily lives of individuals with ADHD (Knouse et al. 2008). People with inattentive symptoms often have difficulty focusing on tasks for a long time. They may forget assignments, lose important items, become easily distracted, or have trouble following directions. In school, these students may understand the material but still struggle because they miss details or lose focus during class. Hyperactive and impulsive symptoms are different. A person with these symptoms may have trouble sitting still, feel restless, talk a lot, interrupt others, or act before thinking. Young children with ADHD may run around or move constantly. Older teenagers and adults may not be physically hyperactive, but they may still feel restless inside.

The absence or presence of each of the two types of symptoms results in three types of presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Individuals with the predominantly inattentive presentation often struggle with sustaining attention, organization, and completing tasks, while those with the predominantly hyperactive-impulsive presentation are more likely to exhibit excessive movement, impulsive behavior, and difficulty remaining still. The combined presentation includes significant symptoms from both categories and is generally associated with greater overall impairment than either presentation alone (Ghaderi et al., 2017; Willcutt et al., 2012). The symptoms must also appear in more than one setting, such as at school and at home. In addition, the symptoms must cause real difficulties in daily life. However, ADHD symptoms may not appear the same in every environment. Adolescents with ADHD have been found to report higher levels of symptoms on school days than on non-school days. Symptoms also tend to worsen throughout the day and often reach their highest levels during the afternoon. These findings suggest that the demands of different settings, such as school and home, can influence how ADHD symptoms are expressed (Pedersen et al., 2020).

ADHD can affect school performance, friendships, and everyday responsibilities. However, not every person with ADHD experiences the same challenges. Some people have mild symptoms, while others have more serious difficulties. Because ADHD affects people differently, proper evaluation and diagnosis are important.

Historical Trends and Modern Rates

ADHD diagnoses have become more common over the last several decades. Today, experts estimate that about 5.29% of children worldwide have ADHD (Polanczyk et al. 2007). In some countries, especially the United States, diagnosis rates are even higher (Centers for Disease Control and Prevention [CDC], 2024). This increase has led many people to ask whether ADHD is becoming more common or whether doctors are simply getting better at identifying it. Many researchers believe that better diagnosis is a major reason for the increase (e.g., Martin et al. 2025; Sayal et al. 2017), while others suggest that increases in ADHD rates may also reflect increased misdiagnosis (e.g., Abdelnour et al., 2022). Teachers, parents, and doctors now know much more about ADHD than they did in the past. As a result, children who may have been misunderstood years ago are more likely to receive help today.

Changes in diagnostic rules have also affected the number of diagnoses. As doctors learned more about ADHD, the definition of the disorder became clearer. This allowed more people with symptoms to be recognized and diagnosed. Some researchers believe that modern society may also play a role (e.g., Kazda et al., 2021; Sayal et al., 2018;). Modern schools often require students to sit still for long periods, pay attention during lectures, and complete structured assignments. These expectations can make ADHD symptoms easier to notice. Technology may also affect attention in some ways, although scientists continue to study this issue (e.g., Domingues-Montanari, 2017; Nikkelen et al., 2014; Ra et al., 2018).

While experts continue to debate the exact reasons for increasing diagnosis rates, most agree that greater awareness and better evaluation methods are important factors (e.g., Kazda et al., 2021;Sayal et al., 2018). Thus, it appears that more people are being identified because ADHD is now better understood than it was in the past.

ADHD and Creativity

ADHD is also becoming increasingly understood as a cluster of characteristics that are not objectively “disordered” but that are moreso poorly matched with our modern human environment. The evolutionary mismatch hypothesis posits that many human traits evolved to help our ancestors survive in past environments but may not function as well in today’s rapidly changing world (Lloyd et al., 2011). As a result, characteristics that were once adaptive can appear maladaptive when they no longer match the demands of modern environments. Perhaps the most well-known example of evolutionary mismatch wherein our innate psychology produces poor outcomes in modern settings has to do with eating behavior and obesity. Humans evolved in environments where food was often scarce, so storing energy efficiently and consuming calorie-rich foods increased the chances of survival. In modern societies, however, the widespread availability of inexpensive, high-calorie foods combined with sedentary lifestyles creates an evolutionary mismatch that contributes to high rates of obesity (Sellayah et al., 2014).  Norman and colleagues (2018) further highlight that the evolutionary mismatch hypothesis applies to ADHD among other issues and make note of the implications of evolutionary mismatches for psychological science and public policy. Those implications include designing environments and interventions that better match evolved human psychology instead of working against it. The authors argue that understanding evolutionary mismatches can help researchers develop more effective policies to improve physical and mental health and address problems in modern society.

With this understanding that ADHD characteristics are not inherently flawed but rather mismatched with many aspects of modern environments, we can begin to explore the ways in which ADHD characteristics are related to traits and outcomes that are perceived. One such positive characteristic is creativity. Researchers have long noticed a link between ADHD traits and creative thinking, especially divergent thinking (e.g., White & Shah, 2006). Divergent thinking is the ability to come up with many different ideas or solutions to one open problem. This skill is different from convergent thinking, which means finding one correct answer through logical steps (Runco & Jaeger, 2012).

Several studies show that people with higher ADHD symptoms often score well on divergent thinking tasks. White and Shah (2006; 2011; 2016) found that adults with ADHD produced more ideas, more different types of ideas, and more original ideas than adults without ADHD. White and Shah (2006) used the Unusual Uses Task to test this, and also found ADHD adults scored worse on a task requiring one single correct answer. In their 2011 paper, the same authors found that ADHA adults also reported more real-world creative achievement, such as engaging in artistic pursuits or creative writing (White & Shah, 2011). In yet another followup, White and Shah (2016) further unpacked the relationship between ADHD and creativity by showing ADHD minds activate a wider, more flexible network of word associations, giving them more raw material for original ideas. This pattern suggests that while ADHD traits like distractibility and impulsivity cause problems in school or work settings, other ADHD traits might actually help people think in more flexible and open ways

However, the connection between ADHD and creativity is not simple and not all studies support a clear connection. Healey and Rucklidge (2006) tested children with and without ADHD using creativity tests and found no clear difference between the two groups. A more recent review of 31 studies by Hoogman and colleagues (2020)  also found mixed results. It reported that divergent thinking was linked to higher ADHD symptoms mainly in people who showed ADHD traits but did not have a clinical diagnosis. Among people who had an actual clinical diagnosis, the results were less consistent (Hoogman et al., 2020). This means that having a few ADHD-like traits might support creative thinking, but having a full, severe form of ADHD does not always lead to the same benefit.

Even with these mixed results, one finding appears fairly steady across studies: people with ADHD often show strong creative achievement in daily life. Creative achievement means real-world creative output, such as writing, art, music, invention, or new business ideas, rather than just scores on a lab test. Hoogman et al. (2020) noted that both people with a clinical ADHD diagnosis and people with subclinical ADHD traits reported higher levels of everyday creative achievement compared to people without these traits. This suggests that the ADHD mind may not always shine in a structured testing room, but it often shines in open, flexible, real-life situations where new ideas are needed.

Why would this happen? One possible answer connects back to the evolutionary mismatch idea. In ancestral environments, quick shifts in attention could have helped early humans notice new threats, spot unexpected food sources, or explore new territory (Hoogland & Ploeger, 2022). A mind that jumps between ideas, notices small details others miss, and feels drawn to new and different stimuli may have supported exploration and problem-solving in a world that was less structured and less repetitive than modern schools or offices. Today, this same style of thinking can look like a lack of focus in a classroom. But in an open, creative task, the same style of thinking can produce many new and useful ideas.

Mind wandering is another trait connected to this pattern. Mind wandering happens when a person’s thoughts drift away from the main task and move to unrelated ideas (Smallwood & Schooler, 2006). Mind wandering is common in ADHD (Seli et al., 2015). It is often seen as a weakness because it can reduce performance on repetitive or boring tasks (Mooneyham & Schooler, 2013). Yet some studies link mind wandering to stronger divergent thinking, since a wandering mind naturally makes new and unusual connections between ideas (Yamaoka et al., 2020). In other words, a trait that looks like poor focus in a mismatched environment can become an advantage in a creative environment that welcomes free thinking.

Together, these findings support the evolutionary mismatch view of ADHD. The same traits that cause trouble in a traditional classroom or a strict nine-to-five job, such as restlessness, quick shifts in attention, and a pull toward novelty, may also support flexible, original thinking. Instead of framing ADHD only as a set of deficits, researchers increasingly argue for a more balanced view. This view sees ADHD traits as tools that were shaped by an older environment and that still hold value today, especially in fields that reward new ideas rather than repetitive routine. This shift in framing does not deny real challenges that come with ADHD. It simply asks us to look at the full picture, including the strengths, rather than only the difficulties that appear in mismatched modern settings.

References

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American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
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About the author

Youngwoo Nam

Youngwoo is a student at Avon Old Farms School in Connecticut with strong interests in mathematics, behavioral science, and entrepreneurship. He has pursued advanced mathematics through accelerated coursework, earning A+ grades in both Algebra II/Trigonometry and Calculus, and participated in Cornell SCE Precollege Studies. He has also developed a strong interest in research. As a research assistant under Dr. Isaac Dilanni, he investigated the relationship between part-time employment and adolescents’ academic performance and long-term outcomes. Outside the classroom, he is involved in Environmental Club, Math Club, and Entrepreneurship Club, while competing in hockey and lacrosse and participating in wrestling. Beyond academics and athletics, he has demonstrated a commitment to community involvement through volunteer work and athletic operations at his school. He is also interested in drawing and sculpture and speaks English, Korean, and Spanish.

The post Understanding ADHD and Its Association with Creativity appeared first on Exploratio Journal.

Abstract

Dementia is an umbrella term for symptoms that are caused by underlying brain disorders that impair everyday functioning, including memory, thinking, and social abilities. Dementia can arise from a combination of genetic, biological, environmental, and lifestyle factors and is most commonly associated with Alzheimer’s disease (AD). Although available treatments may help manage symptoms and improve quality of life, there is currently no cure for most forms of dementia. As the number of dementia cases increases, understanding not only its causes and treatments but also strategies that may reduce disease risk has become increasingly important. In particular, preventative measures may help reduce the risk of developing the disorder. In this manuscript, I discuss current advances in dementia prevention, with a particular focus on cognitive stimulation and its potential role in promoting cognitive resilience, while offering my perspective on how these approaches could contribute to future prevention strategies. This narrative review evaluates evidence linking cognitive stimulation and structured cognitive training to cognitive resilience and considers whether accessible games could be studied as tools for supporting brain health.

Keywords: Dementia, Alzheimer’s Disease, Preventative Care, Treatment, Cognitive Resilience

Introduction

When I was younger, I did not fully understand what Alzheimer’s disease (AD) truly was. I only knew that my grandmother, Vilma, was gradually changing. She had grown up in Italy and spoke limited English. Although she could still remember episodic memories from her childhood with her two sisters back in Italy and with her husband, my grandfather, she increasingly struggled to remember recent events and routine experiences. At first, the symptoms appeared subtle. She would misplace familiar household items (like putting her undergarments in the freezer), and my family dismissed these episodes as a normal part of the aging process. One day, however, my father and I found her walking alongside the road carrying Stop & Shop plastic bags full of her clothes because she believed she was traveling back to Italy. It was at that moment that I recognized something much more serious than normal aging was occurring.

My grandmother lived with AD for more than a decade. At the time of her diagnosis, my grandmother was in her early-seventies, placing her in the age group at the highest risk for developing AD. Although advanced age is the greatest known risk factor, genetics and family history also play an important role in an individual’s susceptibility (Tenchov et al., 2024). Then I learned that several of my grandmother’s relatives had also been diagnosed with Alzheimer’s disease, showing a possible inherited predisposition. While she was never genetically tested, both her age and family history likely contributed to her risk of developing the disease.

AD is by far the most common cause of dementia, representing about 60-80% of all dementia cases. In the United States alone, an estimated 7.4 million adults in 2026 currently living with Alzheimer’s dementia (Eugene et al., 2026). As life expectancy continues to increase around the world, the number of people living with dementia is expected to rise dramatically, making it one of the greatest public health challenges of the twenty-first century. While researchers have made significant progress in understanding the biological mechanisms responsible for dementia, developing treatments capable of stopping the disease has remained an ongoing challenge.

As the disease progressed, her cognitive function continued to deteriorate, as is usually characterized (Tenchov et al., 2024). She gradually lost her memory and eventually became unable to ambulate independently, dress herself, feed herself, or communicate effectively. Her speech became limited to mumbled words and the occasional repetition of familiar names (my name was one of the main ones she would repeat). As her functional decline became more severe, my mother and aunt could no longer provide the level of care she required, leading to her admission into a long-term care facility where she received around-the-clock supervision and support. During the later stages of the disease, she was prescribed Donepezil (Winblad, 2009), an acetylcholinesterase inhibitor commonly used to improve cognitive function and slow symptom progression temporarily (Dooley & Lamb, 2000). Although the medication modestly delayed aspects of her cognitive decline, it could not stop or reverse the underlying neurodegenerative process responsible for AD. More recently, the anti-amyloid antibodies lecanemab (Li et al., 2026) and donanemab (Sims et al., 2023) were approved for selected patients with early Alzheimer’s disease. These treatments can modestly slow clinical decline but do not cure the disease and carry important risks, including brain swelling and bleeding.

To better understand AD, it is important to understand the areas of the brain responsible for the formation of memory. The brain consists of four major lobes (frontal, temporal, parietal, occipital). Within the temporal lobe lies the hippocampus, a structure essential for learning, memory formation, and spatial navigation (Lee, 2023). The hippocampus works closely with the limbic system, which helps control emotions, motivation, and the formation of long-term memories. As AD progresses, neurons within these regions gradually become damaged and die, causing the hippocampus to shrink over time (Rao et al., 2022). This loss of brain tissue contributes to the progressive decline in memory, learning, and other cognitive abilities experienced by patients with dementia (Fogwe et al., 2026). Understanding how these structures change throughout the disease has become a major focus of modern neuroscience and has provided researchers with valuable insight with respect to potential treatment methods (Simpson et al., 2021).

Modern medicine has transformed the treatment of countless diseases through advances in pharmaceuticals, biotechnology, and medical research. In spite of these breakthroughs, AD remains one of the few major neurodegenerative disorders for which there is still no cure. Current medications for Alzheimer’s disease include donepezil (Buck et al., 2024), rivastigmine (Gao et al., 2024), and galantamine (Gao et al., 2024), targeting the cholinergic deficits characteristic of Alzheimer’s disease by inhibiting acetylcholinesterase and increasing the availability of acetylcholine in the brain (Saud et al., 2024). These may briefly improve symptoms or slow cognitive decline, but they cannot prevent the disease from progressing.

Watching my grandmother’s decline and seeing its effects on my family motivated me to ask whether cognitive decline might be delayed before symptoms become severe.

Preventative care

Preventative care is the use of proactive healthcare strategies to lower the likelihood of disease, identify health conditions before symptoms become severe, and reduce the long-term effects of chronic illnesses through methods that promote overall health and well-being (Hensrud, 2000). Preventative care strategies for Alzheimer’s disease include regular cognitive stimulation, physical exercise, proper sleep, and a balanced diet, all of which have been associated with improved brain health and a reduced risk of cognitive decline (Livingston et al., 2024). Among these strategies, cognitive stimulation has emerged as one of the leading promising areas of research (Woods et al., 2023).

Cognitive Training

Cognitive stimulation broadly includes activities that engage memory, attention, language, or reasoning. Cognitive training is more specific: it involves structured, repeated practice designed to improve particular cognitive skills. Reading, writing, puzzles, and games may be mentally stimulating, but they should not automatically be considered validated cognitive-training interventions (Gates et al., 2019). This may include reading, writing, learning a new language, solving puzzles, or even something as simple as playing a cell phone game. By actively using your brain, these activities strengthen the connections between neurons and keep different areas of the brain engaged (Jahan et al., 2026). This is called neuroplasticity (Margetis & Vadakekut, 2026).

