FROM TOXIC RELATIONSHIPS TO PERSONAL GROWTH

EXPLORING BREAKUPS AS A CATALYST FOR SELF

IMPROVEMENT

Lavanya Pandey

(K.R.Mangalam University, Sohna, Gurgaon-122103)

Abstract

Toxic relationships, characterized by emotional abuse, manipulation, and neglect, often leave
profound psychological scars, especially among young adults navigating critical stages of
identity and emotional development. While breakups from toxic relationships are typically
associated with emotional distress, emerging research highlights their potential to catalyze self-
awareness, resilience, and personal growth. This study explores how young adults (18–25
years) experience breakups as transformative events that foster emotional regulation,
boundary-setting, self-esteem rebuilding, and renewed life focus. Using a qualitative design
with semi-structured interviews and thematic analysis, the findings reveal that although
participants faced significant emotional turmoil initially, many reported enhanced emotional
intelligence, healthier relationship expectations, and personal empowerment over time. The
study contributes to existing theories of post-traumatic growth and resilience by illustrating
how relational trauma can lead to positive psychological outcomes. These insights hold
practical implications for therapeutic interventions aimed at promoting holistic healing and
empowering young adults to view relational adversity as a foundation for long-term personal
development. Additionally, the study underscores the importance of social support, self-
reflection, and therapeutic guidance in facilitating recovery. It also offers a nuanced
understanding of the role of self-discovery and personal agency in overcoming the aftermath
of toxic relationships.

Keywords: Toxic Relationships, Breakups, Self-Improvement, Post-Traumatic Growth (PTG),

Emotional Resilience
Introduction

Toxic relationships are characterized by patterns of emotional abuse, manipulation, neglect,

and power imbalances that result in persistent emotional distress and hinder an individual's
psychological well-being (Campbell & Sternberg, 2021; Andriana & Astuti, 2024). Such
relationships, particularly during young adulthood, interfere with critical developmental tasks
including the establishment of identity, emotional regulation, and autonomy (Bowlby, 1988;
Erikson, 1968). Young adults encountering toxic relational dynamics often experience a
significant erosion of self-esteem, heightened attachment anxiety, depressive symptoms, and a
disrupted sense of self-worth (Johnson & Taylor, 2020; Williams & Hartman, 2018). These
psychological consequences may not only affect immediate mental health but also shape future
relational patterns and emotional resilience.

Existing research largely emphasizes the detrimental impacts of toxic relationships and
breakups, highlighting emotional sequelae such as anxiety, depression, identity disturbances,
and increased vulnerability to re-victimization (Fagundes, 2012; Dunham et al., 2011).
However, recent scholarship has drawn attention to the potential for positive psychological
outcomes following relational trauma, emphasizing concepts such as post-traumatic growth
(PTG) and emotional resilience (Tedeschi & Calhoun, 2004; Southwick et al., 2014). Breakups
from toxic relationships, while intensely painful, may catalyze critical processes of emotional
introspection, the development of healthier relational boundaries, enhanced emotional
regulation, and the reconstruction of a coherent and empowered self-concept (Franklin, 2015;
Rahimah et al., 2022). Through mechanisms of self-reflection, social support, and adaptive
coping, individuals may not merely recover but achieve significant personal growth and
emotional maturity in the aftermath of toxic relational dissolution.

Despite these developments, several gaps remain in the current literature. Much of the existing
body of work tends to focus disproportionately on the negative outcomes of relational trauma,
with limited empirical investigation into the pathways of self-improvement and personal
growth, particularly among young adults (Wesselmann et al., 2012; Michaels & Simmonds,
2018). Furthermore, research often overlooks the role of cultural and gendered experiences in
shaping the trajectory of post-breakup recovery and growth. Within the Indian socio-cultural
context, where relational norms and gender expectations are distinctively influential,
understanding the nuanced experiences of young adults navigating toxic breakups is especially
critical (Choi & Lee, 2016; Rosenblum & Shulman, 2005).
In light of these considerations, the present study aims to explore how breakups from toxic
relationships serve as catalysts for self-improvement among young adults aged 18 to 25 years.
Specifically, it seeks to examine the emotional, psychological, and behavioral transformations
that occur following toxic breakups, focusing on the development of self-awareness, emotional
regulation, relational discernment, and personal empowerment. Employing a qualitative
research design and thematic analysis, this study endeavors to contribute to the theoretical
understanding of resilience and post-traumatic growth, while offering practical insights for
therapeutic interventions aimed at supporting young adults' holistic recovery and long-term
well-being.

