People-pleasing: why saying no feels so hard and what helps

People-pleasing means pushing down your own feelings and needs and fitting in with what others expect, for fear of being disliked or letting someone down. Korean calls it the “good-child complex” or “good-child syndrome”, and the Korean national dictionary Urimalsaem defines the syndrome as a tendency to suppress your own feelings and wishes and go along with whatever others say, trying too hard to be thought of as good (National Institute of Korean Language, n.d.-a). Research defines people-pleasing as a tendency to put the needs and goals of others before your own (Blötner, 2026).

It is not a diagnosis. The World Health Organization’s ICD-11 diagnostic guidance has no diagnosis by this name. The closest wording is “submissiveness”, one of the terms it uses to describe symptoms related to personality: a tendency to adapt your behaviour to the actual or perceived interests and wishes of others, even when that runs against your own interests, needs or wishes (WHO, 2024). Scales that measure people-pleasing have only recently been built, and the researchers who analysed one describe it as an everyday rather than a clinical construct (Blötner & Werner, 2026, a preprint not yet peer reviewed). In a study of 2,203 Chinese university students, people fell into four groups ranging from mild to severe (Kuang et al., 2025). It is a matter of degree, not something you either have or do not have.

Research has studied the same pattern under several names. “Unmitigated communion” is a focus on others to the exclusion of the self; unlike communion, a caring orientation towards others, it is related to psychological distress, including depressive symptoms (Helgeson & Fritz, 1998). “Self-silencing” means not voicing your thoughts and feelings in relationships, and its link with depression has been studied widely (Pintea & Gatea, 2021). “Sociotropy”, which includes trying not to offend others and fearing being separated from them, has also been studied as a personality dimension that makes people more vulnerable to depression (Cho et al., 2011; Marfoli et al., 2021). Japanese researchers study “over-adaptation”, adapting too much to others (Ishizu & Ambo, 2008), and schema therapy, a form of psychotherapy, names “subjugation” (surrendering control to others), “self-sacrifice” (meeting others’ needs at the expense of your own gratification) and “approval-seeking” (Young, 2012).

mind.io does not offer a people-pleasing test, and this guide is not a diagnosis. It sets out, from research, what the label describes and how it relates to mental health, what has been studied as causes, how it differs from kindness and from personality disorders, how to practise saying no, and which kinds of help have evidence. Caring about others is not the problem. What went with distress was relying on others’ reactions and keeping yourself last (Fritz & Helgeson, 1998).

This is not a scored checklist, but research has found the same picture again and again. You look after other people’s requests and problems first and neglect yourself, and you judge your own worth by how others react (Fritz & Helgeson, 1998). You put your needs behind everyone else’s, yet find it hard to ask others for help (Helgeson & Fritz, 2000). Beliefs such as “saying no is selfish”, “if I say no, they will not like me any more” and “other people’s needs are more important than mine” can get in the way of saying no (Centre for Clinical Interventions, 2008).

If you say yes when you really mean no, resentment and anger can build up towards the other person even though they have done nothing wrong. Over time, a clinical self-help guide warns, this can lower your self-esteem and lead to depression and anxiety (Centre for Clinical Interventions, 2008). Schema therapy also describes “subjugation”, giving in to others too much, as generally leading to a build-up of anger (Young, 2012). Ways to handle anger that has built up are covered in How to manage anger.

This pattern is linked with mental health. In a meta-analysis of 42 studies (10,108 people) on self-silencing and depression, the correlation between the two was medium-sized, r = .39 (Pintea & Gatea, 2021). A focus on others that leaves the self out went with poorer psychological adjustment in both men and women across three studies, including one that followed adults in the community for 10 years (Aubé, 2008), and in Chinese university students, a stronger people-pleasing tendency went with lower mental well-being (Kuang et al., 2025). Most of these studies looked at a single point in time, so they cannot show what causes what.