To understand neuroplasticity, think of your phone updating. Your phone requires updates every so often to keep up with new improvements and improve your experience while using it. Neuroplasticity works similarly. When your brain learns something new, it creates and strengthens connections to store that information. It allows you to learn new skills and accommodate new situations. In a way, you’re working out your brain. Just as lifting weights strengthens muscles, repeatedly challenging your brain strengthens the pathways between neurons, allowing it to compensate for damage longer before symptoms begin to appear. This introduces another important concept called cognitive reserve.

Cognitive reserve refers to the brain’s skill to adapt, improvise, and find alternative ways to function despite physical damage or age-related changes. You can think of it as mental padding. Individuals with a higher cognitive reserve can withstand more disease-related damage before showing noticeable symptoms of cognitive decline. Although cognitive reserve cannot stop aging or cure AD, it may significantly delay the onset of symptoms, allowing people to maintain their memory, independence, and quality of life for a longer period.

To improve neuroplasticity and cognitive reserve, researchers have shown that reading is one of the most accessible ways (Liu et al., 2024; Perdue et al., 2022; Simfukwe et al., 2025). These studies show that, as you read, your brain is constantly interpreting the words your eyes are following while also connecting them to language, comprehension, attention, and memory (Landi et al., 2013). Instead of relying on just one area of the brain, reading activates several regions at the same time, strengthening communication between neurons; because of this, reading acts as a full workout for the brain rather than exercising only one cognitive skill (Turker et al., 2025). Over time, these repeated mental challenges may help build cognitive reserve and make the brain more resistant to age-related decline.

Writing is another way to activate the brain (Hajikarim-Hamedani et al., 2025). Although it uses many of the same thinking skills as reading, writing requires even more active participation (Tindle & Longstaff, 2015). It forces the brain to arrange thoughts, retrieve memories, choose language, and communicate ideas in a meaningful way. Even something as simple as keeping a journal or writing about your day before bed encourages the brain to recall experiences and put them into words. Rather than allowing memories to pass by, writing requires you to actively process them, giving your brain another opportunity to strengthen its pathways.

The previous two activities may sound like a bore to many, so how about something enjoyable? It has been shown that phone games that involve puzzles and reasoning can also stimulate the brain (Urwyler et al., 2023).

Commercial games such as Candy Crush and Block Blast require visual attention, pattern recognition, planning, and rapid decision-making. However, practicing these games may primarily improve performance on the games themselves. There is currently insufficient evidence that either game improves everyday cognition or reduces dementia risk. Their accessibility and popularity nevertheless make them interesting candidates for controlled research.

Growing research surrounding cognitive training suggests that keeping the brain active throughout life may delay when symptoms begin to appear (Coe et al., 2026). However, cognitive training focuses on strengthening the brain before significant damage develops. This shift from treating dementia to preventing or delaying it has become one of the most encouraging fields of Alzheimer’s research. While scientists continue searching for a cure, something as simple as picking up a book, writing in a journal, or solving a puzzle may help protect the memories that make us who we are.

Limitations

Although research on cognitive training and dementia prevention has produced encouraging results, several limitations still exist. One of the greatest challenges is that AD develops very slowly. Amyloid-beta plaques and tau tangles can begin accumulating in the brain decades before any symptoms appear (Gordon et al., 2018). Because of this, researchers often need to follow participants for many years before determining whether a potential risk-reduction strategytruly reduces the risk of developing dementia. Long-term studies are expensive, time-consuming, and difficult to complete, causing it to be difficult to gather conclusive evidence.

Another limitation is that dementia does not develop the same way in every individual. Genetics, age, cardiovascular health, education level, lifestyle, and environmental elements all influence a person’s risk. Certain individuals may have large amounts of amyloid-beta plaques and tau tangles yet never develop noticeable symptoms because of a high cognitive reserve. In contrast, others experience cognitive decline with much less brain damage. In addition, Alzheimer’s disease is only one cause of dementia. Other conditions, such as vascular dementia, Lewy body dementia, and frontotemporal dementia, involve different biological mechanisms, meaning that a potential risk-reduction strategy effective for one type may not be equally effective for another.

An important limitation is the problem of transfer. A person may improve on a practiced puzzle or game without showing improvement in untrained abilities, everyday functioning, or dementia risk. Observational studies also cannot fully exclude confounding: people who read, write, or solve puzzles regularly may differ in education, health, income, and social engagement from people who do not.

Finally, it is impossible to predict with certainty who will eventually develop dementia. As a result, preventative strategies such as cognitive training, exercise, and healthy lifestyle habits would need to be practiced by everyone rather than only those considered high risk. Even then, keeping these habits over an entire lifetime can be difficult. Although the current evidence strongly suggests that keeping the brain mentally active is beneficial, additional long-term research is needed to determine which activities provide the greatest protection, how often they should be performed, and how to incorporate them into everyday life.

Although researchers have made significant progress in understanding Alzheimer’s disease, there is still a long way to go before a cure is found.. Rather than relying on one medication to treat every patient, many researchers now believe that future treatment will involve a combination of therapies based on each person’s biology, genetics, and stage of the disease. In other words, Alzheimer’s treatment may become much increasingly personalized instead of using the same approach for everyone. While these advances are encouraging, they are still being studied in clinical trials. Until more effective treatments become available, prevention through healthy lifestyle habits and keeping the brain active will continue to be one of the best tools we have for decreasing the risk of dementia.

Conclusion

Watching my grandmother slowly lose the memories that made her who she was showed me that Alzheimer’s disease affects far more than memory itself alone. It changes a person’s independence, relationships, and identity while deeply affecting the families who care for them. My goal is to delay the progression as much as possible for myself and others who are worried they may develop this symptom.

Evidence supports lifelong cognitive engagement as one component of a broader brain-health strategy that also includes physical activity, cardiovascular risk management, sufficient sleep, education, and social connection. These behaviors may support cognitive resilience, but none can guarantee that dementia will be prevented.

Candy Crush should therefore be viewed as a testable example, not a proven intervention. Future randomized, long-term studies should compare accessible commercial games with established cognitive-training programs and determine whether any benefits transfer beyond gameplay to everyday cognition and dementia risk. Even familiar activities may inspire useful scientific questions, but those questions must be tested before conclusions are drawn.

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About the author

Emma Iasevoli

Emma is a high school student from Watertown, Connecticut. She is involved in Interact, FBLA, National Honor Society, and several other honor societies and clubs. Science has always been her greatest passion since she was young. She has also volunteered at Saint Mary’s Hospital and Yale New Haven Hospital, which has helped grow her interest in medicine. In the future, she hopes to study neuroscience, attend medical school, and become a neurologist.

The post (Candy) Crushing Dementia? Exploring Cognitive Training as Strategy for Cognitive Health appeared first on Exploratio Journal.

Abstract

Dissociative identity disorder (DID) is a treatable mental disorder that has a proven neurochemical basis. However, public misunderstanding prevents patients from getting appropriate and timely treatment, and medication focusing on dissociation is limited. Therefore, this paper proposes an approach of delivering JDTic and paroxetine by lipid nanoparticles (LNP) through the intranasal route. JDTic and paroxetine target the dysregulated neurotransmitter system. LNPs improve delivery efficacy by increasing bioavailability and drug stability. The intranasal route was chosen as the administration route for its ability to target the brain directly. Limitations and development visions are discussed to inspire further research. 

1. Introduction

DID is a mental illness that affects approximately 1% of the general population. Studies suggest that it is strongly related to severe childhood trauma, most often caused by caregivers. Typical symptoms include subjective experience of identity alteration, memory gaps, frequent experience of depersonalization, along with post-traumatic stress disorder, depression, and anxiety (Purcell et al., 2024). Due to the special symptoms it displays, the disorder and DID patients are receiving public attention, yet few people know the scientific facts about the disease, which has led to misunderstandings about DID patients. This mental disorder has been proven to be treatable, with multiple reported structural and neurochemical basis. However, current medication mainly targets the depression and anxiety symptoms of DID, and focuses less on its dissociations, which are the symbolic symptoms. This study aims to discuss DID from a biological perspective and dive into its dissociation aspect. 

In this paper, we explored a new way of DID treatment. We targeted the opioid system and serotonergic system, whose dysregulations are believed to be the main cause of dissociation. Medications are chosen according to the targeted receptors, namely JDTic for opioid receptors and paroxetine for serotonin receptors. Lipid nanoparticles are then designed to deliver the drugs to the brain. We proposed to administer the drugs intranasally, which was reported to target the brain through olfactory neurons, circumventing the blood-brain barrier (BBB). This could enable more efficient drug administration as well as reduce systemic side effects. Furthermore, we envision several directions related to the theme of this paper. Future studies in these directions could improve medical treatments for DID. We hope to provide new insight into treating this mental illness based on its neurotransmitter basis.

2. The Neurotransmitter Basis of DID

The dissociative symptoms of DID are related to multiple neurotransmitter systems. In this section, we will discuss two neurotransmitter systems that are believed to contribute to dissociative experiences (including depersonalization, derealization, amnesia, etc.), namely the opioid system and the serotonergic system. 

2.1.Opioid System

The opioid receptors are a kind of G protein coupled receptors (GPCR). The system regulates multiple biological and cognitive processes, such as nociception, analgesia, endocrine and immune functions, stress and emotions, and more (Reeves et al., 2022). Opioid receptors are differentially expressed throughout the brain, with higher concentrations in the cortex, limbic region (including amygdala, hippocampus, hypothalamus, and cingulum gyrus), and brainstem (Purcell et al., 2024) . The receptors are categorized into three subtypes: mu (MOR), kappa (KOR), and delta (DOR). The subtypes accept different signaling peptides (Reeves et al., 2022). Exposure to stressful stimuli activates kappa opioid receptor (KOR) signaling, a process known to produce aversion and dysphoria and related to stress-related disorders(Jacobson et al., 2020). A study conducted on nine adult volunteers suggests that enadoline, a kind of KOR agonist, leads to confusion, dizziness, visual distortions, and depersonalization reported by participants (Walsh et al., 2001). Other related studies also suggest that salvinorin is a KOR agonist that relates to depersonalization (Roth et al., 2002). This might indicate that kappa-opioid receptors might be helpful in regulating certain dissociative symptoms. While naloxone, naltrexone, and nalmefene were reported to reduce the dissociative symptoms, these therapeutics have yet to be systematically studied, and conflicting results were shown in recent studies (Purcell et al., 2024). Therefore, we propose JDTic, an alternate medication that targets the KOR, thus in theory can alleviate dissociation. 

2.2.Serotonergic System

The serotonin receptors can be classified into six different GPCR populations (namely 5-HT₁, 5-HT₂, 5-HT₄, 5-HT₅, 5-HT₆, and 5-HT₇) and one family of ligand-gated ion channels (5-HT₃). Every receptor class regulates neural processes through a different mechanism. Under each class, they can be further divided into specific subtypes, each of which has a different function, agonists, and antagonists (Pytliak et al., 2011). The receptors are distributed throughout the brain, regulating affect, cognition, autonomic, and other behavioral activities (Purcell et al., 2024). Sixty-seven subjects received depersonalization ratings after double-blind, placebo-controlled experiments with the partial serotonin agonist meta-chlorophenylpiperazine (m-CPP). Results show that m-CPP significantly induced more depersonalization than the placebo did (Simeon et al., 1995). Another study performed a positron emission tomography scan on a patient with dissociative amnesia. Images were compared between the patient in amnestic state and recovery state and 14 other healthy subjects. The patient in the recovery state displayed significantly higher 5-HT_1A receptor bindings than healthy subjects in multiple cortical regions (Kitamura et al., 2014). This might indicate that the serotonin system is possibly related to dissociative experiences. Study suggests that paroxetine, a selective serotonin reuptake inhibitor, might relieve dissociation. 

3. Possible Therapeutics

In this part, we mainly give two medications that seem promising in dissociation treatment and introduce their mechanisms and metabolism. Namely, we will introduce JDTic and paroxetine, targeting the opioid system and the serotonin system, respectively. 

3.1.JDTic

Currently, JDTic is not used clinically. Therefore, we only discuss it as a possible treatment of dissociation due to its medical mechanism. Further study is still needed to enable its clinical application. JDTic is a kind of highly selective competitive antagonist of KOR. Notably, it is not derived from the opiate class of compounds. The potent and selective κ antagonist properties can be explained by the “message−address” concept, a theory that explains the interaction between the ligand and receptor. The “message” component of the ligand specifies primary receptor recognition, and the “address” portion enables selectivity by specifically recognizing a particular receptor subsite (Thomas et al., 2003). 

After JDTic was intraperitoneally administered to mice, its brain level peaked within 30 minutes and declined gradually over a week. JDTic did not show high lipophilicity, demonstrating high water solubility and low distribution into octanol. Brain homogenate binding was within the range of many shorter-acting drugs. JDTic displayed P-glycoprotein (P-gp)-mediated efflux. The surprisingly slow elimination of the drug is postulated to result from the drug lingering in cellular compartments such as lysosomes (Munro et al., 2012).

There is no current evidence that directly proves that JDTic is effective in dissociation treatment. Being an opioid receptor antagonist, JDTic is believed to restore neuron functions that were overly inhibited by opioid receptors. Considering the relationship between opioid receptors and dissociation symptoms mentioned above (KOR especially), it is reasonable to conclude that JDTic might be conducive to dissociation treatment. However, further researches are needed to validate this assumption.

3.2.Paroxetine

Paroxetine is a drug for a variety of anxiety disorders. It is worth emphasizing that in the treatment of PTSD, there are only two approved pharmacotherapies based on SSRIs, including Sertraline and Paxil (paroxetine hydrochloride). It is a potent, selective serotonin reuptake inhibitor (SSRI). It exhibits the highest known binding affinity for the central site SERT compared to any other currently prescribed antidepressants. Paroxetine acts on the serotonin transporter (SERT) in the CNS, which is a type of monoamine transporter that transports serotonin from the synaptic cleft back to the presynaptic neuron. Inhibiting the SERT increases the serotonin concentration in the synapse, enhancing the activation of postsynaptic receptors.

Paroxetine hydrochloride salt ingested orally is almost completely absorbed, with only 2% of the dose recovered in feces. Its absorption was insusceptible to the influence of food or concomitant antacid treatment. It reaches saturation during the pass through the liver. With repeated administration, the steady-state concentration of the drug is achieved within 4 to 14 days. There is no further accumulation of the compound. The distribution of paroxetine in the body is extensive, aligning with its lipophilic amine character, with only 1% of the drug remaining in systemic circulation. After administered intravenously, the volume of distribution ranges from 3.1 to 28.0 L/kg. The mean elimination half-life is estimated to be about 21 h. Almost two-thirds of the drugs are eliminated through the kidneys. Up to 95% of the drug is bound to proteins, mainly P-gp, which is involved in transportation through the blood–brain barrier (BBB) (Data from reference (Paroxetine—Overview of the Molecular Mechanisms of Action, n.d.)(Paroxetine—Overview of the Molecular Mechanisms of Action, n.d.)). 

Paroxetine is mainly metabolized by cytochrome P450 family 2 subfamily C member 19 (CYP2C19) and CYP3A4, producing a catechol metabolite (Benedetti et al., 2009). It is one of the most potent inhibitors of CYP2D6 and CYP2B6, members of the CYP450 family, among SSRIs (Paroxetine—Overview of the Molecular Mechanisms of Action, n.d.). Autoinhibition is observed in the metabolism of Paroxetine, which means that some drugs can inhibit the enzyme(s) involved in its metabolism. When autoinhibition occurs, observed plasma concentrations are higher than the value expected by linear accumulation, which could cause adverse effects or an enhanced therapeutic effect (Benedetti et al., 2009).

