Think you’ve got a solid handle on diagnostic criteria and clinical distinctions? This DSM-5-TR (Part 1) quiz will put your knowledge to the test. You’ll review core features, duration requirements, and differentiating symptoms across a variety of disorders—just like you’ll see on the NCE and in real clinical practice. Take your time, trust what you know, and notice where you might want a little more review. Let’s get started.
Once you’re finished with Part 1, move on to Part 2. If you’re studying for the NCE, you may also want to consider taking the free NCE 2025-2026 Practice Exam.
Understanding Prolonged Grief Disorder in Clinical Practice
Grief is a universal human experience. Most of us, at some point, will lose someone we love—and the emotional pain that follows is not something to “fix,” pathologize, or rush. But there are times when grief doesn’t soften. It doesn’t shift. It doesn’t make room for life again. Instead, it remains intense, consuming, and disruptive long after the loss.
This isn’t “just grief.” It’s not weakness. It’s not resistance. It’s not a failure to cope.
It may be Prolonged Grief Disorder (PGD)—a clinical condition recognized in the DSM-5-TR, characterized by sustained longing, identity disruption, and functional impairment that doesn’t resolve with time alone.
As clinicians, we need to know how to distinguish adaptive grief from clinically significant prolonged grief, without rushing to diagnose, minimize, or invalidate. That requires clarity, competence, and respect for cultural and individual mourning practices.
To support that work, I’ve created a 10-module clinical training on Prolonged Grief Disorder designed for counselors, social workers, psychologists, bereavement specialists, and anyone providing grief-informed care. The training is evidence-based, clinically practical, and grounded in trauma-informed, person-centered practice.
You’ll learn how to:
Recognize the clinical presentation of PGD
Differentiate PGD from depression and PTSD
Conduct appropriate assessment and screening
Understand risk patterns and diagnostic nuance
Apply core treatment approaches supported by research
The aim is simple: No pathologizing grief. No guessing in diagnosis. No forcing closure. Just clear, competent, compassionate clinical care.
Grief doesn’t follow rules, and prolonged grief disorder is more than “taking too long to move on.” This training cuts through the confusion.
We’ll break down the core symptoms, explore what makes grief become prolonged, and walk step-by-step through how Prolonged Grief Treatment approaches healing. If you work with clients who feel stuck, overwhelmed, or disconnected after a loss, this training gives you practical tools you can start using right away.
Most people think of a cane as a simple mobility aid—something for balance, a sign of aging, or a marker of weakness. I never thought much about them myself… until I had a stroke. This is my stro-called life now.
Suddenly, a cane wasn’t just a stick with a handle. It was possibility. It was strategy. It was even a little bit of power. And it stirred up something complicated in me—part shameless, part protective, part pride.
I don’t remember exactly how the cane was first introduced—whether it was handed to me or just left leaning against a chair at IRC. But I remember this:
I wanted it.
Not for balance. Not for stability. But because it might get me off the fall-risk list while I was in rehab. And if I’m being brutally honest, because it might let me board planes first—before first class. (I travel a lot, and yes, I’m shameless enough to view a mobility aid as a golden ticket.)
Here’s an excerpt from my new memoir, My Stro-Called Life: Notes from the Brain That Betrayed Me:
My Stro-Called Life: Notes from the Brain That Betrayed Me
Okay, and maybe I like the idea of a statement cane—something bold, like one topped with a gilded dragon egg. Or a discreet weapon I’d never actually use but can fantasize about wielding in some artful, heroic act. Not that I’m violent. I’m very anti-violence. But the image of a perfectly timed cane whack? Makes me smile.
“Then something Tookish woke up inside him, and he wished to go … and wear a sword instead of a walking‑stick.”
-J. R. R. Tolkien
Also, I have another, quieter reason for wanting the cane. I know I’m different now—slower, off in ways I can’t always pinpoint but others can probably sense.
The cane would be a kind of shield, a visible explanation for my invisible disability. Instead of people wondering, What’s wrong with her?, the cane would answer for me. It would give context. It would give me cover. If I stumbled, forgot something, or acted a little strange, the cane would speak before anyone had to ask.
…
Pre-Stroke Brain: So… we’re actually excited about a cane now?
Post-Stroke Brain: [Is excited and lies] Not excited. Just… it’s strategic. This bad boy could be our ticket off the fall-risk list.