Studies in Korea and Japan found something similar. In a study of 305 Korean university students, “trying not to offend others” was more strongly linked with depression and social anxiety than “fear of being separated from others” (Cho et al., 2011). In Japanese junior high school students, adapting to others helped them fit in at school but also added to their stress reactions (Ishizu & Ambo, 2008). Having this tendency does not mean you have an illness. But if you often feel worn out and low, it is a sign worth looking at.

One much-studied experience is feeling that parents gave affection and approval only when you met their expectations (conditional regard). In a meta-analysis of 31 samples, people who felt more conditional regard had more contingent self-esteem, self-worth that depends on approval (r = .29), and more depressive symptoms (r = .22) (Haines & Schutte, 2023). Teenagers who felt loved more when they did well felt an inner pressure that they “had to” and tended to suppress negative feelings (Roth et al., 2009), and students who felt more conditional regard tended to help others more for self-focused reasons than for the other person’s sake (Roth, 2008). All of these are correlational studies of what children perceived, so they do not prove that parents are to blame.

Taking on the role of looking after a parent’s feelings as a child (psychological parentification) has also been studied. In a study of 322 Korean university students, more of this experience went with a stronger need for approval, which went with more self-silencing and more frequent depression (Jeong & Seo, 2021). In a study of 387 adults in their twenties, parentification, self-silencing, loneliness and depression were all linked (Kim & Ahn, 2025). Because everything was measured at one point in time, the order cannot be settled.

Inborn temperament and attachment play a part too. Among 285 university students, those who said they had been strongly inhibited in unfamiliar situations since childhood (behavioural inhibition) sought more approval from others (Byun & Kim, 2019). In 423 Japanese university students, a focus on others that leaves the self out was linked with preoccupied attachment (Hagiwara et al., 2022), and in 364 young adults, anxious attachment emerged as a consistent predictor of stress in relationships (Shih et al., 2018). The fear of being abandoned is covered in Anxious attachment: how to cope. A study that interviewed seven middle-aged women in depth found temperament, family relationships, and the attitudes of their era and religion together shaped their good-child complex (Lee & Choi, 2026).

Culture and gender may play a part as well. The Korean word nunchi means sensing what others feel from the situation as it unfolds (National Institute of Korean Language, n.d.-b), and in itself it is a useful social skill. The Korean researchers above suggested that an unspoken social rule that you should act in line with others’ expectations may become a psychological pressure (Cho et al., 2011). On the other hand, for people who see themselves as closely connected to others, holding back negative feelings while making a sacrifice felt authentic and was linked with better well-being and relationships (Le & Impett, 2013). What matters is less whether you hold back than whether it feels like your own choice. In the United States, women’s assertiveness rose and fell with their social status between 1931 and 1993, which suggests it follows social status and roles rather than being a fixed sex difference (Twenge, 2001). The link between a focus on others that leaves the self out and poorer adjustment also held for both men and women (Aubé, 2008).

You may also come across the “fawn response”. The trauma therapist Pete Walker named it as a fourth response after fight, flight and freeze: seeking safety by going along with the wishes of a threatening person (Walker, 2003, n.d.). It comes from clinical experience, and a 2026 review found that, in substance use research, this response remains underdeveloped and understudied (Algarin et al., 2026). Not everyone who tends to please others has been through trauma. Reactions after trauma are covered in Trauma and PTSD: what helps.

Kindness itself is not the problem. In a meta-analysis of 27 studies (4,045 people), acts of kindness raised the well-being of the person doing them by a small-to-medium amount (δ = 0.28; Curry et al., 2018), and helping that people chose freely benefited both the helper and the person helped (Weinstein & Ryan, 2010). In a meta-analysis of studies on romantic relationships, being willing to make sacrifices went with better well-being, but actual sacrifices went with slightly lower personal well-being (r = −.07; Righetti et al., 2020). People-pleasing also overlaps with the Big Five trait agreeableness, but it is not the same thing (Blötner, 2026).