In a study conducted to determine the efficacy of paroxetine on PTSD symptoms, results show that paroxetine continued to perform superior to placebo in reducing dissociations during the 12-week maintenance phase. Specifically, significantly more patients treated with paroxetine were rated as responders compared to patients treated with placebo. Mixed effects models showed greater PTSD feature reductions in the paroxetine groups than the placebo groups. Paroxetine was also superior to placebo in reducing dissociation and self-reported interpersonal problems (Marshall et al., 2007). This suggests that paroxetine is a promising medication against dissociation. 

4. Lipid Nanoparticle

To deliver therapeutics for DID to the brain, there are multiple approaches used. The use of lipid-based nanoparticles first came from the biocompatible concept, where the tiny lipid cholesterol molecules and phosphatidylcholine are popular. Lipid-based nanoparticles enable easy cellular uptake of drugs because of the lipid coat. Two of the most important lipid-based nanomaterials are liposomes and solid lipid nanoparticles (SLN). Liposomes are composed of lipid bilayers and enclosed aqueous cores, while SLN consists of a lipid monolayer enclosing a solid lipid core. While they are slightly different in structure, both can be effectively used in drug delivery applications, and nasal administration studies on both types of nanoparticles have been done (Trapani, A et al., 2021). According to existing research, we propose that the medication for DID could be delivered by lipid nanoparticles through the intranasal route. By applying adhesive components such as chitosan to nanoparticles, we can improve the drug internalization of olfactory neurons, increasing bioavailability. The molecule size and surface properties of nanoparticles can be accommodated to adjust to both passive and active drug targeting, which might be helpful in drug administration. Additionally, nanoparticles protect drugs from degradation, improving stability and delivery efficacy (Chenthamara et al., 2019). 

In the study of (Wang et al., 2025), the authors designed and synthesized ionizable lipids. Specifically, small-molecule ligands known to traverse the BBB, such as MK-0752, were chemically coupled with amino lipids to synthesize a series of structurally diverse BBB-crossing lipids. The BBB-crossing module enables the nanoparticle to cross the BBB. The amino groups function to provide ionization properties, enabling the lipids to exhibit variable charge states, determining their apparent pKa, a critical parameter and the basis of endosomal escape. The lipid tails form the hydrophobic core of the nanoparticle, the length of which influences the efficiency of MK-series BLNPs in delivering mRNA to the brain. The study administered the drug intravenously into mice. MK16 BLNPs are distributed throughout the body, with most of the dose being absorbed by the liver and part of the dose (15.3±0.4%) in the brain. Notably, the study also demonstrated that caveolae and γ-secretase might be critical mediators in facilitating the BBB crossing of MK16 BLNPs (Wang et al., 2025). The study proved that lipid nanoparticles are capable of carrying large organic particles like mRNA, providing a theoretical possibility for delivering paroxetine and JDTic. However, it also showed a high rate of missing the targeted administration region, which could cause systemic side effects or increased metabolic stress. In order to target the brain better, we referred to an alternate model of LNP. In “Dopamine-loaded lipid-based nanocarriers for intranasal administration of the neurotransmitter: A comparative study”, the researchers structured the SLN based on the self-emulsifying lipid Gelucire® 50/13, coated with stearoyl polyoxyglycerides, surrounded by a hydrophilic polyoxyethylene chain shell. The study evaluated two types of liposomes, which were composed of an aqueous drug solution core and the coating fat phase, which was made of a mixture of phosphatidyl choline, phosphatidyl glycerol, and cholesterol. Lip 1 was uncoated, while Lip 2 was coated with Chitosan-glutathione conjugate. Both liposomes were outperformed by SLNs in encapsulation efficiency. The two types of SLNs are unmodified DA-SLN (SLN 1) and Glycol Chitosan-associated GCS-DA-SLN (SLN 2). In the case of SLN 2, the GCS component contributed to the network on the shell of the nanoparticle, reducing the leakage of the drug. Therefore, SLN 2 outperformed SLN 1 in encapsulation efficiency. The drug was administered intranasally. The GCS component increased the mucoadhesive ability of SLN 2, allowing the nanoparticles to be taken up with high efficiency by olfactory ensheathing cells (OECs), enabling better drug administration. The study also proved that the SLNs lack cytotoxicity towards OECs, rendering it a rather safe route (Trapani, A et al., 2021). 

Inspired by SLN 2, the general image of our proposed lipid nanoparticle carrier of paroxetine is shown Figure 1. We surrounded the lipid basis and its stearoyl polyoxyglycerides shell with a hydrophilic layer and GCS in order to increase the mucoadhesive ability of the nanoparticle. Notably, according to the structure of paroxetine, it will be involved in the outer network of hydrogen bonds and molecular interactions, as dopamine was in the paper. The methods of preparation were recorded in the reference (Trapani, A et al., 2021). We are uncertain if chemicals like Gelucire® 50/13 or stearoyl polyoxyglycerides still apply here. Specific components of the designed SLN need to be determined in further research. 

JDTic does not display good lipophilic properties. To avoid the challenge of encapsulation of hydrophilic compounds in SLN, as mentioned in the paper, since the paper suggests that liposomes have aqueous cores (Trapani, A et al., 2021), we propose to use a liposome carrier to deliver JDTic, as shown in Figure 2. Notably, although in the study of Wang et al., the delivered mRNA is aqueous, the following studies and property determination are all done in the context of intravenous delivery. We are not sure if the results still apply to intranasal administration. Thus, we did not adopt the LNP used in this study (Wang et al., 2025). We propose to use the same component as coating lipids as used in the reference. To increase encapsulation efficiency, an appropriate polymer coating (e.g., chitosan, alginate) may be applied to limit such drug leakage. Its preparation methods were also recorded (Trapani, A et al., 2021). Still, the exact component of the liposome requires further determination. 

5. Nasal Route

After intranasal administration, drugs primarily enter the brain by interacting with neural pathways within the nasal cavity. Specifically, drugs absorbed from the nasal mucosa can be transported along the axons of the olfactory and trigeminal nerves. Olfactory sensory neurons take up the drugs and transport them via their axons to the olfactory bulb, the first site of entry into the brain. Subsequently, drugs can diffuse further from the olfactory bulb to more distant brain regions, such as entering cortical and hippocampal areas via cerebrospinal fluid circulation. Beyond intracellular transport along nerve axons, drugs may also enter through extracellular pathways—specifically, by crossing tight junctions between epithelial cells into the lamina propria of the submucosal layer, then traversing perineural spaces to ultimately reach the subarachnoid space, thereby diffusing into brain tissue (Erdő et al., 2018). 

The primary advantage of the intranasal route of administration lies in its ability to bypass the blood-brain barrier, enabling direct delivery of drugs to the central nervous system. This opens therapeutic possibilities for large molecules or hydrophilic drugs—such as dopamine, neuropeptides, and even mRNA—that struggle to cross the BBB. Compared to oral or intravenous administration, this route typically yields higher brain bioavailability, achieving greater brain tissue exposure at equivalent doses. Simultaneously, reduced systemic circulation helps minimize peripheral side effects. Furthermore, intranasal administration offers non-invasive delivery, facilitates patient self-administration, and provides a relatively rapid onset of action. It demonstrates potential for treating both acute and chronic central nervous system disorders, including neurodegenerative diseases, epilepsy, and pain management (Erdő et al., 2018). 

6. Developments and Limits

JDTic has yet to be applied clinically, and its effectiveness in humans is still lacking validation. Also, existing study suggests that nonsustained ventricular tachycardia is a potential JDTic toxicity in humans (Buda et al., 2015), indicating potential medical safety problems. Further assessments and studies on the drug safety of JDTic are required. 

The reported effectiveness of the drugs on dissociation is conflicting, and any significantly effective drug for dissociative symptoms is not clear yet. For instance, although opioid receptor antagonists are believed to be effective in dissociation, research indicates that naltrexone, an opioid receptor antagonist, cannot cancel out the dissociative symptoms induced by ketamine (Jacobson et al., 2020). It is possible that ketamine induced dissociation is not the same as dissociation observed in DID patients in terms of mechanisms. However, further determination is still needed.

The stability and storage of lipid nanoparticles still need to be improved. The paper suggests that the liposome can be stored for 6 days under 4 degrees Celsius, while SLN can maintain stability for 1 month before undergoing particle aggregation and drug autoxidation. Also, the encapsulation efficiency of liposomes is not quite satisfying due to drug leakage, and the polymer coating can only improve this condition to a limited extent (Trapani, A et al., 2021). The refrigeration requirement might lead to increased storage and transportation costs, and the drug delivery efficacy requires further improvement. 

Due to the omnipresence of the serotonin receptors and KORs in the brain, we are not sure if the impact of the medication on the whole brain will bring any side effects. Medication safety requires future confirmation. 

As this study is about mental illness medication, which must be applied carefully, this study lacks experimental data, and the effectiveness of the therapeutics proposed in this study remains to be seen. Further experiment is needed to test its viability, and more assessments of its effectiveness are required.

The glutamatergic system might also be related to the dissociative symptoms of DID. Glutamate receptor can be classified into ionotropic glutamate receptors(iGluRs), which are ion channels, and metabotropic glutamate receptors (mGluRs), which are GPCRs. They are widely distributed in the central nervous system (CNS). They are involved in synaptic transmission and regulate learning, memory, and neural plasticity through long-term potentiation (LTP) and long-term depression (LTD) (Wang et al., 2024). Ketamine is a dissociogenic drug that influences NMDA, a kind of iGluR. Moreover, glutamate levels in the anterior cingulate cortex positively correlated with dissociative symptoms in a borderline personality disorder sample. However, evidences are still limited, and the medications acting on the glutamatergic system show conflicting results on relieving dissociative symptoms (Purcell et al., 2024). Therefore, we did not concentrate on this neurotransmitter system. However, we believe there might be a potential relationship between the glutamatergic system and the dissociation, which calls for further study. 

Clinical evidence suggests that DID is induced by childhood abuse (Purcell et al., 2024). It has been suggested that epigenetics is the link between environmental factors and physiological features (Weir, 2012), so we are convinced that DID can also be related to epigenetics, which may inspire further exploration or other treatment routes. Additionally, DID was also proven to display multiple neural structural differences compared to normal brains, such as reduced cortical and subcortical volumes in the hippocampus, amygdala, and parietal structures (Blihar et al., 2020), or dysregulation of activity in the prefrontal cortex, amygdala, and other brain areas (Shimiaie, 2025). While this paper mainly focused on the neurochemical basis of DID, this might suggest another perspective on the neurological basis of the disorder, thus leading to future research. 

In DID, the dissociation symptoms usually appear along with other disorders, namely depression, anxiety, and somatization, which could require concomitant drug application (Purcell et al., 2024). To explore drug interactions and avoid adverse effects due to concomitant drugs, an artificial intelligence application has been introduced, and a systematic review of the viability of this method has been conducted (Zhang et al., 2024). With further development, this application of AI could lead to more improvement in DID treatment. 

The treatment mentioned in this paper may also be applicable to dissociation under other circumstances. However, further research is needed to validate this hypothesis, since dissociative symptoms could appear slightly differently in different illnesses.

Considering nasal administration, there could be ways to improve the drug delivery efficiency. The nasal epithelium can be a rate-limiting barrier of drug uptake, where cells are joined together by tight junctions. Therefore, permeation enhancers, such as borneol, chitosan, and cyclodextrins, are applied to enhance drug transportation. The effectiveness of intranasal administration is more influenced by the administration technique compared to other routes. The administration technique should be efficient and feasible for the patient to administer by themselves. Nasal drops spread over a larger area than nasal sprays and display a higher deposition rate compared to nasal sprays, if administered correctly. While drops are more easily cleared from the administration region than sprays, adding mucoadhesive agents can address this problem. However, nasal drops require a highly accurate administration technique and correct head position. Some novel intranasal delivery devices include the Vianase^TM electronic atomizer and the bi-directional delivery device Opt-Powder by Optinose^®, the potential of which on lipid nanoparticle delivery requires further studies. Multiple approaches have been studied to increase brain uptake of drugs, including increasing drug lipophilicity, increasing carrier-mediated transport through the BBB, and decreasing efflux by applying transport inhibitors (Erdő et al., 2018). Studies of delivery efficacy-enhancing methods could further propel the development of intranasally administered mental disorder medications.

7. Conclusion

This paper offers a novel insight into DID medical treatment based on KOR and serotonergic system and LNP delivery through the intranasal route. Although this treatment possesses the theoretical advantage of targeting the brain and improving bioavailability, its clinical transformation still needs to overcome major obstacles. JDTic, a proposed medication, has not been put into clinical application and faces safety challenges. The stability of nanoparticle carriers could be improved. There is a lack of experimental data. Future studies could focus on medication trials, nanoparticle carrier improvement, delivery efficacy enhancers, and more exploration into the neurologic basis of DID. We hope to develop safe and accurate medical therapy for DID. 

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About the author

Kaifeng Zhu

Kaifeng is currently an 11th grade student in EHSBNU, graduating in 2027, and anticipating future study in biomedicine.

The post Possible Lipid Nanoparticle Drug Treatment for DID Based on its Biological Mechanism Administered from the Nasal Route appeared first on Exploratio Journal.

Abstract

The long-running socio-economic crisis in Venezuela has severely damaged public healthcare systems, which now face persistent shortages and restricted service availability. This research investigates Venezuelan patients’ healthcare challenges and their strategies for managing these obstacles, with particular attention to gender-specific barriers in service accessibility. The researcher conducted semi-structured interviews with 13 Venezuelan adults from different regions between July 14 and July 16, 2025. Interviews were conducted in Spanish through WhatsApp text and voice notes, then transcribed, translated into English, and pseudonymized. Inductive thematic analysis identified recurring patterns, while frequency counts determined the relative prevalence of each theme. Seven main themes emerged: medication shortages, poor public hospital facilities, insufficient specialist care, reliance on private healthcare services or HCM insurance, non-traditional medical approaches and foreign medication acquisition, preventive self-care measures, and community-based fundraising and support systems. Women described additional challenges accessing reproductive healthcare, managing chronic illnesses, and obtaining medical treatment outside their local areas. Current patient adaptation strategies—including preventive actions, unofficial support networks, and cross-border medication procurement—remain unstable and create unequal outcomes that affect women most severely. Policy priorities should focus on reliable medication supply chains, protected crossborder medical a

Keywords: Venezuela; healthcare access; qualitative interviews; women’s health; resilience; health systems.

1. Introduction

The public health system of Venezuela which used to rank as one of the best in Latin America has experienced a significant decline because of ongoing political instability, economic decline and hyperinflation (World Health Organization [WHO] 2023; Ortega et al. 2020). The healthcare facilities in Venezuela face ongoing problems with medicine, supply shortages, equipment breakdowns and massive healthcare worker departures to find better employment opportunities abroad (Doocy et al. 2019; Pan American Health Organization [PAHO] 2023). The healthcare system operates at reduced capacity because of these disruptions which force wealthier patients to seek private care or foreign medical services while low-income patients receive inadequate treatment (Rodríguez 2020; Hetland 2021).

The research examines how typical Venezuelans handle the structural failures that affect their healthcare system. The research investigates two main questions which are (1) What obstacles do patients face when they try to receive medical care in their daily lives? and (2) What strategies do patients use to overcome these barriers and how do women patients specifically handle these challenges? The research uses patient testimonies from 2025 to show the actual experiences that exist beyond official reports about system failures and it also provides a patient-centered perspective through its focus on their coping mechanisms and emotional responses which enhance existing quantitative and infrastructure-based studies of Venezuela’s healthcare emergency (Doocy et al. 2017; PAHO 2023).