Research Question

How do breakups from toxic relationships act as a catalyst for self-improvement among young
adults aged 18–25 years?

Objectives

1. To explore how breakups from toxic relationships act as a catalyst for self-improvement
among young adults.
2. To understand the emotional, psychological, and behavioral changes experienced by
individuals post toxic breakup.
3. To examine how coping mechanisms contribute to the recovery and personal growth
process after toxic breakups.
4. To study the role of social support systems in facilitating emotional healing and resilience
among young adults.

Significance of the Study

The present study holds substantial significance for both theoretical advancement and practical
application within the fields of psychology and mental health intervention. Theoretically, it
contributes to the growing body of research on post-traumatic growth (Tedeschi & Calhoun,
2004) by highlighting the transformative potential embedded within adverse relational
experiences. While much of the existing literature emphasizes the detrimental psychological
outcomes of toxic relationships, this study shifts the focus towards the positive psychological
changes that can emerge following toxic breakups, particularly among young adults. By
integrating concepts from attachment theory (Bowlby, 1988), resilience theory (Masten, 2001),
and self-concept development, this research deepens the understanding of how relational
trauma can catalyze emotional growth, identity reconstruction, and long-term psychological
well-being.

Practically, the findings of this study offer valuable insights for mental health professionals,
counselors, and educators working with young adults recovering from relational trauma.
Therapeutic interventions can be better designed to not only address emotional distress but also
to actively foster self-awareness, emotional regulation, boundary-setting, and resilience-
building. Understanding that relational dissolution can serve as a catalyst for self-improvement
enables practitioners to adopt a strengths-based approach, empowering individuals to view
their experiences as opportunities for growth rather than solely as sources of suffering.
Additionally, the study has important implications for designing culturally sensitive programs
that consider the unique socio-cultural and gendered experiences of young adults in India, thus
enhancing the relevance and effectiveness of psychological interventions in diverse settings.

Furthermore, the study provides young adults with a renewed perspective on emotional
recovery, emphasizing that the end of a toxic relationship can mark the beginning of a profound
personal transformation. By highlighting pathways of emotional healing, social reintegration,
and personal empowerment, the research contributes to reframing societal narratives around
breakups from a discourse of victimhood to one of resilience and self-actualization. In doing
so, it not only advances academic knowledge but also fosters hope and agency among
individuals navigating the aftermath of toxic relational experiences.

Review of Literature

Toxic relationships are interpersonal dynamics marked by manipulation, emotional abuse,

neglect, and power imbalances that erode individuals’ emotional and psychological well-being
(Campbell & Sternberg, 2021; Andriana & Astuti, 2024). Emotional abuse within these
relationships often involves verbal assaults, gaslighting, invalidation, and control, which
cumulatively diminish an individual’s self-esteem and autonomy (Engel, 2002; Brown &
Miller, 2017). Victims of toxic relationships frequently internalize negative self-perceptions,
leading to chronic self-doubt, shame, and identity confusion (Johnson & Taylor, 2020; Voss &
Markel, 2019). Manipulative behaviors, including guilt-tripping, love-bombing, and isolation
from support networks, further entrench emotional dependency (Azkia et al., 2024).

The psychological consequences of toxic relationships are profound, particularly for young
adults who are in critical stages of identity formation. Research suggests that prolonged
exposure to toxic relational dynamics can result in anxiety, depression, complex PTSD, and
impaired relational functioning (Williams & Hartman, 2018; Davis & Roberts, 2020). These
effects highlight the necessity of early recognition and intervention to mitigate long-term
psychological harm.

The process of relationship dissolution, especially from toxic relationships, is emotionally

complex and often mirrors the stages of grief outlined by Kübler-Ross (1969), including denial,
anger, bargaining, depression, and acceptance. According to Duck’s (1982) model of
relationship breakdown, breakups are not sudden but evolve through phases of emotional and
cognitive disengagement.