Pre-Stroke Brain: Uh-huh. And the priority boarding thing?
Post-Stroke Brain: Obviously.
Pre-Stroke Brain: And the fantasy about a cane topped with a dragon egg?
Post-Stroke Brain: Yes?
Pre-Stroke Brain: Or the imaginary person you’re mentally whacking with said dragon-egg-cane?
Post-Stroke Brain: They earned it. Every. Single. Whack. [Snorts in laughter]
Pre-Stroke Brain: Right. Totally. And the part where you want it so people won’t wonder what’s “wrong” with you?
Post-Stroke Brain: [Somber now] Yeah… that part’s real. It feels safer when the cane explains me before I have to.
Pre-Stroke Brain: Or maybe it just explains what you think people are wondering.
Post-Stroke Brain: Maybe. But if it makes them pause before they jump to conclusions? I’ll take that trade-off.
Pre-Stroke Brain: Fair enough.
…
My dad, on the other hand, genuinely needs a cane—his mobility is limited—but he chooses not to use it.
I think, for him, it’s about pride. He doesn’t want to be seen as disabled. He’d rather stumble his way through the world than carry something that signals vulnerability. It’s interesting, really—how we see the same object so differently. For him, a cane represents weakness. For me, it feels like armor.
“I put my armor on, I’ll show you that I am”
-Sia
I used to roll my eyes at my dad’s stubbornness. Now I wonder if I’m any less prideful—just in a different way.
He resists the cane because it reveals something he doesn’t want the world to see.
I reach for it because it reveals something I need the world to understand.
Maybe we’re both just trying to control the narrative in a world that often jumps to conclusions.
And honestly, maybe I also like the idea that, with a cane, I can be the one who’s noticed for something, instead of judged.
It’s not just about mobility or boarding planes early. It’s about context. It’s about walking into a room and having a silent explanation for the moments when my words get stuck or my processing lags. A visual cue that says: Don’t judge me too quickly. There’s a reason. And it’s now my stro-called life.
No release date yet—because writing this memoir, much like stroke recovery, takes patience, persistence, and more than a little creativity. But like the cane, it’s also a shield—something that helps me steady myself while letting the world know what’s really going on. Just like the cane became my unexpected armor, this book is becoming a way to carry the story forward—with humor, honesty, and resilience. When it’s ready, you’ll be the first to know. Until then, stay tuned for more glimpses into a journey that proves strength sometimes comes disguised as a stumble.
My brain broke in the night, and by the time I reach the hospital, it is already too late. This is my stro-called life.
“Nothing prepares you for the moment your brain betrays you—not training, not experience, not even a lifetime of helping others.”
When the paramedics rush me to the ER, a code stroke is called immediately. But I am already outside the window for treatment. The clot came and went in the night, leaving its damage behind. What follows isn’t the dramatic chaos you might expect if you’re a fan of Grey’s Anatomy, but something stranger: a fog of hunger, humiliation, and denial that became my first real taste of my stro-called life.
Here’s an excerpt from my new memoir, My Stro-Called Life: Notes from the Brain That Betrayed Me:
My Stro-Called Life: Notes From the Brain That Betrayed Me
The first few days are mostly a blur, thanks to the edema in my brain—time passes in disjointed fragments stitched together by fluorescent lights and the steady beeping of machines. The thing I remember clearly is how hungry I am—and how I’m not allowed to eat. It feels absurdly unfair. What kind of place is this, anyway? A steady stream of doctors, nurses, and specialists file in, each asking different versions of the same questions. My response never changes: “Can I have something to eat?”
Then, a remarkably handsome doctor with kind eyes enters, and my spirits lift. Eagerly, I report my most pressing concern: I am starving. His face, however, falls with genuine disappointment.
“I was hoping you were going to report having a bowel movement,” he replies. While he doesn’t bring me food, Dr. Morven proves to be one of the most caring and attentive doctors I’ve ever encountered, and I am fortunate to have him on my team.
That said, apparently, pooping is a big deal after a stroke. A stroke can damage the part of the brain that controls bowel function. More on this later.
Swallow Test + Fall Risk
No food until I pass a swallow test. The objective is straightforward: sip water without choking. A speech-language pathologist supervises. I’m parched and overly confident. I fail spectacularly—choking on the water as it goes down the wrong pipe.