This research has shown that hospitals face medicine shortages, stockouts and administrative breakdowns but it has not fully explored how patients make decisions when resources are scarce. The research connects these findings by showing how Venezuelans handle broken healthcare systems and how gender influences their treatment routes, women experience unique barriers to healthcare access because of their reproductive needs and caregiving duties. Limited mobility actually worsens their unequal healthcare opportunities. The analysis of gendered healthcare system performance under extreme economic conditions provides valuable knowledge about system breakdowns.

Research Questions:

1. What barriers do patients in Venezuela encounter in everyday efforts to obtain healthcare?
2. How do patients, particularly women, adapt to or circumvent these barriers?

2. Literature Review

Multiple research studies from national and international experts have documented the complete breakdown of Venezuela’s healthcare system. Multiple research studies confirm the severe state of infrastructure deterioration through reports about continuous medicine shortages, equipment breakdowns and even healthcare worker departures (Doocy et al., 2019; Ortega et al., 2020; PAHO, 2023; WHO, 2023). The public healthcare system which used to serve as a regional benchmark now operates with permanent shortages that force hospitals to stop vital services while patients must bring their own medical supplies. The healthcare system shows that major urban hospitals continue to operate at reduced capacity but peripheral medical facilities have lost almost all of their operational ability which results in major disparities between urban and rural areas as well as between different social classes (Rodríguez, 2020; Hetland, 2021).

Research on healthcare system collapse has led experts to study how patients experience medical care delivery in deteriorating facilities. The combination of unstable supply chains and currency fluctuations results in unpredictable access to vital medications according to Doocy et al. (2017) and Hetland (2021). The research community agrees that patients directly experience the consequences from both international sanctions and domestic governance problems although they disagree about which factor has the most impact. Households actually manage medicine shortages through three main strategies which include buying from informal markets and using remittances and implementing medicine rationing (Freitez, 2022; International Organization for Migration [IOM], 2022). The survival systems that Venezuelans create operate independently from official healthcare systems through parallel networks or function completely outside of them.

The current research on healthcare system failures provides essential information about large-scale breakdowns yet fails to examine how people and their families make independent decisions when facing scarcity at the individual level. Research using qualitative and feminist methods demonstrates that healthcare emergencies reveal existing gender-based social inequalities (Melo et al., 2023; Rueda-Salazar & García, 2024). The healthcare challenges Venezuelan women encounter stem from multiple factors which include reproductive care restrictions, family care duties as well as limited freedom of movement. The combination of financial constraints and shut-down specialized maternal facilities forces women to handle their pregnancies and also chronic diseases and family health crises without institutional backing. Research conducted in neighboring countries indicates that Venezuelan migrant women encounter equivalent healthcare obstacles because of their immigration status and social discrimination which demonstrates that gender-based healthcare disparities exist across international borders (Melo et al., 2023; Rueda-Salazar & García, 2024).

Academic researchers now employ resilience frameworks to study how people and their communities handle extended crisis situations. According to Norris et al. (2008) community resilience emerges from social networks and economic resources and information access which enable stress absorption. The survival of Venezuelans depends on individual resourcefulness as well as the support systems which include family networks and community structures and international connections. The research on Venezuelan families shows that they use remittances together with informal support networks and preventive self-care techniques to create their survival strategies (Freitez, 2022). The distribution of these survival strategies remains unequal due to people who possess foreign currency and have access to border travel and stable communication networks succeed in adapting better than those who do not.

Research on Venezuelan healthcare infrastructure deterioration has received extensive study but patient decision-making within Venezuela actually remains highly understudied. Most of the research found focuses on institutional breakdowns instead of showing how patients experience these breakdowns in their daily lives. The research combines patient testimonies with structural evaluations to show how women and other individuals handle healthcare access in a system that has stopped operating effectively.

3. Methods

This study used qualitative methods to explore Venezuelan patients’ experiences of healthcare access and adaptation under system collapse. Semi-structured, one-on-one interviews were chosen to capture the nuance of personal narratives and to be able to allow participants to describe their healthcare decisions in their own personal words.

3.1 Participants and Recruitment

The research included thirteen women aged 17 to 65 who participated in individual interview sessions. The researcher picked participants who lived in Venezuelan cities and mainly surrounding areas including Caracas, Guarenas, Maracay, Ciudad Bolívar and Valles del Tuy. The researcher was able to use trusted local contacts to find participants in June 2025 before they expanded the participant pool through WhatsApp using snowball sampling techniques; this method was selected because it helped achieve both geographic and socioeconomic diversity while safeguarding participants from political dangers in the unstable setting.

The study participants were all Venezuelan residents who received healthcare from the national system during the previous years. While the study excluded participants who lacked capacity to give consent or lived outside Venezuela. The study selected women as participants because their input was necessary for conducting gender-based research.

The three-day interview schedule from July 14 to July 16 2025 worked with participants’ work commitments and protected them from dangerous extended online sessions because of unreliable power supply. The researcher understands that snowball sampling could have brought social-network bias because people with restricted smartphone access became less probable to join the study. The Study Limitations section provides further information about these methodological restrictions.

3.2 Data Collection

The research team conducted Spanish-language interviews through WhatsApp text and voice calls from July 14 to July 16 2025 with each session lasting between 30 to 55 minutes. The platform enabled participants to interact at their own pace while ensuring their safety through asynchronous communication. The interview guide asked participants to answer open-ended questions about their care-seeking actions, their experiences with medication access, healthcare facilities, specialist availability and their financial approaches and their coping strategies.

The researcher conducted a pilot test of the interview guide with two Venezuelan contacts to verify both cultural understanding and language precision. The participants gave their consent through WhatsApp messages of all interviews while bilingual reviewers checked the accuracy of the English translation to preserve the original meaning which confirmed their willingness to participate and their ability to leave the study anytime. The transcription researcher substituted all personal information with pseudonyms to protect participant confidentiality.

3.3 Ethical Considerations

The research followed all necessary ethical guidelines for qualitative studies with low risk while the participants received information about digital communication privacy risks in Venezuela while being told to keep hospital names and official identities undisclosed. The researcher stored all data through encrypted files which required password protection and immediately removed identifying information from translated transcripts. The researcher also did not offer any payment to participants because they wanted to protect them from external influences in a region with limited resources.

3.4 Data Analysis

The researcher conducted inductive thematic analysis (Braun & Clarke, 2006) to find recurring patterns and categories. The researcher performed multiple readings of transcripts for familiarization before using line-by-line coding to produce initial codes which later became broader thematic categories. The researcher examined candidate themes throughout the complete dataset to develop them into final themes while creating analytical memos for support.

The researcher documented all coding choices in a very detailed audit trail while performing negative-case searches and by also maintaining reflexive notes about positionality and translation decisions.The study’s exploratory nature required a single coder to analyze data while reflexive documentation replaced traditional intercoder reliability assessment.

4. Results

The research study found seven core themes which demonstrate how Venezuelan patients handle their healthcare needs in a system that lacks stability and has broken down into seven separate parts. The themes show how patients experience multiple forms of scarcity, adaptation and inequality which demonstrate both the complete breakdown of official healthcare services as well as the development of survival methods outside formal care. The following section presents an overview of theme distribution and relationships through Figures 1 and 2 before moving to the detailed analysis.

Figure 1 presents a frequency chart showing how often each of the seven themes appeared across the thirteen interviews. All participants discussed medication unavailability but specialist shortages and substandard public hospital conditions were mentioned by most many participants. The frequency chart in Figure 1. The themes of preventive health behaviors and private insurance use emerged less often but generated intense emotional as well as social responses. The visual data shows that scarcity-related problems took center stage in participant experiences while serving as the foundation for their coping mechanisms.

The binary-coded matrix in Figure 2 shows which seven key themes each of the thirteen participants discussed during their interviews. The left column contains participant identification numbers which match the thematic categories found in the right columns. The maroon filled cells in the matrix indicate participants discussed specific themes while yellow cells show their absence. The visualization shows that participants experienced both common barriers like medication shortages and less common challenges related to community fundraising and also preventive self-care. The chart demonstrates how different participants experienced various structural barriers at different levels which reveals how coping strategies spread unevenly throughout the healthcare system collapse.

4.1 Theme 1→Medication Unavailability

The thirteen participants in the study all described their ongoing struggles to get necessary medications through Venezuela’s public healthcare system. The participants identified medication shortages as their main obstacles which made it difficult to treat hypertension, diabetes, Parkinson’s disease and even asthma.

The woman from Nueva Casarapa explained that her friend received no medical supplies during her pneumonia hospitalization because her family needed to purchase all necessary items including gloves, she stated “the experience made me lose faith in the public healthcare system.” The patient population learned to accept that hospitals would only offer physical care facilities.

A healthcare provider at Guarenas Hospital stated that medications remain the hospital’s top priority but the supplies never reach on schedule. The resident of Ciudad Bolívar described how his grandmother suffered from severe leg pain because the hospital lacked any pain medication. The testimonies demonstrate how the official supply system has failed to deliver basic pain medication which causes emotional distress to patients.

The scarcity situation made people change their daily routines according to multiple participants. The high prices and unavailability of products in Valles del Tuy forced residents to share their medication and reduce their dosage for extended usage. The practice of medicine supply management through informal prescription sharing and dose reduction demonstrates both creative problem-solving as well as very high risk dangerous consequences because families had to stretch their limited medication supplies.The participants chose to purchase medications from outside their country because they had no other options left.

The mother from Maracay described her experience of buying medicine in Cúcuta after her son developed asthma because the hospital refused to provide oxygen, “the experience made me understand that we needed to leave the country.” The situation forced her to migrate to Colombia with her family after she obtained medication in Cúcuta.

The participants from different areas shared similar experiences about medicine shortages which they viewed as both a system failure and a heavy emotional and moral challenge. The participants displayed three main emotional responses to the situation: they worried about their family members’ worsening health and felt responsible for their inability to help and even lost faith in the healthcare system they used to trust. The widespread nature of these accounts demonstrates that medicine shortages represent both a national healthcare emergency and a personal indicator of Venezuela’s failing healthcare system.

4.2 Theme 2 →Substandard Public Hospital Conditions

Nine participants painted a grim picture of the extent to which Venezuelan public hospitals were very overcrowded, dirty, chronically under-resourced and unsanitary. Together, their accounts offer a glimpse into how systemic infrastructure failure has transformed the very meaning of hospital care from a site of treatment to one of uncertainty and survival.

A Guarenas woman described, “In public hospitals it’ s a mess, there are too many patients, no medicine, and sometimes not even water. And you sit there for three hours only to be told there’ s no specialist available.” Her experience is a mirror of the common experience of trying to work one’s way through institutions which can no longer maintain minimum standards of hygiene or even effectiveness.

A third participant from Caracas shared her mother-in-law’s ordeal after falling: “There, at Salud Chacao, they took an X-ray and said there was no traumatologist, we had to carry her across town to El Llanito and there were not even painkillers. Imagine seeing an old person in pain and being told there’ s no basic pain medicine.” This accounting of pain shows how staff shortages and supply deficits are magnifying suffering ushering routine emergencies into the territory of traumatic scourge.

A health-office worker who used to oversee public-sector spending gave an infrastructure-oriented explanation: “I could look at paper and see how little money was given versus what communities needed. This was always a gap between what people needed and what they could get.” And her double identity as administrator and patient bridges personal experience as well as systemic dereliction.

Some also relayed what they had seen of medical personnel being run ragged with unmanageable work duties where one woman said, “You see a doctor alone trying to assist 20-something people with not one glove nor disinfectant, absolutely nothing. After hours of waiting, most leave without being seen.” In the eyes of patients, these images of sick and very exhausted staff serve as visual reminders that the public health system had tragically caved from within.

In all of these stories, public hospitals serve as concrete avatars for Venezuela’s broader institutional collapse as respondents didn’t depict them as isolated failures but rather demonstrated how they were the product of visible outcomes from a chronic underinvestment, staff migration, and bureaucratic rot. Their stories demonstrate how systemic failure undermines trust by forcing patients to rely on private clinics or informal options whenever they can.

4.3 Theme 3→Specialist Shortages and Delays

Most participants described long waiting times and difficulty accessing medical specialists such as cardiologists, neurologists, and oncologists. These delays were not isolated inconveniences but structural outcomes of Venezuela’s shrinking medical workforce and deteriorating hospital capacity as participants consistently framed these shortages as both a medical as well as psychological burden turning treatable conditions into prolonged uncertainties.

A man from Caracas recounted, “My mother had tachycardia. At the emergency room, the EKG machine wasn’t working and there was no cardiologist. We had to take her to a private hospital.” His story reveals how technical failures and missing personnel really forced families to seek private care regardless of their financial hardship.

A former Indigenous Health Office employee offered a similar account from the administrative side: “My father needed a cardiology exam. Every hospital said the same thing, the machine was broken, or the technician wasn’t there. In the end, we had to pay privately, and my family had to pool money just to make it happen.” Her testimony links institutional scarcity to unequal outcomes where access depends on financial capacity rather than the patients medical needs.

Another participant from Caracas recalled the fatal consequences of these delays: “We took my mother to Vargas Hospital for an emergency. They didn’t even run tests, they just said she was fine and sent her home. Two days later, she died. I can’t explain the anger and pain.” Her account conveys the moral, emotional toll of systemic neglect as well as the collapse of clinical accountability.

For others, the absence of specialists created a cycle of deferred care. A participant from Valles del Tuy summarized, “If you need a specialist, you travel to Caracas, wait weeks, and still might not get seen. People just give up.” These accounts show how spatial and temporal barriers combine to make even basic specialist consultations inaccessible.

Together, these testimonies portray specialist scarcity as both a symptom and a driver of broader healthcare inequality. The inability to access specialized treatment deepens existing vulnerabilities, particularly for older adults and those managing chronic illness. Specialist shortages thus stand as one of the clearest indicators of Venezuela’s fractured health infrastructure where time itself has become a form of rationed resource.

4.4 Theme 4→ Reliance on Private Care or HCM Insurance

As public healthcare deteriorated, many participants described shifting toward private clinics or even employer-sponsored insurance programs known as HCM (Hospitalización, Cirugía y Maternidad). This reliance on private coverage emerged not as a preference but as a survival strategy as an adaptation to the state’s withdrawal from healthcare provision. Participants’ narratives show that while private access provided greater reliability it also reinforced very deep financial inequalities and excluded those without stable employment.

A woman from Guarenas explained, “When my neighbor couldn’t get care in the public hospital, she went to a private clinic. It cost her everything she had, but at least she was treated. People say, ‘If you want to live, you have to pay.” Her statement captures both the necessity and resentment surrounding privatized care.

Several participants reported prioritizing jobs that offered HCM insurance as a healthcare worker from Caracas shared, “I took a position mainly because it included private health insurance. Public hospitals don’t have medicine or equipment, so you end up needing HCM for even basic care.” Insurance thus functioned as a form of social capital, one that actually determined not only medical outcomes but also employment choices.

Another participant highlighted the limitations of such plans: “Even with HCM, you still pay a lot out-of-pocket. The coverage runs out fast, and the prices keep going up. It’ s like having a lifeboat with holes in it.” Her metaphor reflects the precariousness of middle-class adaptation under crisis conditions.

For women, these disparities were compounded by reproductive health needs. A participant from Caracas noted, “There’ s almost nowhere left for gynecological care unless you pay privately. Public hospitals cancel appointments all the time, and traveling far alone doesn’t feel safe.” Her account illustrates how gender, safety, and mobility intersect to limit care options even for those with insurance access.