It also differs from dependent personality disorder. At the heart of that disorder is a pervasive, excessive need to be taken care of, which shows as submissiveness and clinging. The US diagnostic criteria (DSM-5-TR) include difficulty expressing disagreement for fear of losing support or approval, but at least five of eight criteria must be met, and fewer than 1% of people in the US are estimated to have the disorder (Zimmerman, 2023). ICD-11 has no separate diagnosis of dependent personality disorder; it describes personality disorder and its trait domains, such as negative affectivity (WHO, 2024). Finding it hard to say no is not, by itself, a personality disorder.

It overlaps with social anxiety too. Social anxiety disorder centres on worry about being judged negatively by others, with social situations consistently avoided or endured with intense fear (WHO, 2024). In a meta-analysis of 143 studies (80,285 people), the correlation between fear of negative evaluation and social anxiety was r = .53 (Peng et al., 2026). If being around people is itself frightening and you avoid it, see Social anxiety: what helps and Avoidant personality disorder; if your mood stays low, see Depression: what helps; and if you see yourself as worth little, see Signs of low self-esteem.

“Codependency” is used in a similar sense, but it is not a diagnosis and is a contested idea among researchers. A 2026 review of 30 studies found the term is applied to a wide range of relationship problems and remains conceptually fragmented. Even so, the difficulties called by this name were consistently linked with emotional distress, a disrupted sense of identity and problems in relationships (Molina et al., 2026).

If you cannot say no because you are afraid of the other person, it is a safety problem, not a personality problem. Abuse takes many forms, but it is always about having power and control over you (NHS, 2026). In that situation, safety comes before practising saying no. In immediate danger, call your local emergency number. US: National Domestic Violence Hotline 1-800-799-7233 · UK: National Domestic Abuse Helpline 0808 2000 247. How to recognise control and manipulation is covered in Gaslighting: what helps.

Start by looking at the beliefs that stop you saying no. A self-help module from a clinic run by the Western Australian health department suggests replacing thoughts like “if I say no, they will not like me” with “other people have the right to ask and I have the right to refuse” and “when you say no, you are refusing a request, not rejecting a person”. It adds that people who find it hard to say no usually overestimate how hard the other person will find the refusal (Centre for Clinical Interventions, 2008). In experiments, too, people declining invitations worried more than they needed to that the inviter would be angry or would not invite them again (Givi & Kirk, 2024). If a new belief does not feel true straight away, you can test it with a thought diary or a small behavioural experiment (Centre for Clinical Interventions, 2008).

You do not have to answer on the spot. Buy time with a phrase like “Let me check my schedule and get back to you.” Deciding in advance what you will say can help too. Part of what makes saying no hard is finding the words when you are put on the spot, and in experiments, giving people a phrase they could use to decline made their decisions about whether to agree feel more freely chosen (Schlund et al., 2024).

When you say it, keep it brief, polite and honest. Be courteous, for example “Thank you for asking”, and it is fine to say that you find it difficult. You do not need to apologise at length or give elaborate reasons (Centre for Clinical Interventions, 2008). The same module describes six ways of saying no: the direct no, simply saying “no”; the reflecting no, acknowledging the request and how the person feels before refusing; the reasoned no, giving a very brief and genuine reason; the raincheck no, saying not now but maybe later (only if you really want to say yes later); the enquiring no, asking whether there is another way the request could be met; and the broken record no, calmly repeating the same refusal (Centre for Clinical Interventions, 2008).

Saying no is part of assertiveness, which respects both yourself and the other person, between passive communication that erases you and aggressive communication that overrides the other person (Santé publique France, 2026). Japan’s workplace mental health portal also presents assertion as a way of expressing yourself that values both you and the other person (Ministry of Health, Labour and Welfare, n.d.-a). Before an important conversation, you can use DEAR MAN from dialectical behaviour therapy (DBT) as a checklist: describe the situation factually, express how you feel, assert what you want or say no clearly, reinforce what is in it for the other person, stay mindful of your goal, appear confident, and negotiate if needed (Texas Juvenile Justice Department, 2025).