My mom is right there, trying to advocate for me, saying I’m just overeager from hunger and thirst. But my excitement isn’t enough for a pass.
Each denied meal feels like my body reminding me: you’re not in control anymore.
Although the timeline is hazy—it feels like hour, maybe days—before I am allowed to attempt the swallow test again. This time, I pass. No coughing, no choking, no signs of aspiration. I am finally cleared for real food.
My reward? A tray of unidentifiable lukewarm hospital fare: rubbery beige stuff and something that might have once been fruit. It is objectively unappetizing—and I devour it like it’s a five-star meal.
I’m not entirely sure why I’m labeled a “fall-risk.” (It turns out I am temporarily paralyzed on my entire left side, which makes a decent case for it. Funny, the things we remember—and the things we forget.) This means I’m not allowed to get out of bed without assistance from medical staff—including for basic things like using the bathroom. But ever the rebel (or just impatient), I routinely get up on my own. As a result, my bed is alarmed. I pay it no mind, getting up and moving, er, swaying, about as I please, which not only sets off the alarm, but the nurses too.
In my defense, it’s not like I’m doing this alone. I’ve got company—two voices in my head who can’t agree on anything. Pre-Stroke Brain: practical, easily annoyed, and annoyingly responsible. Post-Stroke Brain: impulsive, distractible, and weirdly enthusiastic about bad ideas. This is now my stro-called life.
Pre-Stroke Brain: Wait… we need medical clearance to drink water now?
Post-Stroke Brain: Yeah. Apparently, difficulty swallowing and choking on liquids is a whole thing after a stroke. It’s called dysphagia.
Pre-Stroke Brain: Oh. And everyone’s suddenly invested in our bowel habits?
Post-Stroke Brain: Deeply invested. It’s a group project!
Pre-Stroke Brain: Fantastic.
Post-Stroke Brain: At least we passed the second swallow test. Even if all it earned us was a tray of hospital slop.
Pre-Stroke Brain: You inhaled it though.
Post-Stroke Brain: It was sustenance. We’re wasting away here.
Pre-Stroke Brain: And now we’re on fall risk?
Post-Stroke Brain: Yep.
Pre-Stroke Brain: So you get up on your own.
Post-Stroke Brain: Every chance I get!
Pre-Stroke Brain: Classic. Still trying to outrun your own limitations.
Post-Stroke Brain: Better than giving in to them
The things that horrify pre-stroke brain are the same things post-stroke brain finds funny—or can’t be bothered to care about anymore.
My hospital stay wasn’t heroic, inspiring, or anything close to Grey’s Anatomy. It was fluorescent lights that never dimmed, bed alarms that shrieked if I so much as shifted the wrong way, and trays of rubbery beige food I devoured like it was five-star cuisine because I was that desperate.
It was strangers monitoring my bathroom habits, and my dignity circling the drain faster than the purple dye bleeding from my hair. Survival didn’t look triumphant—it looked awkward, humiliating, and sometimes funny in ways I wish it weren’t. But if I can laugh at hospital slop and bed alarms, I can survive just about anything.
Still no release date—because writing a memoir is a lot like my stro-called life: messy, unpredictable, and never on anyone’s timeline. But when it’s ready, you’ll be the first to know. Stay tuned for more excerpts—stories that prove recovery isn’t always pretty, but it can be pretty hilarious. After all, if I can survive having my bodily functions monitored and charted, you can survive waiting for the book.
“Recovery isn’t always pretty, but it can be pretty hilarious.”
We often think lasting health change requires a big lifestyle overhaul—strict routines, bold resolutions, or a sudden surge of motivation. But in reality, meaningful improvement usually starts with something much smaller: small habits-consistent, doable habits that fit easily into your day.
As a practicing doctor, I’ve seen this firsthand. Many of my patients assume they need to transform their lives to feel better. But time and again, it’s the tiniest daily actions—the small habits that require no special tools and only a few minutes—that lead to the most reliable results. These “micro-habits” are deceptively powerful. They reduce stress, improve sleep, and slowly nudge the body and mind toward resilience.
Let’s explore a few of these low-effort, high-impact habits—along with the science that explains why they work.