Across these testimonies, private healthcare appears as both refuge and reminder of inequality. While HCM coverage temporarily shields patients from systemic failure it simultaneously deepens divides between those with institutional protection and those without as participants portrayed this duality with ambivalence gratitude for access mixed with anger that survival had become conditional on wealth or employment.

4.5 Theme 5→Alternative Practices and Cross-Border Procurement

When official healthcare systems failed many participants described turning to alternative remedies and informal medication channels to manage illness. These adaptations ranged from home herbal treatments to complex cross-border purchasing networks coordinated through many relatives abroad. The accounts portray a spectrum of creativity and desperation which are strategies that temporarily alleviated suffering but also carried risks of misinformation and even inequity.

A woman from Guarenas shared, “People started using natural medicine as teas, herbs, whatever helped. We learned recipes from neighbors or online because the pharmacies were empty.” Her story highlights how traditional knowledge re-emerged as an informal safety net when biomedical options vanished.

A healthcare worker from Caracas described a similar pattern of cautious substitution: “When medicines disappear, you do what you can use home remedies, eat healthy, try to stretch the little medicine you have left. It’ s survival.” This pragmatic tone resignation without illusion echoed through many interviews.

For others, adaptation required geographic movement. A mother from Maracay who had ultimately migrated to Colombia, explained, “Every few months, someone from our neighborhood crossed the border to buy insulin or antibiotics. We all pitched in money and sent lists. Sometimes they came back empty-handed; sometimes they didn’t make the trip.” Her narrative shows how scarcity created collective networks of cross-border cooperation grounded in trust and necessity.

Participants viewed these alternative strategies ambivalently: they provided temporary control but also underscored dependence on unstable, unregulated systems. A man from Valles del Tuy summarized, “You feel proud that people find ways to survive, but also scared—because it shouldn’t be this way.” His reflection captures the tension between resilience and resignation that runs throughout the data.

Ultimately, these testimonies reveal that informal and transnational health practices have become integral to everyday survival in Venezuela. Yet the uneven access to information, money, and cross-border mobility means that such coping mechanisms often reproduce the very inequalities they are meant to alleviate.

4.6 Theme 6→ Preventive Health Behaviors

Six participants described developing preventive health routines as a way to reduce dependence on Venezuela’s collapsing medical infrastructure. With hospitals being unreliable and medicines scarce many prevention became a deliberate survival strategy as a an attempt to regain control in an unpredictable environment.

Participants framed these lifestyle adjustments not as wellness trends but as pragmatic risk management.A woman from Guarenas explained, “I try to eat well, exercise, and meditate. During the hardest years, when medicine disappeared, that was all we could do.” Her statement reflects how self-care practices became substitutes for unavailable treatments.

A healthcare worker from Caracas expressed a similar sentiment: “You learn to avoid getting sick. I rely on my job’ s small clinic, but mostly I take care of myself because public hospitals are too dangerous.” The combination of precaution and fear shows how prevention emerged from distrust rather than health promotion.

Another participant from Venezuela’s Indigenous Health Office connected this shift to structural awareness: “After seeing how little funding there was, I started saving money for emergencies and taking vitamins. Prevention is cheaper than depending on the system.” Her comment reveals an economic logic to self-care, framing it as an investment in personal resilience.

Across these accounts, preventive health practices carried both empowerment and burden; they offered participants a sense of agency yet simultaneously transferred responsibility from institutions to individuals. A man from Guarenas summarized this trade-off: “It’ s good to be healthy, but it’ s also exhausting because you’re doing the government’ s job.”

These narratives highlight the privatization of risk at the household level and prevention, once a public-health goal, has become an individual coping mechanism as a an act of necessity shaped by structural abandonment.

4.7 Theme 7→ Community Fundraising and Support Systems

When formal health systems broke down the respondents narrated seeking solutions through traditional and informal medicine for their ailing bodies. These adaptations covered different levels, from herbal treatment in the home to intricate transborder shopping strategies passed on through relatives living abroad. The accounts reflect a range of creativity and desperation strategies that offered such temporary relief while also posing the risk of misinformation, expense, and inequality.

One health-care worker in Caracas said that these were part of the gradual process of standing-in: “You do what you can because when medicines vanish from the store shelves, you have to treat yourself at home and eat healthfully and stretch out the last bit of prescription drugs. It’ s survival.” This pragmatic coarseness of resignation without illusion sounded through many interviews.

Others had to move geographically to adapt, “From time to time, someone we knew would go over and buy insulin or antibiotics,” said a mother in Maracay who eventually relocated to Colombia. “We all chipped in money, and we sent lists. Sometimes when they went out in the morning, they didn’t come back with anything; sometimes they never left.” Feign’s story illustrates how the scarcity generated cross-border networks of collective action based on trust and mutual need.

Such alternatives were actually only weakly accepted by the participants; in a way as they gave temporary power but at the same time repeated and underlined an insufficient dependency on unstable, unregulated systems. A man from Valles del Tuy put it like this: “You feel proud that people are finding ways to survive but also scared because people shouldn’t have to do things this way.” His reflection is a poignant tension between that of resilience and resignation that courses through the data.

Ultimately, these testimonies illustrate that informal and transnational health practices are now central to everyday survival in Venezuela but the unequal ability to access information, money, and cross-border mobility means that these coping strategies can themselves replicate the inequalities they are intended to ameliorate.

5. Discussion

5.1 Understanding Patient Adaptation Through Resilience

The research results show that Venezuelan patients’ healthcare collapse experiences extend beyond institutional breakdowns because they demonstrate intricate social and psychological adaptation patterns which align with resilience theory. According to Norris et al. (2008) community resilience exists as the ability of social systems to withstand disturbances while keeping their fundamental operations intact. While according to Ungar (2018) resilience emerges through the continuous interaction between personal initiative and environmental resource availability. The presented stories show Venezuelans performing both individual adaptation and social environment boundary adjustment at the same time.

The coping strategies of participants including preventive health practices and informal medication distribution and private insurance usage and community-based fundraising efforts demonstrate the interconnected systems which Norris and Ungar describe. People use “navigation and negotiation” according to Ungar to find or even establish alternative resource access routes when faced with restricted circumstances. The adaptive strategies people use to cope with their situation demonstrate how digital networks function as a replacement for missing state-based infrastructure. The adaptive capacity shows uneven distribution patterns among the population. The research supports Norris et al. (2008) who state that resilience depends on four essential domains which include economic development and social capital and information and community competence yet these resources remain unevenly accessible in present-day Venezuela.

The research indicates that patients demonstrate remarkable resourcefulness but their adaptive actions take place within systems that maintain significant social inequalities. Women encountered multiple barriers which restricted their ability to join resource-sharing networks because they faced limitations in mobility and safety and reproductive healthcare access. The anthropological concept of “bounded resilience” describes their situation because they showed bravery through adaptation yet their actions remained restricted by structural barriers.

The research evidence contradicts positive views about resilience as a solely empowering force and it also reveals that people must take on institutional responsibilities when public institutions abandon their duties which results in resilience becoming a sign of systemic failure. The Venezuelan patients’ ability to adapt serves as proof of human flexibility yet it also reveals the unacceptable circumstances which force people to endure such hardships.

5.2 Gendered Vulnerabilities and Health Inequality

The research findings from women participants demonstrate that gender plays a fundamental role in determining how Venezuelan women experience the collapse of their healthcare system. Women took on dual responsibilities by providing care to their families while simultaneously acting as medical coordinators who located medications and arranged transportation and handled healthcare costs. The gendered tasks women performed during this time increased their stress levels and financial difficulties which strengthened existing social and economic inequalities.

A woman who lives in Caracas described her multiple responsibilities when she stated, “You need to perform all nursing duties and medical tasks and psychological support and financial management for your family members.” The statement demonstrates the “care work paradox” which feminist scholars describe as women taking on unpaid work to replace absent institutional care according to Hochschild (1995) and Tronto (2013).

The research data indicates that women experienced different levels of risk because of their reproductive and chronic health requirements. Women participants explained that they experienced prolonged delays when trying to obtain gynecological care and birth control methods and prenatal medical assistance. The participant described her experience of seeking gynecological care in Caracas because she needed to travel long distances but doctors frequently canceled her appointments.

Women who are pregnant or have medical issues must handle their health needs independently because they lack proper care. The breakdown of healthcare systems leads to increased health dangers for women and restricts their ability to control their bodily autonomy. Women encountered special risks when seeking medical care because they needed to navigate dangerous areas while dealing with transportation problems and security threats. The participant from Maracay expressed her fear about needing Caracas treatment because bus services were unavailable. The combination of gender with geographical location and security risks produces what scholars call “layered precarity” (Butler, 2016) which restricts women’s ability to make decisions.

Women showed impressive organizational abilities despite facing numerous obstacles in their community such as organized medicine-sharing programs and operated online fundraising campaigns and distributed health information through WhatsApp messaging. Women’s ability to solve problems through resourcefulness continues to perpetuate the societal norm that they should handle institutional breakdowns through emotional work and logistical management. The participant expressed her question about why mothers consistently need to find solutions for every problem.

The research results support feminist anthropological theories which demonstrate that health emergencies reveal and intensify existing social inequalities as the social structure of gender determines how people experience risk exposure and healthcare access. Women in Venezuela experience both the power of their social connections and the weight of enduring a healthcare system that ignores their needs.

5.3 Policy Implications and Structural Change

The healthcare crisis in Venezuela exists beyond resource shortages because it stems from fundamental problems with system organization and unequal distribution of resources. The solution to these problems needs both emergency policy solutions and enduring structural changes to healthcare systems as the healthcare system needs to focus on these essential priorities that participants identified to rebuild trust and minimize gender-based and geographic healthcare inequalities.

The healthcare system needs to create dependable systems for medication distribution across the country. The participants in this research study all mentioned their struggles to get necessary medications which proves that Venezuela needs better medicine procurement systems and improved distribution networks with monitoring capabilities for all regions. The stabilization of pharmaceutical access through international humanitarian organization partnerships should include oversight systems to stop diversion and corruption activities.

The government needs to create official programs that protect patients who need medical treatment outside their home country. The participants needed to use unofficial networks to buy medication outside their country which exposed them to dangerous situations and legal consequences. The government should also establish controlled humanitarian medication import systems through official agreements with Colombia and Brazil. The current system of private and dangerous medication procurement would become unnecessary through these policies.

The healthcare system needs to create immediate specialized outreach programs which focus on treating women and patients who need ongoing medical care. The research shows that women face the most severe health problems which receive insufficient attention during reproductive and preventive care. Mobile health units together with regional telemedicine programs should be implemented to provide better healthcare services in underserved areas while minimizing travel-related dangers. The implemented measures need to adopt gender-sensitive approaches which account for women’s dual responsibilities in caregiving and their limited mobility.

The protection of financial resources for healthcare services must become a priority to stop the growing separation between different social groups in healthcare access. The current healthcare system operates based on wealth because most people depend on private insurance (HCM) and pay medical expenses directly from their pockets. The health system needs more than technical fixes because it requires public trust to be rebuilt as the participants expressed their sense of being left behind and their complete emotional depletion. The recovery of public trust in healthcare institutions depends on transparent governance and professional retention strategies and community involvement in health planning processes. The success of well-designed reforms depends on rebuilding trust between healthcare providers and their patients because without it these reforms will fail to benefit the intended population.

The proposed recommendations follow the principles of resilience frameworks developed by Norris et al. (2008) and Ungar (2018) which state that recovery success depends on building up social and institutional frameworks at the same time. The combination of supply chain improvement with humanitarian channel legalization and gender-focused policies will enhance healthcare results while bringing back the lost sense of national security.

5.4 Study Limitations and Future Research

As with all qualitative inquiry, this study has several limitations that should guide the interpretation of its findings.

First, the sample was relatively small and although it reached regional diversity between age groups, it cannot be generalized to all women in Venezuela. The study’s aim was depth rather than breadth and its findings should not be taken as statistically generalizable but illustrative.

Second, recruitment occurred through WhatsApp networks and snowball sampling leaving out consideration of those without digital access or outside their social network. As a result, the lives of the most marginalized groups, like people in rural areas who do not possess smartphones or are in absolute poverty, may have been unaccounted for.

Third, the 3-day window of data collection precluded follow-up interviews or even longitudinal tracking. Further fieldwork over a longer term might show how coping strategies shift with continued economic or political changes.

Fourth, all interviews were translated from Spanish to English and some nuance may have been lost in translation despite the benefit of careful checking. Future research would gain from bilingual analysis or Venezuelan co-researchers to increase cultural and linguistic precision.

Lastly, the study focuses on gendered experiences and does not provide in-depth analyses of how class, ethnicity, and disability intersect. Future research could explore the interplay of these attributes with access to care and resilience strategies.

Despite these constraints, the study provides a valuable look at how average Venezuelans are dealing with a failing healthcare system. The uniformity of themes by respondents suggests that such issues are not few and far between and could be examined further through mixed-method or cross-regional designs.

6. Conclusion

The research investigates how Venezuelan patients experience the breakdown of their national healthcare system. The research used qualitative interviews with thirteen participants from different areas to document their daily experiences with medication shortages and insufficient hospital facilities and specialist shortages and their need to use private and informal healthcare services and the gender-based differences in healthcare access. The stories present a survival mechanism which people develop because of necessity which researchers term as resilience under constraint.

The participants demonstrate that their ability to cope with the situation exists without choice and has its limits as people and their families have developed survival methods through resourceful behavior, mutual support and personal sacrifices which demonstrate the moral and structural weaknesses of failed institutions. Women take on most of the responsibility for caring for others and managing healthcare services and maintaining household stability. The women’s community support work upholds social structures yet demonstrates how women consistently take on unpaid care duties because of societal expectations about their role.

The study uses resilience theory (Norris et al., 2008; Ungar, 2018) to demonstrate that adaptation depends on the availability of social, economic and informational resources which Venezuelan society distributes unfairly. The creative solutions patients develop show human capability but complete healing needs more than individual perseverance. The path to recovery needs people to work together while institutions must change and public trust needs to be restored.

The research joins multiple academic studies that analyze health emergencies as humanitarian crises while revealing their connection to social inequalities and governmental failures and ethical duties. The testimonies from participants demonstrate that resilience should never serve as a reason for the government to step away from its responsibilities. The recognition of resilience should lead to system reconstruction which will transform survival from improvised measures into an entitlement.

Acknowledgments

This research was made possible by the generosity of thirteen Venezuelan participants who shared their life experiences, including some of their most challenging moments. I am deeply grateful to those who assisted with translating the Spanish interviews into English while preserving the integrity and emotion of each story. I also thank everyone who contributed to transcription and offered valuable feedback throughout the research process.

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About the author

Hillary Porco

Hillary Porco is a senior researcher at NSU University School whose work centers on global health access, qualitative research, and health policy in Latin America, particularly Venezuela. She completed this project under the mentorship of Dr. Reed Jordan (NYU Public Policy) where her research interests include healthcare inequities, patient narratives, and community-based health systems. She intends to pursue a career in medicine and global public health.

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Abstract

The psychological impact of facial disfigurements includes many factors, such as low self-esteem, anxiety, depression, and social isolation. Essentially, people with facial disfigurements often may feel self-conscious, have a constant fear of being judged by their appearance, or even undergo emotional distress due to intense social scrutiny or be bullied for their appearance. This potentially leads to challenges in building confidence, mental and emotional well-being, and developing healthy relationships. This paper will discuss facial disfigurements in depth and how different interventions can help mitigate these issues.

Facial disfigurements can have long-term psychological impacts in the form of low self-esteem, anxiety, depression, and social isolation. The majority of those who suffer from facial disfigurements are self-conscious or anxious about being judged, often bullied, or emotionally upset. All these issues may undermine confidence, well-being, and the quality of relationships. This essay explains the causes and impacts of facial disfigurements and interventions aimed at helping sufferers.