Assertiveness does not mean refusing everything. In some situations, such as when your boss gives you a task, simply saying no may not be appropriate (Centre for Clinical Interventions, 2008). There, negotiating by offering to look for solutions together is a realistic option (Texas Juvenile Justice Department, 2025); you can also ask to narrow the scope or move the deadline. Guilt often comes at first. People sometimes keep saying yes to avoid feeling guilty, and no one is assertive all of the time (Leicestershire Partnership NHS Trust, 2018). Practise with small requests first, and for the guilt and self-criticism after saying no, see How to build self-compassion.

No treatment has yet been tested specifically for people-pleasing. The closest is assertiveness training. It has been described as an evidence-based approach used across many problems, but research on it as a stand-alone treatment has dropped sharply (Speed et al., 2018). In a trial that randomly assigned 100 Egyptian university students, eight group sessions based on DBT skills reduced stress (d = 0.52), anxiety (d = 0.30) and depression (d = 0.21) (ElBarazi et al., 2024). This was one small trial with small-to-medium effects, so larger studies are needed. A review of 14 studies in nurses and nursing students found mixed results, but chances to practise speaking assertively helped people speak up (Lee et al., 2023).

In cognitive behavioural therapy, you identify beliefs such as “if I say no, I will be disliked”, check whether they hold up, and test them gradually through action. The module mentioned above is also based on cognitive behavioural therapy (Centre for Clinical Interventions, 2008). Schema therapy works with patterns set early in life, such as subjugation, self-sacrifice and approval-seeking (Young, 2012). Its evidence, however, comes mainly from personality disorders (Taylor et al., 2017); for depression, seven small studies reported that it was no worse than established treatments such as cognitive behavioural therapy (Xu & Brockman, 2026).

Interpersonal skills such as DEAR MAN are part of dialectical behaviour therapy. In a randomised trial of 99 women with borderline personality disorder, treatments that included skills training worked better than those without it (Linehan et al., 2015), but studies of skills training on its own have methodological limits that make strong conclusions difficult (Valentine et al., 2015). For dependent personality disorder, psychodynamic therapy and cognitive behavioural therapy that address fears of independence and difficulties with assertiveness can help (Zimmerman, 2023).

For counselling, one suggestion is to pay particular attention to two aspects of self-silencing: judging yourself by others’ standards (externalised self-perception) and a self split between the outside and the inside (the divided self) (Pintea & Gatea, 2021). A counselling case study of clients who had suppressed their feelings in a good-child role concluded that it helps to explore the parental words they had taken in, reshape self-critical inner talk into more accepting language, and support emotional awareness and the recovery of assertiveness (Im, 2026).

If this habit leaves you low, anxious or so worn out that daily life is hard, do not carry it alone; consider talking to a professional. You can look at your mood over the past two weeks with the PHQ-9 depression check-in. If someone frightens or controls you, safety comes before practising saying no. In immediate danger, call your local emergency number. US: National Domestic Violence Hotline 1-800-799-7233 · UK: National Domestic Abuse Helpline 0808 2000 247.

In Korea, help is available from psychiatry clinics and city, county or district community mental health welfare centres, and the mental health crisis line 1577-0199 (24 hours) connects you to the nearest centre (Ministry of Health and Welfare, 2025). What happens at a first visit is described in Seeing a psychiatrist for the first time. In England, you can refer yourself to NHS talking therapies for anxiety and depression without a diagnosis (NHS, 2025). Elsewhere, start with your family doctor or local mental health services.

If things feel like too much and you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services. In Korea, call 109 (24 hours, free).

Q. Is people-pleasing an illness? A. No. The ICD-11 diagnostic guidance has no diagnosis by this name (WHO, 2024), and the researchers who analysed a people-pleasing scale saw it as an everyday tendency (Blötner & Werner, 2026, a preprint not yet peer reviewed). But holding back your thoughts and feelings to fit in is linked with depression (Pintea & Gatea, 2021), so if your mood stays low, consider talking to a professional.