Breathing for Calm: One Minute Can Change Your Day
Modern life keeps our nervous systems revved up. From tight deadlines to nonstop notifications, it’s easy to get stuck in a constant low-grade “fight-or-flight” mode. But your body also has a built-in brake: the parasympathetic nervous system, which helps you relax and recover.
A simple breathing pattern can help you access that state. Try this small habit: inhale for four seconds, hold for six, and exhale slowly for eight. Just one minute a day. Research shows that slow, controlled breathing lowers heart rate, reduces blood pressure, and activates the vagus nerve—a key pathway for relaxation and stress recovery.
This one-minute breathing routine is easy to anchor to your day. Try it in the morning before coffee, during a break at work, or while waiting at a red light. Over time, it trains your body to downshift more easily from stress, which can lead to better sleep, sharper focus, and fewer physical symptoms like headaches or muscle tension.
We don’t often think of posture as a health issue, but how we sit and stand influences far more than appearance. Slouching restricts breathing, tenses muscles, and can subtly impact mood and alertness. Over time, poor posture can lead to back pain, fatigue, and shallow breathing.
That’s why a simple one-minute posture reset—once or twice a day—can go a long way. Stand or sit tall. Relax your shoulders. Breathe in deeply and gently tuck your chin. It’s not about perfection. It’s about awareness.
Interestingly, posture doesn’t just affect the body—it may also influence the mind. Research suggests that upright posture is associated with more positive emotions and reduced symptoms of depression, while slouched posture can increase self-focus and negative affect.
This small habit will help you reconnect to your body and move through your day with more intention. And as posture improves, many people report feeling more energetic and emotionally grounded.
When it comes to nutrition, many people get overwhelmed by rules and restrictions. But you don’t need a meal plan or a supplement stack to make meaningful changes. Start with one daily swap, just one small habit. Choose water instead of soda. Add a handful of vegetables to lunch. Pick whole grains over refined ones.
These choices may not seem like much on their own—but they build momentum. They reduce blood sugar spikes, improve digestion, and gradually shift your taste preferences. Perhaps even more importantly, they reinforce a powerful message: I’m someone who takes care of my body.
You don’t have to overhaul your diet to be “healthy.” You just have to keep choosing what supports you, one bite at a time.
Gratitude as a Mental Health Tool & Powerful Small Habit
You’ve probably heard that gratitude is good for you—but the real power lies in how easy it is to practice. Before bed, pause and notice one thing that went well today. A kind word from a friend. A meal you enjoyed. A quiet moment.
That’s it. No journal, no timer, no need for perfect phrasing. Just a brief mental note of what brought you comfort or joy.
There’s strong research behind the benefits of gratitude. People who practice it regularly report lower stress and fewer symptoms of depression. Some studies also suggest a link to better sleep. In fact, gratitude has been shown to trigger positive neural activity in the brain and help regulate the emotional centers that influence anxiety and mood.
You don’t have to “feel grateful” all the time. But building this 30-second small habit can help train your brain to notice what’s going right, even during tough times.
Movement Stacking: Small Habits for Exercise That Hide in Plain Sight
If you’re too busy for a workout, try pairing light movement with something you already do—like brushing your teeth. While standing at the sink, do a few calf raises. March in place. Try some gentle squats or heel-to-toe balances.
It might feel silly at first, but two minutes of movement, twice a day, adds up. It improves circulation, strengthens stabilizing muscles, and reminds your body that it was built to move.
From a doctor’s perspective, this kind of “habit stacking” is incredibly effective. It reduces friction—there’s no need to carve out gym time or change clothes—and it turns physical activity into a normal part of your daily rhythm. Over time, small bursts of movement have been linked to improvements in insulin sensitivity, cardiovascular fitness, and musculoskeletal strength—even in people with limited time. While more research is needed on their long-term cognitive effects, incorporating movement into daily routines remains a practical and evidence-supported way to support whole-body health.
Why These Small Habits Stick (Even When Life Gets Messy)
So what makes these small habits so powerful?
First, they’re easy. They don’t require a major time commitment or a change in identity. You don’t need to become “a fitness person” or “someone who meditates.” You just need to breathe for a minute, stand a little taller, or choose an apple instead of chips.
Second, they create positive feedback loops. When your body feels calmer, or your digestion improves, or you sleep a bit better—you’re more likely to stick with the habit. And when habits are consistent, they start to shift your baseline experience of health.