Attachment theory (Bowlby, 1969) offers further insight, suggesting that individuals with
insecure attachment styles—particularly anxious attachment—experience heightened distress
during relational separations (Fagundes, 2012). Studies reveal that individuals emerging from
toxic breakups often report intense emotional upheaval, including attachment anxiety,
depression, identity loss, and suicidal ideation (Dunham et al., 2011; Fagundes, 2012).

The emotional distress associated with toxic breakups also manifests in physical symptoms
such as sleep disturbances, somatic complaints, and elevated cortisol levels, which further
complicate emotional recovery (Brockmeyer et al., 2014; Hamer et al., 2009). Therefore,
understanding the breakup process from toxic relationships requires a comprehensive approach
that accounts for both emotional and physical dimensions of distress.

Healthy coping mechanisms such as seeking social support, engaging in mindfulness, and
practicing self-care have been associated with reduced psychological distress and enhanced
well-being (Bolger et al., 2000; Templeton et al., 2011).

The concept of Post-Traumatic Growth (PTG), articulated by Tedeschi and Calhoun (2004),
posits that individuals can experience significant positive psychological change following
adversity. After toxic breakups, survivors often report heightened emotional resilience,
improved boundary-setting, increased self-awareness, and a renewed commitment to personal
goals (Agustini & Musslifah, 2024). Studies by Franklin (2015) emphasize the role of
mindfulness and emotional regulation practices in facilitating recovery and promoting
psychological stability post-breakup.

Self-compassion has also emerged as a significant predictor of psychological well-being in

post-breakup contexts. Research shows that individuals who treat themselves with kindness
and understanding after relationship dissolution report higher levels of emotional recovery and
lower rates of depression (Hubungan Antara Self Compassion Dan Psychological Well Being
Pada Dewasa Awal Pasca Putus Cinta, 2023).

Social support systems play a pivotal role in the recovery process following toxic breakups.
Emotional, informational, and instrumental support from friends, family, and community
networks act as buffers against emotional distress (Hogan et al., 2002; Thoits, 2011). Emotional
support provides validation and empathy; informational support offers guidance and
perspective; while instrumental support helps alleviate practical burdens (Cutrona, 1996).

Research indicates that individuals who receive consistent and empathetic social support
experience faster emotional healing, higher self-esteem, and greater post-breakup growth
(Feeney & Collins, 2015). However, social isolation induced during toxic relationships often
complicates survivors' ability to seek and receive support immediately after breakup (Pasch et
al., 2004; Buunk et al., 1996).

Gender plays a significant role in shaping emotional responses and coping strategies post-
breakup. Women are generally more likely to seek social support and express emotions openly,
whereas men are often socially conditioned to suppress emotional vulnerability, leading to
internalized distress (Cross & Madson, 1997; Simon, 2010).

Studies suggest that while women may experience more acute initial distress, they also engage
more readily in processes of emotional reflection and self-reconstruction, thereby facilitating
personal growth (Feeney & Collins, 2015). In contrast, men may face longer-term challenges
in emotional processing due to societal stigmas surrounding male vulnerability (Mahalik et al.,
2003; Rosenblum & Shulman, 2005).

The developmental task of identity formation during young adulthood (Erikson, 1968) further
intersects with gendered experiences, influencing how young adults reconstruct their self-
concept and relational patterns post-breakup.

Previous empirical studies, such as those by Wesselmann et al. (2012) and Leary et al. (2011),
have explored the psychological consequences of breakups and the potential for self-
improvement. However, much of this research is either generalized across different relational
types or lacks a focus on toxic dynamics specifically. Moreover, the intersection of cultural
context, gendered experiences, and developmental stage remains underexplored.

Existing theoretical models—attachment theory (Bowlby, 1988), grief stages (Kubler-Ross,

1969), and resilience theory (Masten, 2001)—offer valuable insights but often fail to integrate
the complex socio-cultural realities of young adults in non-Western contexts, such as India.
There is a clear need for studies that capture both the psychological harm and transformative
potential inherent in toxic breakups, considering cultural sensitivity and gender diversity.

By addressing these gaps, the current study seeks to offer a more nuanced understanding of
how young adults navigate emotional distress and foster self-improvement following toxic
relationship dissolution.