The face is typically the initial feature that the majority of people identify upon meeting an individual, and it’s the manner in which we express emotions (Zopf, Furlan, & Larkin, 2018). Humans are born with a seemingly innate bias in favour of the face. Infants have been discovered by Otsuka et al. (2014) to identify and keep focus on their mother’s face within hours of birth, proving just how crucial recognition of the face is for early socialization. This biological responsiveness to the face demonstrates how deeply it is ingrained in our ability to bond, connect, and communicate with other people from the very beginning of life. Because of this, any alteration in facial appearance—such as a disfigurement—can not only disrupt communication but also affect the way individuals are perceived and treated by others (Macgregor, 1990).

We can convey happiness, sadness, anger, confusion, or interest using our faces, without even saying a word. A flash of a smile, a frown, open eyes—these are all ways we convey how we feel. That’s why the face is such a significant part of nonverbal communication (Macgregor, 1990). It allows others to understand how we feel or react, even when we say nothing. It allows people in public places or social groups to look at faces instinctively to sense the mood or the ambiance (Zopf, Furlan, & Larkin, 2018).

By observing the facial expressions of other people, we are able to react accordingly—whether that is to offer support, offer distance, or adjust our actions. This kind of emotional adjustment helps us build stronger connections and avoid social conflict. People can often tell if we’re tired, upset, excited, or confused just by looking at our face. And because so much emotion comes through the face, it becomes something people pay close attention to, whether they realize it or not (Zopf, Furlan, & Larkin, 2018).

In addition to communication, the face is also closely associated with personal identity (Zopf, Furlan, & Larkin, 2018). People often relate their sense of self and identify with their facial appearance. When you are thinking about someone or trying to remember them, you usually visualize their face first. Because of this, something that changes or affects the way a face looks can have a deep emotional and psychological effect. It’s not about appearance—it’s about feeling noticed, recognized, and understood.

For the majority of us, our face is what we present to the world. And on top of that, the world idealizes faces, especially of a certain sort. We all witness it happen on the silver screen, in magazines and billboards, and even on social media (Macgregor, 1990). There is the perception that certain faces are “more beautiful” or “better” than others, usually because of things like symmetry, having good skin, or having specific features. That kind of message impresses itself on people even if they don’t think about it consciously (Zopf, Furlan, & Larkin, 2018). It can create an unspoken rule that if you do have a “pretty” face, then you’re just more valuable, more attractive, or more worthy of attention.

Facial disfigurements can be organized in various ways: acquired (e.g., burns or trauma), congenital (e.g., cleft lip), syndromic (e.g., Treacher Collins syndrome), chronic (e.g., neurofibromatosis), and acute (e.g., trauma from a vehicle accident) (Versnel et al., 2012; Zopf, Furlan, & Larkin, 2018). An estimate by the UK charity Changing Faces (2021) suggests, one in 111 individuals have a visible difference that is noticeable, and around 20% feel anxiety or depression as a result. In 2020, the Appearance Research Collaboration found through a survey that 56% of the visibly different population had been stared at or avoided in public, and 28% bullied (Changing Faces, 2021). These statistics highlight the ubiquity and psychologically taxing character of reactions to facial disfigurements.

Because the face is the center of communication, identity, and self-concept, facial disfigurements often have an impact on a person’s psychological state and the way others treat them (Zopf, Furlan, & Larkin, 2018). Facial disfigurements can be quite psychologically burdensome, often transcending the material. The social reaction of individuals to facial differences—such as staring, ridicule, or avoidance—makes the person with the disfigurement feel criticized, judged, or rejected (Macgregor, 1990). This cycle of adverse social feedback can lead to internalized distress and anxiety. In many cases, the discomfort felt by other individuals in the presence of a person with a disfigurement prompts them to act differently—avoiding them or acting poorly towards them (Papadopulos et al., 2012).

Such reactions have the tendency to stigmatize faces that are different, causing anxiety or shame in them. Cumulative negative social interactions over a period of time could result in low self-esteem, depression, and even identity confusion (Bradbury & Hewison, 2006). When people are treated as being different because of their visible appearance, this might result in deep emotional wounds and make people step back from relationships, avoid social interactions, or believe that they are undeserving of love or affection (Kesting et al., 2022).

For instance, people were found in a study to be much more prone to emotional instability and withdrawal from society if they had extreme facial disfigurations (Papadopulos et al., 2012). Even ordinary activities like video calling or taking selfies may cause distress (Macgregor, 1990). Many individuals with facial disfigurements also report a continuing battle to “mask” or disguise their appearance in some other way—being overly nice, reserved, or overachieving—that can be draining on an emotional level (Macgregor, 1990). Although the cost on an emotional level isn’t always visible, it may still be there.

One major study at Yale New Haven Hospital followed 18-45-year-old patients with facial trauma requiring surgery, 6 months to 2 years post-injury psychological measures. Low life satisfaction, poor self-concept, and high rates of PTSD, depression, and alcoholism were found in these patients compared to their disfigurement-free counterparts. They had problems, such as it was difficult to maintain employment and relationships, and they encountered legal problems, highlighting the long-term psychological effects of facial trauma (Bradbury, Hewison, & McGrouther, 2005).

Another study examined 96 patients aged between 15-47 who were having jaw surgery, with deformities divided into mild, moderate, or severe. Although mild or moderate deformity patients did not show clinically significant psychological differences between controls, most severely deformed subjects reported higher anxiety, emotional instability, and social impairment, pointing towards the importance of integrated mental health care in treatment (Papadopulos et al., 2012).

Another study, an adult-to-adult comparison of individuals with acquired and congenital facial disfigurements, found the former to have a generally higher physical quality of life but greater anxiety and depression levels than controls without a disfigurement. Another study compared adults with congenital facial disfigurements, those who had experienced facial trauma in adulthood, and a non‑disfigured control group. Somewhat surprisingly, the level of social anxiety, interpersonal distress, and social avoidance did not differ significantly between congenital and acquired groups—both differed significantly from controls (van den Elzen et al., 2012). However, adults with acquired facial disfigurements experienced worse physical quality of life, whereas those congenitally disfigured reported relatively good physical health but more internal distress than their non‑disfigured peers. Both groups’ most consistent predictors of psychological adjustment were self-esteem, appearance satisfaction, and fear of negative evaluation (Versnel et al., 2012). Psychological adjustment was highly predicted by self-esteem, satisfaction with appearance, and fear of negative evaluation in all groups (Versnel et al., 2012).

Monasterio et al, (2012) found that social functioning was also found to be impaired by facial disfigurements. In a comparison between congenital, acquired, and control groups, it was found that lower social functioning was more significantly related to patients’ satisfaction with their appearance than to objective severity or the etiology of the disfigurement. This highlights the importance of subjective self-perception in social outcomes for those with facial differences, suggesting the need for interventions that alongside physical appearance also improve self-image and psychological resilience.

All reconstructive medicine specialists agree that psychological care must be at the center of treatment. Plastic surgeons, in particular, emphasize that mental health care is as much a priority as physical reconstruction. A narrative review, “The Psychosocial Burden of Visible Disfigurement Following Traumatic Injury,” emphasizes that even with extensive procedures like facial transplantation, the majority of patients continue to suffer social rejection, stigma, and emotional distress in the long term. The authors recognize a relevant gap in existing medical literature using stigma-based models and suggest long-term, in-depth psychological interventions be included in the treatment process—especially for those patients who receive complex surgeries such as vascularized composite allotransplantation (Sarwer et al., 2022).

Macgregor (1990) highlighted that facial disfigurements specifically interfere with social interaction by interrupting nonverbal communication and increasing stigmatization, especially in the context of first meetings. Such experiences tend to promote social avoidance, decreased self-esteem, and emotional isolation, hence the need for targeted psychological intervention and social awareness.

Although the effect of facial disfigurement is difficult, it may be temporary. With an effective balance of therapy, intervention programs, and a support group, people are able to become more confident, emotionally stronger, and improve the quality of their lives. An instance of such an intervention is the “Inside Out” program, a novel theory-driven psychological group intervention that combines Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Competitive Memory Training (COMET) to treat disfiguring cognitive style, maladaptive behavioral reactions, and social issues associated with disfigurement (Siemann et al., 2022). Inside Out uses psychoeducation, mindfulness, social skills training, and role-playing in a supportive peer group. The program helps the participants feel heard and not so alone. While early case studies reported moderate distress and condition acceptance gains, self-esteem gains were small, reflecting the need for longer-term support (Siemann et al., 2022).

Another promising intervention is the Look Beyond the Face program, a school-based peer education intervention that uses personal experiences and classroom discussion to reduce stigma and raise awareness of facial differences (Roberts & Mathias, 2019). Student participants showed increased empathy and lowered judgment of disfigured peers. Although it didn’t cure disfigurement itself, the social effects were powerful, establishing a culture in which facially different students were more included.

Sadia, a young Bangladeshi girl known to me personally, offers a compelling case study of how teenagers with facial disfigurements can develop resilience in the face of ongoing social and emotional adversity. She was born with a congenital deformity that impacted the alignment of her jaw and mouth. She was frequently bullied and excluded by her peers at school, such that early difficulty with low self-esteem and anxiety became pronounced. “Where I go out, I tend to feel like am the same as other people,” she explained, “but when they start staring at me, it makes me feel different… like am not supposed to fit in just because of the way I look.” Nevertheless, Sadia gradually developed a range of coping mechanisms that allowed her to cope both with the external judgment and internal emotional effect.

She derived power in self-expression—through art and jewelry-making as avenues for her feelings—and established new relationships with peers and instructors who opened up ways for her to be noticed beyond her looks. She also engages in online support groups with other disfigured teenagers across the globe. “I have to remind myself every time that it is not their fault that they are staring… it is likely just from curiosity and nothing bad,” she explained to me. “I always try to get their stares as a good thing and not let it hurt me.” In this way, Sadia changed her attitudes and developed a greater sense of belonging. Her work emphasizes the importance of making spaces for empathy, welcoming spaces, and constructing supportive networks that affirm the dignity and worth of individuals with facial differences. It is a call to remember how necessary it is to see beyond physicality and treasure the entire individual of the person who may appear different.

In conclusion, facial disfigurement has a significant influence on how individuals perceive themselves and how others perceive them. The psychological impact can be vast, but through the use of psychological interventions, education classes, and emotional support, the negative consequences can be reduced. Ongoing research and social education are still needed to offer every individual with a visible difference an understanding instead of judgment. Above all, we must not forget to see beyond the surface—to see the whole person within the face. Through empathy and fighting against stigma, we construct a society in which difference is not a barrier but a bridge.

References

Bradbury, E., & Hewison, J. (2006). Early parental adjustment to visible difference in a newborn infant. Child: Care, Health and Development, 32(1), 33–39.

Changing Faces. (2021). My visible difference: A report on the experiences of people with visible differences. https://www.changingfaces.org.uk/wp-content/uploads/2021/07/My-Visible-Difference-Report-2 021.pdf

Kesting, M. R., Holzle, F., Poxleitner, P., et al. (2022). Psychosocial distress in patients with severe facial disfigurement: A multi-center survey. Journal of Cranio-Maxillofacial Surgery, 50(2), 135–142.

Macgregor, F. C. (1990). After plastic surgery: Adaptation and adjustment. Praeger Publishers.

Otsuka, Y ., Nakato, E., Kanazawa, S., Yamaguchi, M. K., Watanabe, S., & Kakigi, R. (2014). Neural activation to upright and inverted faces in infants measured by near-infrared spectroscopy. NeuroImage, 34(1), 399–406.

Papadopulos, N. A., Kovacs, L., Krammer, S., Biemer, E., & Gubisch, W. (2012). Quality of life following cosmetic surgery: A 10-year follow-up study. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(6), 766–772.

Roberts, A., & Mathias, A. (2019). Evaluating the effectiveness of a school-based intervention to increase acceptance of children with facial differences. British Journal of Educational Psychology, 89(2), 251–269.

Siemann, H., Ubbink, M., van Veldhuizen, I. J. T., & de Jongh, A. (2022). Inside Out: A psychological group intervention for individuals with visible differences. Body Image, 41, 1–9.

Versnel, S. L., Duivenvoorden, H. J., Passchier, J., Mathijssen, I. M. J., & Cohen-Kettenis, P. T. (2012). Gender differences in long-term psychosocial outcomes of individuals with craniofacial anomalies: A follow-up study. Cleft Palate-Craniofacial Journal, 49(2), 165–176.

Zopf, D. A., Furlan, S. R., & Larkin, S. C. (2018). Pediatric facial paralysis and visible facial differences: Clinical management and psychological impact. Facial Plastic Surgery Clinics of North America, 26(4), 321–328.

van den Elzen, M. E. P., Versnel, S. L., Hovius, S. E. R., Mureau, M. A. M., & Passchier, J. (2012). Adults with congenital or acquired facial disfigurement: Impact on relationships and psychological functioning. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(11), 1484–1490. 5

Sarwer, D. B., Siminoff, L. A., Gardiner, H. M., & Spitzer, J. C. (2022). The psychosocial burden of visible disfigurement following traumatic injury: A narrative review. Frontiers in Psychology, 13, 979574.

Bradbury, E., Hewison, J., & McGrouther, D. A. (2005). Psychological adjustment following disfiguring injury and reconstructive surgery: An evaluation of patients’ perceptions of appearance and function. Psychology, Health & Medicine, 10(1), 70–83.

Monasterio, X., Molina, C., & Eguiguren, A. (2012). Psychological and social functioning in patients with facial disfigurement. Journal of Craniofacial Surgery, 23(4

About the author

Sarita Kaiser

Sarita is a senior at AESA Prep Academy. Outside of school, she has largely focused on addressing the emotional and mental well-being of marginalized groups. She has worked with both Casa Marianella (an immigrant women’s and children shelter in Austin for women who were neglected, abused or kicked out of their own country) as well as a group in Bangladesh, focusing on low poverty-leveled disabled teenage girls, who are often outcast, neglected, and subjected to abuse due to societal stigma.

This led Sarita to open her own project called Inclusive Impacts, extending her passion toward helping them overcome emotional hurdles and work toward self-reliance and independence.

The post The Psychological Impact of Facial Disfigurements and Interventions appeared first on Exploratio Journal.

Abstract

Every four years, swimming and track draw some of the largest audiences during the Olympic Games, yet both sports struggle to maintain consistent fandom outside the Olympics. This study explores the historical development, viewership patterns, and fan engagement strategies for these sports using news articles, Olympic broadcasts, social media analytics, and prior research on sport fandom. The Psychological Continuum Model helps explain why many Olympic viewers only reach the initial stages of interest and attraction, without developing a deeper attachment or loyalty to the sport. Swimming and track face challenges in turning this short-term excitement into lasting fan engagement. Improvements in venues, technology, and storytelling could help. For example, hosting meets in spectator-friendly facilities, using broadcast innovations to highlight athletes’ performances, sharing athlete storylines, and promoting rivalries may encourage fans to stay interested beyond the Olympics. Understanding these patterns is important for athletes, coaches, and sports organizations looking to build stronger and consistent support for nonrevenue sports. This study finds that national pride, media exposure, and athlete success drive short-term engagement, but sustainable fandom requires consistent access to competitions, compelling narratives, and emotional connections between fans and athletes. These findings provide insight for teams, sport marketers, and program directors aiming to grow and maintain interest in swimming and track beyond the Olympic spotlight.