Finally, these practices support multiple body systems at once. Breathing regulates your nervous system. Posture supports your musculoskeletal and respiratory health. Nutrition feeds your gut and immune system. Gratitude strengthens your emotional resilience. Movement improves metabolism and mobility.
From a medical standpoint, these small habits also support key systems: the autonomic nervous system (for stress), the musculoskeletal system (for posture and movement), metabolic and digestive function (through dietary shifts), and the brain (via gratitude and emotional regulation). That’s a lot of benefit for a few minutes of effort.
Final Thoughts on Small Habits
Health isn’t something we flip on with willpower. It’s something we build—through the quiet, repeatable moments we often overlook. The breath before a meeting. The snack you reach for. The way you sit at your desk. These are the places where health is shaped—not in grand gestures, but in small, meaningful shifts.
So if you’re feeling stuck or overwhelmed, start tiny. Start now. A minute of calm. A better snack. A deeper breath.
Because sometimes the smallest habits make the biggest difference.
About the Author
Dr. Antti Rintanen is a licensed medical doctor and the founder of The Internet Doctor, a platform dedicated to translating complex health science into practical guidance. His focus includes musculoskeletal health, postural alignment, and long-term wellness strategies.
References
Jerath R., Edry J. W., Barnes V.A., Jerath V. (2006). Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses; 67(3):566-571.https://pubmed.ncbi.nlm.nih.gov/
Katz S., Arish N., Rokach A., et al. (2018). The effect of body position on pulmonary function: A systematic review. BMC Pulm Med; 18(1):159. doi:10.1186/s12890-018-0723-4. https://pubmed.ncbi.nlm.nih.gov/
Schwingshackl L., & Hoffmann G. (2013). Long-term effects of low glycemic index/load vs high glycemic index/load diets on parameters of obesity and obesity-associated risks: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis.;23(8):699-https://pubmed.ncbi.nlm.nih.gov/
Wood A.M., Froh J.J., & Geraghty A.W.A.(2010). Gratitude and well-being: A review and theoretical integration. Clin Psychol Rev;30(7):890-905. https://pubmed.ncbi.nlm.nih.gov/
Dempsey P. C., Larsen R. N., Sethi P., et al.(2016). Benefits for Type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities Diabetes Care; 39(6):964–972. https://pubmed.ncbi.nlm.nih.gov/
Emmons R .A. , & McCullough, M.E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol;84(2):377–389. https://pubmed.ncbi.nlm.nih.gov/
Wilkes C., Kydd R. R., Sagar M., & Broadbent E. (2017). Upright posture improves affect and fatigue in people with depressive symptoms. J Behav Ther Exp Psychiatry;54:143–149. https://pubmed.ncbi.nlm.nih.gov/
Stroke recovery isn’t just physical therapy sessions. It’s also cheap soap, supervised showers, and the kind of indignities no one tells you about, and it’s my stro-called life.
Here’s an excerpt from my new memoir, My Stro-Called Life: Notes from the Brain That Betrayed Me:
My Stro-Called Life: Notes From the Brain That Betrayed Me
I’m naked, parked on a damp blue shower pad like a soggy noodle, gripping a handheld showerhead and lathering myself with cheap, hospital-issued green goo that smells faintly of mint and despair. It’s an all-in-one shampoo/body wash situation, the kind that promises convenience but delivers dry, scaly skin that later flakes off in my sweatpants.
My left side feels like it belongs to someone else. I reach for the shampoo and my arm ignores me. So I clamp the handheld between my knees to free up my right hand, which mostly results in surprise sprays to the face—or dropping it so it flails on the floor, misting the entire bathroom.
Orla, my assigned shower chaperone and occupational therapist, is seated just outside the stall.
A thin plastic curtain separates us, flapping open at both ends to let in cold air and awkwardness—and giving her a clear view of the spectacle if she decides to look. I’m sure she glances over now and then to make sure I’m safe, but it’s subtle enough that I don’t catch it (thankfully). To her credit, she never stares. If she does, she’d see me in all my naked glory: ghostly pale, skinny but flabby, bruised like a banana from failed IV attempts, and with random patches of grimy medical adhesive still sticking to my skin. (The green hospital goo is no match for medical adhesive.)