Method

Research Design

This study employs a qualitative research design with a phenomenological approach to explore
the lived experiences of young adults regarding self-improvement following breakups from
toxic relationships. This approach is well-suited for providing a rich and nuanced
understanding of the emotional, psychological, and behavioral changes individuals undergo,
focusing on their subjective realities and how they perceive and make sense of these
experiences. The qualitative design allows for in-depth exploration of the research objectives,
which include understanding the effects of toxic breakups, coping strategies, personal growth,
and shifts in understanding relationships and self-worth, providing a depth of insight that
quantitative methods cannot offer.

Participant

The sample consists of 6 young adults, both male and female, aged between 18 and 25,
recruited through purposive sampling.

Procedure

The procedure involved recruiting participants through purposive sampling, obtaining

informed consent, scheduling interviews in comfortable settings, conducting interviews using
an interview guide with open-ended and probing questions, audio-recording interviews with
permission, taking field notes, conducting interviews in Hindi or English based on participant
preference, ensuring interviews lasted 30-40 minutes, transcribing and reviewing recordings
for accuracy, managing data securely, and prioritizing ethical considerations such as
confidentiality and the right to withdraw.
Result and Discussion

Descriptive Analysis

The descriptive analysis of the data collected from the interviews reveals that breakups from
toxic relationships often lead to significant emotional, mental, and physical challenges for
young adults. Participants described feelings of betrayal, low self-esteem, and anxiety as
immediate responses to the breakup. However, over time, many individuals reported
experiencing positive changes, such as increased self-awareness, personal empowerment, and
enhanced emotional resilience. Coping mechanisms like self-reflection, seeking social support,
and engaging in new activities were commonly cited as key strategies that helped participants
navigate the aftermath. Notably, those who were able to reframe the breakup as an opportunity
for personal growth often reported higher levels of self-improvement, whereas others continued
to struggle with emotional scars. The analysis highlights the complex, multifaceted nature of
breakups from toxic relationships and the diverse ways in which individuals process and grow
from these experiences.

Thematic Analysis

1. Emotional Impact and Mental Health Struggles:

Participants reported significant emotional distress, including feelings of helplessness, loss,

anxiety, and depression. Some also showed emotional detachment as a defense mechanism
against prolonged pain.

Emotional toll is in line with previous literature, which suggests that toxic relationships often
lead to psychological trauma and emotional instability.

2. Coping Mechanisms Post-Breakup:

Common coping strategies included engaging in physical activities (fitness, yoga), practicing
mindfulness, and seeking support from friends, family, and online communities.

Unexpectedly, many participants also practiced self-reflection, analyzing the relationship to

learn lessons for the future. This introspection helped foster personal growth.

3. The Role of Support Systems:

Social support (from family, friends, and online communities) played a crucial role in
emotional recovery. Many participants spoke about how their social circles provided
reassurance, encouragement, and practical advice.

The finding of online communities as an emotional support system was an unexpected result,
highlighting the growing role of digital platforms in emotional healing.

4. Self-Improvement and Personal Growth:

Breakups led to significant self-improvement, including increased self-worth, emotional

resilience, and a better understanding of personal needs and boundaries in relationships.

Participants reported personal growth in terms of healthier emotional boundaries, which is

consistent with theories on post-traumatic growth and emotional resilience.

5. Long-Term Changes and Reflections on the Breakup:

Over time, the breakup became a source of empowerment and personal growth. Participants
reflected on how they had become stronger and more capable of maintaining emotional
boundaries.

These reflections align with the concept of post-traumatic growth, where individuals emerge
from traumatic experiences with greater emotional strength and clarity about their life goals.

Interpretation:

Emotional Distress and Emotional Exhaustion: The duality of relief and sadness post-breakup,
along with emotional detachment, indicates complex emotional responses that reflect
attachment theory and emotional exhaustion in toxic relationships.

Coping Mechanisms and Resilience: Social support, physical activities, and introspection were
crucial in participants' emotional recovery. The engagement in self-reflection and journaling
also facilitated personal growth, pointing to the importance of psychological tools for
emotional processing.