Q. What is wrong with being nice? A. Being kind is not the problem. Acts of kindness raised the well-being of the people doing them too (Curry et al., 2018). What went with distress was not caring about others as such, but a focus on others that leaves the self out (Fritz & Helgeson, 1998).

Q. Is there a people-pleasing self-test? A. mind.io does not offer a people-pleasing test. Research scales have only recently been built (Blötner, 2026; Kuang et al., 2025), and we did not find one validated in Korean. You can check your overall self-esteem with the self-esteem test (the 10-item Rosenberg scale), but that test does not measure people-pleasing.

Q. I am afraid that saying no will ruin the relationship. A. When declining invitations, people tended to worry more than they needed to that the other person would be angry or would not invite them again (Givi & Kirk, 2024). Remember that you are refusing a request, not rejecting a person (Centre for Clinical Interventions, 2008), and practise with low-stakes requests first.

Q. Should I say no to my boss too? A. Not necessarily. In some situations, such as when your boss gives you a task, simply saying no may not be appropriate (Centre for Clinical Interventions, 2008). There, try negotiating by offering to look for solutions together (Texas Juvenile Justice Department, 2025); you can also ask to narrow the scope or move the deadline. If the work has piled up and worn you out, see How to recover from burnout too.

Q. What is the “fawn response”? A. It is the name the trauma therapist Pete Walker gave to seeking safety by going along with a threatening person’s wishes (Walker, 2003). It comes from clinical experience, and a review of substance use research found it still understudied (Algarin et al., 2026). Having a habit of pleasing others does not mean you have trauma.

Q. Will reading “The Courage to Be Disliked” help? A. We found no study testing whether reading it helps with people-pleasing. The book is a self-help work that explains parts of Adlerian psychology as a dialogue, and it is discussed in Inferiority complex: what helps. The approaches that research has looked at are practising assertive communication out loud (Lee et al., 2023) and assertiveness training (Speed et al., 2018).

Q. Is it my parents’ fault? A. No single cause can be named. Feeling that love came with conditions was linked with it (Haines & Schutte, 2023), but temperament was linked too (Byun & Kim, 2019), and researchers have suggested that cultural and social expectations may add pressure (Cho et al., 2011). Rather than looking for someone to blame, start with a small step you can practise now.