As I scrub my armpit, it makes a loud, wet squelch. Orla, ever polite and probably assuming it was the last bit of goo being squeezed from the bottle, asks if I need more gel. I don’t correct her. I’d rather let her think it was the bottle than admit it was my own armpit betraying me.
“No,” I call out. “I’m fine.”
I keep scrubbing, trying to get clean while settled into a shower chair that’s probably hosted more naked bodies than I care to imagine, wrestling an unruly handheld showerhead, and shivering like a wet cat.
“Are you okay?” Orla asks—for what feels like the 27th time.
“I’m good,” I reply, my tone flat.
It’s my new post-stroke voice—monotone, devoid of inflection. Handy for keeping emotions under wraps, not so great for sounding like a fully functioning human. Still, a little peace and quiet while I lather my bits with institutional mint goo doesn’t seem like too much to hope for, right?
Stroke recovery = not exactly glamorous. This is one of many humiliating, hilarious, and strangely human moments I unpack in my memoir, My Stro-Called Life: Notes from the Brain That Betrayed Me. It’s not a story of triumph-over-tragedy—it’s a story about what happens when your brain betrays you and you’re left to rebuild with humor, honesty, and the occasional bottle of mint-scented despair.
No release date yet—because apparently writing a memoir is a lot like stroke recovery: messy, unpredictable, and not on anyone’s timeline. But when it’s ready, you’ll be the first to know. Stay tuned for more excerpts from my book, stories that prove recovery isn’t always pretty, but it can be pretty hilarious. Because if I can survive supervised showers and green hospital goo, you can survive waiting for the book.
Navigating love, intimacy, and relationships isn’t always easy—but it’s essential for our wellbeing. Whether you’re exploring your identity, healing from past experiences, improving communication with a partner, or just trying to understand yourself better, this collection of resources for love is here to support you. Below, you’ll find workbooks, guides, and tools that cover everything from setting boundaries and enhancing emotional intimacy to understanding consent and sexual health.
These resources are designed to empower people of all identities and relationship styles to create healthier, more fulfilling connections—with others and with themselves.
Disclaimer: All external content is the property of its respective creators. I am not responsible for the accuracy, content, or availability of linked materials. Please adhere to all copyright laws when using or sharing these resources.
Beducated Beducated offers free trial lessons on topics like tantric sex, sensual massage, oral sex techniques, and more. Courses are high-quality and video-based.
Emily Nagoski, Ph.D. If you’ve read Come As You Are, you know Emily Nagoski is one of the most influential voices in sex education. Her website features videos, worksheets, podcasts, and guides on sexual desire, body image, and pleasure science.
OMGYES While mostly paid, this evidence-based, pleasure-positive site offers free videos and science-backed insights into women’s pleasure. Great for couples looking to learn, not just guess.
Pleasure Mechanics Tons of free podcast episodes, guides, and email series on everything from sensual touch to kink curiosity. Smart, shame-free, and queer-inclusive.
Sexplanations with Dr. Doe A playful, science-based series of short YouTube videos covering everything from orgasms to aftercare to erotic novelty. Smart and entertaining—watch together and discuss after.
The Vulva Gallery An artistic, body-positive project that showcases real stories and illustrations of vulvas in all their diversity. A beautiful, affirming way for couples to explore body image, anatomy, and curiosity without shame.
Learn Your Love Language | Choose your version: Couples, Children’s Quiz, Teens, or Singles. An online assessment to determine your primary love language. (You are required to enter your information to get quiz results.)
Marital Satisfaction Scale | PDF assessment to evaluate marital satisfaction; click on link listed in “Interactive Section for Couples”
Disclaimer: The supplementary materials provided are intended to be used only in conjunction with purchased workbooks. These free resources are designed to enhance the learning and application of workbook contents and do not replace the full workbook itself. Distribution or use of these materials without the accompanying purchased workbook is not authorized.
Please do not duplicate, modify, or distribute these materials for commercial purposes. All content remains the intellectual property of the author and is protected under applicable copyright laws.
Disclaimer: I worked hard to include only tools that are reliable and validated, but please don’t use these tools as diagnostic measures. They’re provided here for educational purposes only. If a questionnaire is copyrighted, please comply with copyright regulations.