Post-Traumatic Growth: The transformative potential of toxic breakups was evident, as

participants reported increased self-awareness, healthier boundaries, and emotional stability in
future relationships. This aligns with post-traumatic growth theory, which suggests that
significant life stressors can catalyze positive changes.
Recognition of Toxic Relationship Patterns: Many participants recognized harmful patterns,
such as emotional manipulation and co-dependency, which empowered them to avoid such
dynamics in future relationships. This reflects the growing understanding of personal
boundaries and relationship dynamics.

Discussion

This study explores the transformative impact of breakups from toxic relationships on young
adults, revealing that while these breakups initially cause emotional turmoil, they can serve as
a catalyst for personal growth and self-improvement. Participants shared their experiences of
sadness, anxiety, and emotional distress following their breakups, but they also demonstrated
remarkable resilience by utilizing various coping strategies such as engaging in physical
activities, practicing mindfulness, and seeking emotional support from friends, family, and
online communities. These strategies enabled them to manage their emotions effectively and
navigate the challenges of post-breakup life. As time passed, participants reported experiencing
a sense of empowerment, greater self-awareness, and enhanced relational skills. The process
of emotional recovery was closely linked to the practice of cognitive reappraisal, where
individuals reframed their breakup experiences as opportunities for personal growth rather than
solely as traumatic events. The findings of this study support the notion that adversity, like the
end of a toxic relationship, can foster post-traumatic growth when individuals have access to
strong support systems and engage in reflective practices. This underscores the importance of
emotional and social resources in navigating and healing from such experiences. The study also
highlights the need for future research to explore how diverse populations, cultural contexts,
and long-term effects of toxic relationships shape individuals’ journeys toward self-
improvement. By gaining a deeper understanding of these factors, mental health professionals
can better support individuals dealing with relationship trauma.
Conclusion:

This study underscores the pivotal role that breakups from toxic relationships can play in
fostering personal growth and self-improvement among young adults. While these experiences
often entail significant emotional distress, they also serve as critical junctures for self-
reflection, the development of coping strategies, and the enhancement of resilience. The
emotional aftermath of a toxic breakup can be tumultuous, often accompanied by feelings of
sadness, anger, confusion, and a diminished sense of self-worth. However, despite these initial
emotional challenges, the findings suggest that these breakups can catalyze transformative
changes, leading to a deeper understanding of oneself and a redefined sense of personal agency.
This process of self-discovery is essential for emotional healing and growth, as individuals are
forced to confront their emotional wounds, reevaluate their past behaviors, and reframe their
future relationship expectations.

The study reveals that cognitive reappraisal, social support, and self-reflection are central
mechanisms in facilitating the transformation of the emotional aftermath of a toxic breakup
into a constructive process of self-growth. Cognitive reappraisal, or the ability to reinterpret
distressing emotions and experiences in a more positive or neutral light, allows individuals to
reframe the breakup as an opportunity for personal development rather than as a source of
permanent emotional damage. By reshaping the narrative surrounding the breakup, participants
are able to regain a sense of control and agency over their emotional well-being. Social support,
whether from family, friends, or support groups, also plays a crucial role in this process.
Positive social interactions provide emotional comfort, encouragement, and validation, which
help individuals feel understood and supported during their recovery. The sense of connection
and belonging offered by these relationships helps buffer against the negative psychological
effects of breakup-related distress.

Self-reflection, a practice of introspection and self-examination, emerged as another key

mechanism in this process of emotional transformation. The ability to reflect on one's
experiences, behaviors, and emotional responses helps individuals gain clarity about their
needs, desires, and personal values, which in turn informs their future relationships and
personal goals. This reflective process often leads to an enhanced sense of self-awareness and
the development of healthier emotional regulation strategies, which can foster long-term
emotional resilience.
The research contributes to the broader understanding of how individuals can derive
psychological strength and self-awareness from adverse relational experiences, with important
implications for mental health interventions and support strategies. By recognizing that
breakups, particularly from toxic relationships, have the potential to serve as a vehicle for
personal growth, mental health professionals can design more effective therapeutic approaches
that focus not only on healing emotional wounds but also on promoting resilience, self-
empowerment, and healthy coping mechanisms. Interventions that emphasize cognitive
restructuring, self-reflection, and social support can help individuals navigate the emotional
aftermath of a breakup and emerge stronger and more self-aware.