Introduction

Every four years, the world’s best athletes face off against each other in the Olympic Games. Competing for the Olympic medals and national pride, they put on a great show for spectators across the world. This historic competition has united countries and created iconic moments in sports history (Canadian Equality Consulting, 2024). The Olympics have an impressive reach: in 2024 around 5 billion people followed the Olympics (International Olympic Committee, 2024). That’s about 84% of the global potential audience. During the Olympics, certain sports are more viewed than others. Both swimming and track and field are among the most watched sports during the Olympics. Despite being fan-favorites during the Olympics, both these sports fail to maintain the fandom that other Olympic sports like basketball or soccer sustain year round (Campbell, 2024). Looking at the history and development of both these sports and the Olympics provides important insight into why swimming and track attract massive Olympic audiences but fail to sustain fandom year-round. Additionally, the Psychological Continuum Model (PCM) helps explain this pattern, as many Olympic viewers may only reach the initial attraction stage (Funk & James, 2001) during the Games but fail to progress toward lasting attachment or allegiance once the spectacle ends.

Understanding this unique fandom pattern is important for sports organizations looking to grow, athletes who rely on fan support, and sports programs looking to be self-sustainable. Both swimming and track are considered nonrevenue sports, meaning they don’t generate consistent income from ticket sales, broadcasting rights, or merchandise. Instead, these sports programs are often supported by the financial success of major sports programs like football and basketball (James & Ross, 2004). If coaches, athletes, and entire sports programs can better understand sport fandom and motivation, nonrevenue sports can turn into self-supporting, revenue generating sports.

Both swimming and track and field fandom have several barriers and constraints that prevent long term fans. These issues can be broken down into two broad categories: the built experience (venue, structure, and tech) and the narrative and emotional connection (storylines, identity). The Olympics naturally provides “fixes” for some of these issues. Boasting impressive stadiums and groundbreaking technology, in-person fans at the Olympics and viewers from home get an enhanced experience. Additionally, fans are drawn into the Games and the storylines created through national pride and rivalries – two things that these sports normally lack. Finally, one innate problem with both sports is the athletes’ hesitancy to race frequently. Top athletes only race a handful of times per year, usually these meets include national champs, World Champs, and NCAAs for the collegiate athletes. This leaves fans with very few opportunities to watch exciting races between the best athletes. The Olympic Games are seen as the world’s most premier athletic competition, so naturally all top athletes choose to compete for their spot on the Olympic team. This paper argues that while swimming and track are among the most-watched Olympic sports, they struggle to maintain fandom outside the Games because they lack the consistent venues, rivalries, and storylines needed to build long-term fan communities.

History of Competitive Swimming

Swimming became a modern competitive sport in the mid 19th century (The History of Olympic Swimming, 2018). Before that moment, swimming was present across the globe, but primarily for recreation and survival. Today, swimming is a worldwide sport and an Olympic classic. Swimming was a part of some civilizations as early as 2500 BC in Egypt (Athanasiou, 2024). In the 16th and 17th centuries, swimming became a form of training and a sign of prestige for ordinary people in society (Vasile et al., 2023). Particularly during the Renaissance and Enlightenment, since swimming was promoted as part of a well-rounded, classical education. By the 20th century, swimming’s benefits to human health and wellbeing were becoming clear, and people saw swimming as an excellent and accessible way to stay in shape, regardless of age, mobility, and social position (Vasile etal., 2023). Swimming’s popularity dramatically increased in the late 20th and early 21st centuries, when Olympic icons like Dawn Fraser, Mark Spitz, Michael Phelps, and Katie Ledecky showcased their talent and dominance on the global stage. Competitive swimming saw an increase in popularity and many competitive swim clubs began forming around the world (Lohn, 2025).

In recent years, swimming experienced significant growth in popularity. In 2022, US Swimming Nationals had 572,000 viewers on NBC, according to Nielsen ratings (Keith, 2022). This was an increase from that same summer’s Swimming World Championships, which only received about 200,000 viewers (Keith, 2022). Even more impressive, World Aquatics’ social media platforms had 1.3 billion impressions, 621 million engagements, and 609 million video views during the 2024 Paris Olympics (Koos, 2024). In total, World Aquatics digital community has a total of 5.6 million fans across the globe, with 1.1 million new fans during the Paris 2024 Olympics. This recent surge prompts the question of what has changed in swimming and what the sport’s future success might look like. Olympic swimming has always had more success than other swimming competitions, but the social media engagement described by World Aquatics is far beyond what swimming has typically seen.

As an Olympic sport, swimming has been a part of every summer Olympic Games since the first modern Olympics in 1896. Just as swimming’s popularity as a sport was increasing, changes to sport’s rules were being implemented. For example, women began competing in Olympic swimming events in the early 1900s. Women were first allowed to officially compete in the Olympics for the first time at the 1912 Stockholm Games, where they swam the 100 meter freestyle and the 4×100 meter freestyle relay (Şarvan & Coşkun, 2023). At these Games, 27 women competed in the events. This was 22.5% of the total swimmers during the Games (Takata, 2024). The percentage of women in swimming reached 46.1%, the highest until 2012, during the 1972 Olympics. Since then, the female to male ratio has been largely similar, with the Tokyo 2020 Games being composed of 45.5% female swimmers and 54.5% male swimmers. The Tokyo Games were also the first Olympic Games to offer the every race to both men and women athletes, allowing women to compete in the 1500 meter freestyle and adding the 800 meter freestyle for the men (Takata, 2024).

Şarvan & Coşkun (2023) outlined how numerous changes to the sport, including some major rule implementations by the Fédération Internationale de Natation (FINA) have impacted the sport. These have included various changes to the stroke techniques, distance allowed underwater, false start procedure, and starting block structure . In 1998, FINA, also known today as World Aquatics, introduced a new rule requiring swimmers to surface above water no further than 15 meters past the wall, coming off the start and turns. Rules around false starts have become more strict: while rules used to permit athletes to have three false starts before a disqualification, the governing body changed the rule in 2001 to make just one false start result in an immediate disqualification and inability to race. More recently, starting blocks have been changed to include a wedge that the athlete’s back foot can rest on and push off from. While it’s not mandated for all swimming competitions, it is a suggestion from FINA, so most new facilities have starting blocks with the footrest (figure 1). Every Olympics since Beijing 2008 has included wedged starting blocks. Researchers have found that FINA’s rule changes to swimming competitions such as those to the start, underwater, and technique directly affect the lap time and record developments in the Olympic Games (Şarvan & Coşkun, 2023).

Pool swimming has races ranging in distance from 50 meters all the way to 1500 meters, while open water swimming races range from 5km to 25k (The Definitive Guide to Open Water Swimming, 2025). While all of the pool distances are swum at the Olympics, the only Olympic open water distance is 10k. At the Olympics, open water races are traditionally competed in lakes, rivers, or oceans. Swimming wasn’t competed in pools at the Olympics until the London 1908 Games (The History of Olympic Swimming, 2018). The Olympic pool spans 50 meters, making the shortest race, the 50 meter, just a single lap and the longest race, the 1500, 30 lengths.

Olympic Swimming Events

At the Olympics, athletes compete in all four strokes: butterfly, backstroke, breaststroke, and freestyle. An additional event called the Individual Medley, or IM for short, is also competed. The IM contains just one or two laps of each stroke, depending on the distance, since both the 200 meter IM and 400 meter IM are swum. The strokes butterfly, backstroke, and breaststroke are raced in both the 100 and 200 meter distances, with 50 meter distance becoming a new addition to the Olympics in the 2028 Games (Folsom, 2025). Freestyle is raced in the 50, 100, 200, 400, 800, and 1500 meter distances. An important part of Olympic swimming is the relays. Countries can put together relays with the best four athletes on their team to represent their country. All relays have four legs to them, and range from 200 meters to 800 meters. The four relays competed at the Olympics are the 200 freestyle relay, the 400 freestyle relay, the 800 freestyle relay, and the 400 medley relay, where each swimmer swims two laps of each stroke. An additional relay, the mixed medley relay, was added in 2020. See Appendix A for a visual breakdown of the Olympic swimming events. The wide variety of distances and strokes makes swimming a unique sport.

History of Track & Field

Track & field has a rich history dating back to the very first ancient Olympic Games in Athens Greece, which took place every four years from 776BC to at least 393AD (Welcome to the Ancient Olympic Games, 2025). In that very first Olympics, track and field events including running, javelin, long jump, and shot put were some of the limited sports competed. Running itself dates back even further;as a vital and innate skill for hunter gatherers (One Foot in Front of the Other, 2015). Persistence hunting allowed for humans to outlast their new meal, following their prey for long distances. Humans have been naturally adapted for efficient long-distance running: our 2.4 million sweat glands help regulate body temperature, while the springy tendons and muscles in our legs store and release energy to keep us moving smoothly between strides (Insider Tech, 2008). Running is also arguably one of the simplest sports, requiring no equipment, so it’s not surprising that it was the earliest sport. Besides running’s history in the Olympics, running has also been a part of ancient stories, like that of Pheidippides, whose story was the inspiration for the marathon long-distance running event (One Foot in Front of the Other, 2015). His story was important in presenting long-distance running as a courageous and patriotic act, though not without danger (he died during the end of his run).

Closely connected to distance running is cross country. This sport involves running longer distances over natural landscapes, not a track. Unsurprisingly, the world’s top distance runners on the track are also top ranking at cross country. Sometimes, obstacles like hills, hay bales, and mud pits are featured on the course. Cross country was an event in the Olympics from 1912 to 1924 (Cross-Country Running, 2024), but hasn’t been in the Games since then, although there have been discussions of reintroducing cross country as a Winter Olympic sport (Dunbar, 2024).

Although running persisted through the ages in various forms, its popularity as a sport and fitness trend didn’t fully return until the 1900s. Specifically, the “jogging boom” in the 1970s (Lathan, 2023). This sudden interest in jogging was sparked by two main figures: New Zealand coach Arthur Lydiard and University of Oregon track coach Bill Bowerman. Together, these coaches successfully spread the idea that jogging was a great way to exercise and stay fit. Ken Cooper supplemented their ideas with his own published book “Aerobics,” which brought up the importance of running for cardiovascular fitness. Similarly, Bowerman wrote his own best-selling book in 1966 titled Jogging. The interest in running was also fueled by the American Olympic victory in the marathon by Frank Shorter in 1972. Shorter remains one of only three Americans to have won the Olympic marathon, with the other two victories coming in 1904 and 1908. Outside of his victory, Shorter popularized running by opening up professional opportunities in running and advocating for clean sport (Futterman, 2022). During the running boom, roadraces, shoe sales, and jogging for exercise all increased. By the late 1980s and early 1990s, the boom slowed down as running became more established.

While the running boom showed steady growth for two decades, it began to decline in the mid 2010s (Bachman, 2016). This decline was especially noticeable among younger adults, as millennials started to favor other forms of exercise including cycling, cross-fit, and boutique classes like pilates. Running has remained popular overall, but participation in races and regular jogging dropped from its peak. This reflects the shift in fitness culture towards more social activities, like fitness classes. Jogging is still common, but the running community moved away from a competitive and race-focused identity toward a broader view with more emphasis on well being.

It’s unclear what the future holds for running. Major changes came with Covid-19 pandemic, with research showing that running gained popularity during the Covid-19 pandemic. In a survey across 10 countries, about 40 percent of people see themselves as runners, and of those, 30 percent run at least once a week (Recreational Running Consumer Research Study Nielsen Sports, 2021). However, since this study was conducted in 2021, some people may have since stopped running after pandemic restrictions eased and routines changed. Additionally, future generations’ level of activity could impact the popularity of jogging. Members of Generation Z have been found to exercise the most compared with Generation X, Millennials, and Baby Boomers (Erikson, 2024). Conversely, there are concerns for the well-being of the younger Generation Alpha members since they’ve grown up fully immersed in a digital world (Generation Alpha: The Real Picture, 2021). The lasting impact of the jogging boom will depend on how well future generations maintain active lifestyles with competing interests and digital distractions.

Today, track and field remains a niche sport in year-round popularity but a major event sport around global competitions like the Olympics. While the 2023 World Championships drew in 280k viewers and the 2024 World Indoor Championships drew in just 95k viewers on NBC (Track and Field Ratings, 2024), 5.2 million people viewed the 2024 US Olympic Team Trials on NBC (Karp, 2024). That is 18 times more viewers for the US Team Trials than World Champs, despite the competitions being just 1 year apart. Similarly, the 2024 NCAA Track and Field Championships drew a total of 1.7 million viewers across multiple days of broadcasts (Chavez, 2024). All 2024 viewership numbers exceeded the 2023 NCAA Championships. Overall, viewership was much higher than the 1.178 million for the 2022 Championships. This shows that track and field gets some attention during big national and college events, leading into the even bigger audiences at the Olympics.

Olympic Track & Field Events

Track and field has an even more diverse event lineup than swimming. The events can be broken down into three major categories: running, jumps, and throws. These categories can also be broken down further. Running includes sprints, distance, and hurdles while jumps include both horizontal and vertical jumps. Track and field also offers relays and combined events, which are multi-discipline competitions where athletes compete in a series of different track and field events over one or two days. For the combined events, the women compete in the Heptathlon (7 events) while the men compete in the decathlon (10 events). All other events except the hurdles are the exact same for men and women. The sprint hurdles are 110 meters for men but just 100 meters for women. See appendix B for a list of all the Olympic track and field events.

Track & field wasn’t an Olympic sport for women until 1928 (Holmes, 2021). Even then, meet organizers only introduced limited events: just the 100m, 4 x 100m relay and 800m. The 800m was removed until 1960 after the 1932 Olympics when some female athletes collapsed after the race. It wasn’t until the 2008 Beijing Games that men and women competed in the same events, once the 3000m steeple chase was added. Still, women aren’t offered the decathlon, instead the heptathlon.

Olympic Fandom‌

The modern Olympics never fail to gain the world’s attention every four summers (Bittle, 2021). Commercials, billboards, documentaries, and all sorts of Olympic media are everywhere in the months leading up to the Games. People who have never watched sports like swimming, track & field, and gymnastics often find themselves enraptured by the competition and national talent in these sports. For example, an Australian study found that viewing someone from your country competing in the Games can create a strong sense of national pride (Hendley, 2024). Additionally, the authors found that watching the incredible athletic performances can provide feelings of joy and inspiration (Hendley, 2024). The media, the excitement, and the emotion all help explain why the Olympics draw so many viewers. However, this high level of interest often fades once the Olympics are over, and many of these sports struggle to keep the same audience for other competitions (Campbell, 2024).

Even though millions tune in to cheer on their favorite athletes, most viewers remain spectators rather than participants. The idea that viewing elite athletic performances drive mass participation is largely a myth. A study done after the 2020 Tokyo Games found that about 70% of people were not motivated to exercise after watching the Olympics (Vukovic, 2021). Those who reported that the Olympics did not make them want to exercise cited reasons like time, age, injury, and cost barriers. The minority who reportedly did feel inspired to exercise said it was because of admiration for athletes and reminder of health benefits.

Researchers have looked into how to get more children involved in sports, and they found that boys are more likely to be influenced by successful athletes, while girls are more likely to look to parents, teachers or peers as role models (Vescio et al., 2005). So, when looking into how to get the children involved in sports after the Olympics, creating role models out of athletes would be more successful for boys.

While the Olympics spark huge interest and national pride every four years, for sports like swimming and track that excitement often doesn’t last much beyond the Games themselves (Campbell, 2024). Many fans tune in during the Olympics but don’t stick around for other competitions. To understand why, it’s important to look at how people become fans and what motivates them to follow sports over time. Researchers understand fandom as a complex mix of emotional connection, identity, and social belonging centered around a particular sport, athlete, or team (Mastromartino et al., 2017). Understanding fandom helps explain both the surge in attention during big competitions and the challenges sports face in maintaining a steady fan base year-round. It is especially important to understand for non-revenue sports, where marketers and organizers must work harder to keep fans engaged with limited media coverage and fewer high-profile events (James & Ross, 2004).