PDF=Direct link to PDF
PDF for download=Link to webpage (or website) with PDF link
What does it mean to truly thrive? Flourishing goes beyond just getting by—it’s about rewiring your brain for growth, resilience, and fulfillment. Discover how positive psychology and neuroplasticity can help you build a thriving life.
Neuroplasticity & Recovery: The brain has the ability to rewire itself—at any age or health status—meaning growth and change are always possible.
Flourishing & Positive Psychology: Martin Seligman’s PERMA model defines wellbeing through Positive Emotion, Engagement, Relationships, Meaning, and Achievement.
Your Brain on Flourishing: Research shows flourishing changes the brain, enhancing life satisfaction, self-esteem, and motivation.
Practical Steps to Flourish:
Gratitude practice
Daily reflection
Identify & use strengths
Final Takeaway:Healing, growth, and thriving are possible—and they start today, not someday in the future
After having a stroke at 42 as a relatively healthy adult with minimal risk factors and spending three weeks in the hospital and then inpatient physical rehab, I’m not taking life for granted. And I’m not going to wait until I retire to do all the things I’ve been wanting to do. Tomorrow isn’t promised. And I want to spend the rest of my life not just existing but flourishing.
The stroke was a profound shock to me and everyone in my life; I maintain a healthy weight, I don’t smoke, and I have no family history of stroke. (I’m even plant-based!) It came out of nowhere.
Fortunately, the damage was minimal: I experience some balance issues and short-term memory impairment, but fundamentally, I’m still the person I was before. I know that some stroke survivors undergo significant personality changes, depending on which part of the brain is most affected. This post has become deeply personal, leading me to research the brain’s capacity to rewire itself—a phenomenon known as neuroplasticity. Through this, I’m learning how to potentially repair neural pathways or create new ones as I recover.
Research indicates that even individuals with mental illness and substance use, including those with chronic or reoccurring disorders, can fully recover and reach high levels of wellbeing (e.g., flourishing) (Keyes et al., 2022).
Neuroplasticity & Flourishing
“Neuroplasticity can be viewed as a general umbrella term that refers to the brain’s ability to modify, change, and adapt both structure and function throughout life and in response to experience” (Voss, et al., 2017)
Reseeardh indicates that neuroplasticity is possible in brains young and old, as well as brains healthy and diseased (Voss, et al., 2017). So there’s hope for everyone, no matter your age or your physical/mental health.
Understanding the brain’s ability to rewire itself naturally leads to the question: What does it mean to truly thrive? This is where the concept of flourishing comes in.
Flourishing & Positive Psychology
Maslow originally coined the term positive psychology in the 1950s, and the movement gained momentum as psychologists sought alternatives to outdated treatment modalities. Around the same time, humanistic psychology emerged, with Maslow arguing that psychology’s focus on disorder and dysfunction overlooked human potential.
Martin Seligman, a co-founder of positive psychology, became a leading figure in the movement during the 1990s (Nash, 2015). His work centered on authentic happiness, which he defined as a fulfillment achieved not by pursuing momentary pleasures but by making intentional choices that bring meaning to life. According to Seligman (2011), authentic happiness consists of three key elements: positive emotion, engagement (flow)—using one’s highest strengths and talents to meet the world—and meaning—”belonging to and serving something greater than oneself” (p. 11, p. 17).
As Seligman worked to conceptualize wellbeing, he determined that it was comprised of fourth element: accomplishment as in “accomplishment for the sake of accomplishment” (p. 19). As he further developed the construct of wellbeing, he observed that wellbeing has five measurable elements, and introduced the concept of PERMA:
Positive emotion
Engagement
Relationships
Meaning
Acheivement
He observed that “No one element defines wellbeing but each contributes to it” (Seligman, 2017, p.24). Eventually, Seligman concluded that the goal of positive psychology within wellbeing theory is “to measure and to build human flourishing” (Seligman, 2011, p. 29) He suggested several practical exercises for flourishing:
Practice gratitude by expressing it in an intentional and thoughtful way.
Focus on the positive. “Every night for the next week, set aside 10 minutes before you go to sleep. Write down three things that went well today and why they went well” (Seligman, 2011, p. 33). Be sure to stick with it for the entire week.