Furthermore, this study highlights the importance of considering the contextual factors that
shape the breakup experience. The emotional and psychological impact of toxic relationships
is likely to vary based on individual characteristics, such as attachment style, previous
relational experiences, and coping resources. Future research should aim to explore the diverse
factors that shape this process across varied demographic groups and cultural settings, thus
offering further insights that can inform clinical practices aimed at assisting individuals in
overcoming relational trauma and promoting sustained psychological well-being. Additionally,
examining how different coping mechanisms interact with social and cultural influences could
provide valuable insights into the ways in which individuals can best navigate the complexities
of post-breakup recovery. Ultimately, a more comprehensive understanding of the factors that
facilitate post-breakup growth could lead to more targeted and effective interventions for
individuals seeking to recover and thrive after toxic relationships.
References:

Agustini, R., & Musslifah, E. (2024). Post-traumatic growth after toxic relationships. Journal
of Positive Psychology Research, 12(1), 45–59. https://doi.org/10.1007/jppr.2024.12.1.45

Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through
the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-
066X.55.5.469

Azkia, M., Fauziyyah, L., & Ahmad, I. (2024). Emotional manipulation and its impact on self-
esteem. Journal of Interpersonal Psychology, 14(1), 88–104.
https://doi.org/10.1016/j.jip.2024.01.001

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities
Press.

Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the
human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–
28. https://doi.org/10.1037/0003-066X.59.1.20

Brown, T. A., & Miller, G. A. (2017). Toxic relational patterns: Understanding and intervention.
Journal of Counseling Psychology, 64(2), 202–215. https://doi.org/10.1037/cou0000183

Campbell, L., & Sternberg, R. J. (2021). The toxic triangle: How narcissism, Machiavellianism,
and psychopathy contribute to dysfunctional relationships. Current Directions in Psychological
Science, 30(2), 153–160. https://doi.org/10.1177/09637214211007075

Choi, H., & Lee, J. (2016). Cultural influences on coping strategies post-breakup. International
Journal of Cross-Cultural Psychology, 47(3), 215–231.
https://doi.org/10.1177/0022022116644432

Cutrona, C. E. (1996). Social support in couples: Marriage as a resource in times of stress.

Sage Publications.

Fagundes, C. P. (2012). Getting over you: Contributions of attachment theory to understanding

the breakup process. Personal Relationships, 19(1), 37–50. https://doi.org/10.1111/j.1475-
6811.2011.01365.x
Feeney, B. C., & Collins, N. L. (2015). A new look at social support: A theoretical perspective
on thriving through relationships. Personality and Social Psychology Review, 19(2), 113–147.
https://doi.org/10.1177/1088868314544222

Franklin, C. (2015). Mindfulness as a mechanism for positive post-breakup adjustment.

Journal of Positive Psychology, 10(6), 504–511.
https://doi.org/10.1080/17439760.2015.1078596

Hogan, B. E., Linden, W., & Najarian, B. (2002). Social support interventions: Do they work?
Clinical Psychology Review, 22(3), 381–440. https://doi.org/10.1016/S0272-7358(02)00005-3

Johnson, C., & Taylor, R. (2020). Emotional abuse and self-esteem in toxic romantic
relationships. Journal of Family Violence, 35(8), 785–797. https://doi.org/10.1007/s10896-
020-00209-0

Leary, M. R., Twenge, J. M., & Quinlivan, E. (2011). Interpersonal rejection as a determinant
of anger and aggression. Personality and Social Psychology Review, 10(2), 111–132.
https://doi.org/10.1177/1088868311411231

Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American

Psychologist, 56(3), 227–238. https://doi.org/10.1037/0003-066X.56.3.227

Tashiro, T., & Frazier, P. (2003). “I'll never be in a relationship like that again”: Personal growth
following romantic relationship breakups. Personal Relationships, 10(1), 113–128.
https://doi.org/10.1111/1475-6811.00036

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and
empirical evidence. Psychological Inquiry, 15(1), 1–18.
https://doi.org/10.1207/s15327965pli1501_01

Williams, K., & Hartman, C. (2018). Anxiety and depression following toxic relationships.
Journal of Anxiety Disorders, 58, 26–33. https://doi.org/10.1016/j.janxdis.2018.07.004