Sports Fandom & Psychological Connection

Sports fans are people that enjoy watching and following sports, teams, and athletes. Through repeated supported behaviors, they express their fan identity (Wang, 2020). Being a fan of sport is so common because being a fan actually meets some of their basic psychological needs like social connection, belongingness, and identity (American Psychological Association, 2025). There’s no single personality profile of a sports fan, but fans tend to be slightly more extroverted. Despite that, people of all types follow all kinds of sports (American Psychological Association, 2025). Even family fans might enjoy violent sports like wrestling or MMA. Being a fan brings groups of people together through a common passion, creating a shared identity and community. Beyond just watching a game, fandom offers rituals, shared experiences, and traditions that strengthen these social ties and contribute to a fan’s personal identity (Media Culture, 2024). From tailgating outside a sporting event to passionately debating stats online, sports fans express their dedication in many ways.

Part of developing fans of a sport comes down to understanding how people form psychological connections. The Psychological Continuum Model (PCM; Funk & James, 2001; 2006) explains that this happens through four stages: awareness, attraction, attachment, and allegiance (figure 2). At first, someone simply becomes aware that a sport or team exists. If the sport or team seems fun or popular, they may feel attracted to it. Over time, the connection can grow into a personal attachment, where the team holds meaning beyond entertainment. The final stage is allegiance, where fans stay loyal over time, even during tough periods.

Understanding how fans get motivated to follow sports in the first place is also important. James and Ross (2004) surveyed various sports fans to determine what key motivations may be, and if they vary from sport to sport. For example, sports like figure skating and gymnastics attract fans through aesthetics and appreciation of skill, while team sports like basketball and baseball are more connected to emotional motives such as drama, team affiliation, and vicarious achievement (James & Ross, 2004). Overall, across baseball, softball, and wrestling, entertainment was rated the highest while empathy was lowest. For these three non-revenue sports, general sport-related motives (entertainment, skill, drama, team effort) were rated higher than self-definition motives (achievement, empathy, team affiliation) and personal benefit motives (social interaction, family). The information about the motivations of fans of these sports can help marketers promote nonrevenue sports to support increased attendance and engagement. By focusing on athletes’ skills, the drama of the sport, and the entertainment experience of these sports, marketers can attract and retain fans, even for nonrevenue sports that typically receive less attention.

Social influences, entertainment value, situational factors like team success or promotions, and emotional investment all play a role in helping people move along this continuum. Not every person reaches the highest stage of allegiance, and progression can move backward as well as forward. This helps explain why so many fans follow swimming and track during the Olympics, when national pride and promotion are at their peak, but then lose interest afterward. These fans may only reach the awareness or attraction stages, without developing the deeper connection needed to stay engaged between Olympic cycles. Most “bandwagon’ fans don’t develop past the attraction stage (Funk & James, 2001).

Understanding Fandom in Swimming & Track and Field

While it’s possible that viewers watch swimming or track during the Olympics simply because it airs at a convenient time, one study suggests that prime-time coverage might not have an impact on creating fans (Li et al., 2018). The researchers analyzed Twitter following for several National Governing Bodies including USA swimming. They found that posting more frequently correlated with more followers, about 18 per post, but also that NBC’s prime-time broadcast schedule, athlete gender, and total medals won didn’t significantly impact follower growth. Only gold medals led to a substantial increase, highlighting that dominance draws more fans than general success. USA Swimming, for instance, gained about 41,000 followers after winning 16 golds in the 2016 Rio Olympics. The fact that only gold medals had a significant impact on follower count suggest that casual viewers are more drawn to US excellence than the sport itself. Fans keep watching throughout the Games because the events are exciting and the media highlights U.S. success. However, they don’t continue following swimming or track after the Olympics end. Track and swimming organizations should focus on how to develop Olympic “bandwagon” fans into true fans who form lasting attachments and allegiance to the sport.

Barriers & Constraints of Swimming and Track & Field Fandom

Both track and swimming have issues that prevent long-term fandom. These issues can be broken down into two large categories: the built experience (venue, structure, and tech) and the narrative and emotional connection (storylines, identity). The Olympics naturally provides “fixes” for some of these issues. Most venues for track and swimming aren’t designed for spectators– but the Olympic stadiums and natatoriums are. Similarly, the Olympics are able to use advanced technology that are rarely available at other competitions to improve the spectator experience. And while track and swimming often lack the team rivalries that keep fans invested, the Olympics create national rivalries by uniting athletes under their countries, giving fans a clear side to root for. Understanding these challenges is key to finding ways to grow and sustain fandom beyond the Olympic spotlight.

Venue and Spectator Experience Limitations

Swimming struggles to keep fans engaged at smaller meets, even though it draws huge crowds during events like the Olympics and World Championships. Outside of those big meets, the stands are often empty (Derom et al., 2023). A big part of the problem is that many swimming facilities aren’t built with spectators in mind. They’re designed for training or recreation, not for watching a meet. That leads to low entertainment value, limited crowd energy, and little reason for people to stay interested. Even experienced swimmers in the crowd can feel disconnected during races. One study found that many fans at swim meets are mainly there to admire the aesthetics of the sport, such as clean strokes or fast finishes, but that doesn’t always mean they’re mentally or emotionally invested (Derom et al., 2023). Just liking the sport isn’t enough to make someone enjoy going to the event.

The success of the 2024 U.S. Olympic Swimming Team Trials proved the importance of a well designed stadium. Taking place in Lucas Oil stadium, USA Swimming designed the venue with the spectator experience in mind. Since it’s primarily a football stadium, there was lots of construction that went into installing the pool– but all the hard work was worth it when the meet broke the swimming attendance record with twenty-two thousand spectators (Rosado, 2024). This venue made for a better experience for both athletes and spectators: the athletes were able to experience the energetic atmosphere from a large energetic packed stadium and the spectators were able to watch elite performances all while having access to traditional sports venue amenities that swimming fans don’t usually get. It also made for a better experience for viewers at home. They experienced the same high energy crowds and athletic performances on television. Future meet organizers should look into hosting meets at larger venues like major sports stadiums. NCAA Championships, US Nationals, and TYR Pro Series could be held in better venues that allow for a better spectator experience.

Similar to swimming, the venues for track could also benefit from improvement. While football, soccer, and baseball stadiums offer a wide variety of food, drinks, and convenient vending options, many track venues fall short in this area. Fans often have limited access to refreshments, with few choices beyond basic concessions. Collegiate track “stadiums” also can’t compare with US collegiate football stadiums, which are as big if not bigger than NFL stadiums. If the venues aren’t spectator friendly, people won’t want to watch the meet, no matter how talented the field of competitors are.

Structural and Format Barriers (Lack of Rivalries)

Additionally, since swimming and running aren’t team sports in the same way that football, basketball, baseball, and soccer are, less rivalries exist. Rivalry creates a clear ingroup vs outgroup for sports fans, which strengthens loyalty to a team (Piercy & Kiser, 2024). The Olympics turns these individual sports into team sports by uniting athletes under their country. This in turn allows some national rivalries to exist, such as the USA swimming rivalry vs Australia (Binner, 2024) and the running rivalry between USA and Jamaica in the sprints (Bowman, 2024). If swimming and running are able to create and hype up more athlete rivalries, fans may be more engaged to follow the sports. The 2024 rivalry between world leaders in the 1500m Josh Kerr and Jacob Ingebrigtsen made the 2024 1500 Olympic final an exciting race for fans that have been following the rivalry for the whole year (Pells, 2024). In both swimming and running, the lack of rivalries contributes to the lower fanship outside of the Olympics. Sports marketers and even professional sport brands like Nike, New Balance, Speedo, and Arena should look to generate and promote any rivalries that may occur between their sponsored athletes.

Another structural problem prominent in both swimming and running is athletes’ hesitancy to race often. At the high level of performance that most professional athletes compete at, training and peaking for certain races requires the perfect build up and taper of workout volume (Wang, 2023). Because of this, swimmers are often only in peak shape once, maybe twice a year. Since athletes usually want to make the Olympic or World Champs team every year, the meet they taper for is usually US team trials. Oftentimes, US swimmers actually end up swimming faster at Olympic/World team trials than at the actual Olympics or World Championship meet that takes place a month or two later (Mering, 2016). This is because the athletes plan their taper to maximize their chances of making the team, and don’t have enough time between trials and the actual event (if they made the team) to build back their training and then taper down again. In order to change this, swimmers would need to normalize more frequent racing and potentially less intense training. This would likely result in slower performances, so it’s unlikely athletes would choose to race more.

This phenomenon is more talked about in swimming than running, but is still present in Track and Field. In track, top athletes are still training very hard, going to high altitude training camps and working out multiple times again. Racing, especially distance races (like the 1500/mile, 5k, 10k), are very physically demanding races. Athletes would struggle to compete in those races every week, like other sports like football, basketball and baseball regularly do. Still, track & field does have more professional racing opportunities than swimming. The Wanda Diamond League, Grand Slam, and other smaller competitions provide chances for the world’s best track and field athletes to race against each other multiple times a year (Sim, 2025). Meanwhile, the only comparable competition that swimming offers would be the TYR Pro Series, which gets a few US Olympians every so often, but is mostly attended by NCAA athletes and top high schoolers. In 2019 the International Swim League (ISL) was created, but failed due to geopolitical events like the war in Ukraine and other fiscal mismanagement, and no longer exists (Ross, 2025). These natural limitations to athletes’ willingness to compete frequently in both swimming and running make it difficult to maintain a consistent fanbase.

Technology Use and Accessibility (Swimming and Running Tech Enhancements)

New technology has also helped fans get engaged with the sport and athletes (Bi et al., 2019). Both swimming and running can use technology to create a more immersive experience for fans. Modern swim broadcasting on television already uses underwater cameras to show the swimmers’ flipturns and dives while also showing the swimmer’s speed in meters per second. By displaying the athletes’ speed, fans can understand just how much faster some athletes can finish their races compared to others. Additionally, larger and improved jumbotrons can show athlete’s reactions to winning, lap splits, and close-up footage can bring fans in the stands closer to the action (Kraus, 2014). While some natatoriums have good scoreboards/jumbotrons, swim organizations should consider choosing a venue with the screen in mind. The 2024 Olympic pool venue (Paris La Defense Arena) boasted a 1400 square meter screen while the location of the men’s 2024 NCAA championship, Indiana University’s pool, only had a 16 ft x 59 feet screen. (Schwarb, 2019).

Track and field can also use technology to enhance the spectating experience for fans (Bi et al., 2019). From live athlete heart rate monitoring to pace lights around the track, technology helps fans follow races and understand splits. In distance running especially, the interaction between fans and athletes is very short. Bi et al. (2020) found that allowing fans to follow online splits and gps tracking makes them feel more connected to the runners. Additionally, knowing the runners goal strengthened fan engagement. Participants explained that knowing the goals, physical, and emotional effort put into the training by their runner made them deeply connected to their runner’s success. This can be applicable to professional running: while fans might not know the athletes personally, through social media and general knowledge, they can understand the rigorous training that these athletes put themselves through to maximize their performance. This helps explain why projects like Breaking 2 and Breaking 4 foster good fan response: showcasing the hard work and extreme lengths that athletes, coaches, and sponsors are going through just shaving off a few seconds resonates with people. This finding also suggests that the fitness social media app Strava is a tool professional athletes should be active on. This app allows athletes to share their daily runs to the feeds of other athletes. So, more media attention on specific workouts and training that athletes’ do, like those shared on Strava, could help get fans more invested in professional athletes’ success.

Narrative Limitations and Difficulty Connecting to Athletic Feats

Both swimming and running evidently have problems with keeping fans engaged in the sport. Creating fan connection to athletes and specific storylines is crucial to developing fans of sports (Shain, 2023). Swimming in particular struggles to create these storylines that allow fans to get engaged with the sport. While running races often have impressive time-barrier breaking performances/goals, swimming isn’t able to create such exciting stories. Famous in distance running was the sub 2-hour marathon attempt by Kenyan distance runner Eliud Kipchoge in 2017 and the more recent female sub 4-minute mile attempt by world record holder Faith Kipyegon in 2017 (Boswell, 2025). Both were big projects run by Nike that were televised and advertised well. Although neither initially succeeded in actually breaking their respective time barrier, they succeeded in generating massive global attention and excitement, ultimately helping fanship of the sport (Rogers, 2018).

Part of the problem may be that the swimming talent is harder to understand for non-swimmers. While most people understand that running a sub 4-minute mile is incredibly fast (15 mph), less understand just how fast the world record holders are swimming in their events. Information about the sport should be included by marketers in advertisements and announcers during competitions. If more people are able to understand swimming, they may find themselves more drawn to the sport and the incredible performances being swum by the world’s top swimmers.

National Identity and Patriotism as Emotional Anchors

Another factor that helps explain Olympic fan engagement is the strong connection people feel toward their national teams. Brown et al. (2020) found that strong fandom during the 2018 Winter Olympics was connected to increased feelings of nationalism and patriotism. The study defined nationalism as a belief in the superiority of one’s nation over others and patriotism as positive feelings about one’s country, like pride and support. They found that fans of their National Olympic team were the most engaged in sport media compared to general sport fans and fans of the winter Olympics as an event (Brown et al., 2020). This reflects the study’s finding that national team fandom was the strongest predictor of media consumption across all formats. This helps explain why largely individual sports like swimming and running succeed during the Olympics when national identity is emphasized, but maintain that audience after the Games end, and athletes return to their individual competition schedule.

Conclusion

Track and field and swimming are some of the Olympics most watched sports, but fail to maintain a consistent fanbase outside of the Games (Campbell, 2024). Both sports have rich histories, dating back to centuries of competition and recreation (Athanasiou, 2024; Sears, 2015). Analyzing why track and swimming have these issues with fandom is important for athletes, the media, sports organizations, and psychologists hoping to better understand sports fandom. For both sports, national pride sparks short-term fandom but rarely translates into lasting allegiance. Fans likely don’t move past the attraction stage of the PCM (Funk & James, 2001): the media attention and national talent draws them into the sport, but their interest fades once the Games are over. True fandom requires connection, identity, and continuity. Swimming and running lack the venues, meets, and storylines to build lasting fan communities. This pattern highlights a broader truth about sports fandom: attention built on rare spectacle and national pride cannot substitute for the consistent community and identity that other sports maintain. The future of swimming and track fandom may depend on whether these sports embrace technology, host competitions in fan-friendly venues, build rivalries, and craft storylines that keep audiences engaged long-term.

This research is limited by its qualitative approach. Relying primarily on news articles, reports, and media coverage to understand trends in swimming and track fandom, it fails to capture the personal experiences and motivations of the fans themselves. Additionally, the lack of data surrounding swimming and track viewership makes it difficult to quantify the difference in fandom between the Olympics and other competitions. While other sports have viewership data about major competitions published or accessible on their websites, both USA Swimming and USA Track and Field do not share this information. The absence of publicly available viewership data may also suggest that these organizations place less emphasis on tracking or promoting fan engagement compared with other sports. It’s important to continue to understand these gaps in fandom as doing so can create opportunities for sports to strengthen fan engagement. Future research could use fan surveys to quantify viewership differences between the Olympics and other major events. This study highlights that without intentional strategies to engage fans, even historic and elite sports risk losing their audience once the spotlight fades

Appendix A

Olympic Swimming Events

Appendix B

Olympic Track and Field Events

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About the author

Kyle Padilla

Kyle is a high school senior with academic interests in history and environmental science. He has conducted research on the relationship between urban green space and biodiversity in U.S. cities. Outside the classroom, he is an avid athlete, competing year-round in swimming, cross country, and track, and he is especially interested in the role of sports beyond the Olympic stage.

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