Identify and use your signature strengths. Start by discovering your signature strengths by taking the free VIA Strengths of Character Survey here: Questionnaire Center | Authentic Happiness. (The assessment is interactive and self-scoring. Registration required.) Examine your top five strengths and determine whether each is a signature strength. Once you’ve determined your signature strengths, carve out a time in your weekly schedule to exercise one or more of these strengths in a new way and then reflect on it through writing. Seligman suggested answering the following questions: “How did you feel before, during, and after engaging in the activity? Was the activity challenging? Easy? Did you lose your sense of self-consciousness? Do you plan to repeat the exercise?” (Seligman, 2011, pp. 39-40).
Seligman observed that the exercises were effective even in depressed individuals.
To measure your current level of flourishing, take the short assessment below.
Citation: Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2009). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247-266.
Description: The Flourishing Scale is a brief 8-item summary measure of the respondent’s self-perceived success in important areas such as relationships, self-esteem, purpose, and optimism. The scale provides a single psychological wellbeing score.
Instructions:Below are 8 statements with which you either agree or disagree. Using the 1-7 scale below, indicate your agreement with each item by indicating that response for each statement.
1= Strongly disagree—————————–7=Strongly agree
I lead a purposeful and meaningful life.
My social relationships are supportive and rewarding.
. I am engaged and interested in my daily activities.
actively contribute to the happiness and well-being of others.
I am competent and capable in the activities tf
I am optimistic about my future.
People respect me.
Total your score. The possible range of scores is from 8 (lowest possible) to 56 (highest possible). A high score represents having many psychological resources and strengths.
Click on the link below to download a PDF version of the scale:
Advancements in brain imaging technology have demonstrated that talk therapy induces measurable physical changes in the brain, including alterations in both neural activity and structural connectivity (American Psychiatric Association, 2020). Research further suggests that flourishing in life is associated with brain changes such as increased activity in specific regions and enhanced connectivity between hemispheres (Goldbeck et al., 2019).
Expanding on this, Waugh (2022) found that brain areas linked to life satisfaction, self-esteem, relationship satisfaction, and goal progress exhibit differences in structure and neural functioning in individuals who experience higher levels of flourishing. Additionally, positive emotions activate key regions of the prefrontal cortex and limbic system, which enhance cognition, behavior, and motivation. This neural activation fosters better decision-making and supports healthier lifestyle choices, ultimately contributing to improved physical wellbeing (Kandel, 2013).
This journey has taught me that flourishing isn’t about waiting for the perfect conditions—it’s about making intentional choices today. The brain is adaptable, healing is possible, and wellbeing is within reach. Neuroplasticity shows that our brains can rewire and grow, no matter our circumstances. Positive psychology teaches that thriving isn’t about chasing fleeting pleasure, but about cultivating meaning, engagement, and accomplishment. Science confirms that our thoughts, actions, and experiences can reshape the brain, reinforcing wellbeing. I’m not waiting until retirement to do the things I’ve always wanted to do—because tomorrow isn’t promised, but flourishing starts now.
Resources for Flourishing
Action for Happiness Daily actions, community-based well-being initiatives, and science-backed happiness resources
Goldbeck, F., Haipt, A., Rosenbaum, D., Rohe, T., Fallgatter, A. J., Hautzinger, M., & Ehlis, A.-C. (2019). The positive brain – Resting state functional connectivity in highly vital and flourishing individuals. Frontiers in Human Neuroscience, 12, Article 540. https://doi.org/10.3389/fnhum.2018.00540
Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2009). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247-266.
Kandel, E. R. (2013). The new science of mind and the future of knowledge. In S. H. Koslow & M. F. Huerta (Eds.), Neuroscience in the 21st century (pp. 3–20). Academic Press. https://doi.org/10.1016/B978-0-12-407236-7.00001-2
Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. Free Press.
Voss, P., Thomas, M. E., Cisneros-Franco, J. M., & de Villers-Sidani, É. (2017). Dynamic brains and the changing rules of neuroplasticity: Implications for learning and recovery. Frontiers in Psychology, 8, 1657. https://doi.org/10.3389/fpsyg.2017.01657
augh, C. (2022). An affective neuroscience perspective on psychological flourishing: How the brain believes that things are going well. In I. Ivtzan (Ed.), The psychology of flourishing (pp. 33–47). Springer. https://doi.org/10.1007/978-3-031-09786-7_3