References: National Institute of Korean Language (n.d.-a), Chakan ai jeunghugun [good-child syndrome], Urimalsaem [in Korean], https://opendict.korean.go.kr/; Shogakukan (n.d.), Happō bijin, Digital Daijisen and Nihon Kokugo Daijiten via Kotobank [in Japanese], https://kotobank.jp/word/%E5%85%AB%E6%96%B9%E7%BE%8E%E4%BA%BA; Blötner, C. (2026), Valuing others over oneself: Development and validation of a people pleasing scale in two German samples, Current Psychology 45(9), https://doi.org/10.1007/s12144-026-09519-2; World Health Organization (2024), Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR), https://www.who.int/publications/i/item/9789240077263; Blötner, C., & Werner, J. (2026), Is it difficult to be a people pleaser? An item response-theoretical examination of the People Pleasing Scale, PsyArXiv preprint, https://doi.org/10.31234/osf.io/zacwm_v2; Kuang, X., Li, H., Luo, W., Zhu, J., & Ren, F. (2025), The mental health implications of people-pleasing: Psychometric properties and latent profiles of the Chinese People-Pleasing Questionnaire, PsyCh Journal 14(4), 500-512, https://doi.org/10.1002/pchj.70016; Helgeson, V. S., & Fritz, H. L. (1998), A theory of unmitigated communion, Personality and Social Psychology Review 2(3), 173-183, https://doi.org/10.1207/s15327957pspr0203_2; Pintea, S., & Gatea, A. (2021), The relationship between self-silencing and depression: A meta-analysis, Journal of Social and Clinical Psychology 40(4), 333-358, https://doi.org/10.1521/jscp.2021.40.4.333; Cho, A., Kim, H. Y., Oh, K. J., & Khatri, N. (2011), Structure of sociotropy and autonomy and their correlation with psychological adjustment in a Korean university sample, Korean Journal of Clinical Psychology 30(1), 337-347, https://doi.org/10.15842/kjcp.2011.30.1.018; Marfoli, A., Viglia, F., Di Consiglio, M., Merola, S., Sdoia, S., & Couyoumdjian, A. (2021), Anaclitic-sociotropic and introjective-autonomic personality dimensions and depressive symptoms: A systematic review, Annals of General Psychiatry 20(1), 53, https://doi.org/10.1186/s12991-021-00373-z; Ishizu, K., & Ambo, H. (2008), Tendency toward over-adaptation: School adjustment and stress responses [in Japanese], Japanese Journal of Educational Psychology 56(1), 23-31, https://doi.org/10.5926/jjep1953.56.1_23; Young, J. E. (2012), Early maladaptive schemas, Schema Therapy Institute, https://www.schematherapy.com/id73.htm; Fritz, H. L., & Helgeson, V. S. (1998), Distinctions of unmitigated communion from communion: Self-neglect and overinvolvement with others, Journal of Personality and Social Psychology 75(1), 121-140, https://doi.org/10.1037/0022-3514.75.1.121; Helgeson, V. S., & Fritz, H. L. (2000), The implications of unmitigated agency and unmitigated communion for domains of problem behavior, Journal of Personality 68(6), 1031-1057, https://doi.org/10.1111/1467-6494.00125; Centre for Clinical Interventions (2008), Assert yourself! Module 6: How to say “no” assertively, Department of Health, Western Australia, https://cci.health.wa.gov.au/~/media/CCI/Consumer%20Modules/Assert%20Yourself/Assert%20Yourself%20-%2006%20-%20How%20to%20Say%20No%20Assertively.pdf; Aubé, J. (2008), Balancing concern for other with concern for self: Links between unmitigated communion, communion, and psychological well-being, Journal of Personality 76(1), 101-133, https://doi.org/10.1111/j.1467-6494.2007.00481.x; Haines, J. E., & Schutte, N. S. (2023), Parental conditional regard: A meta-analysis, Journal of Adolescence 95(2), 195-223, https://doi.org/10.1002/jad.12111; Roth, G., Assor, A., Niemiec, C. P., Deci, E. L., & Ryan, R. M. (2009), The emotional and academic consequences of parental conditional regard: Comparing conditional positive regard, conditional negative regard, and autonomy support as parenting practices, Developmental Psychology 45(4), 1119-1142, https://doi.org/10.1037/a0015272; Roth, G. (2008), Perceived parental conditional regard and autonomy support as predictors of young adults’ self- versus other-oriented prosocial tendencies, Journal of Personality 76(3), 513-534, https://doi.org/10.1111/j.1467-6494.2008.00494.x; Jeong, Y. M., & Seo, S.-G. (2021), The relationship between childhood psychological parentification and depression: The mediating effect of need for approval and self-silencing [in Korean], Journal of Human Understanding and Counseling 42(2), 59-80, https://doi.org/10.30593/JHUC.42.2.4; Kim, S., & Ahn, M. (2025), The effect of childhood parentification on young adults’ depression: The mediating role of silencing the self and loneliness [in Korean], Korean Journal of Youth Studies 32(2), 127-157, https://doi.org/10.21509/KJYS.2025.02.32.2.127; Byun, K. R., & Kim, E. J. (2019), The effects of behavioral inhibition and parental psychological control on social anxiety: The mediating role of negative self-concept and need for reassurance from others [in Korean], Clinical Psychology in Korea: Research and Practice 5(1), 91-115, https://doi.org/10.15842/CPKJOURNAL.PUB.5.1.91; Hagiwara, C., Shimotsukasa, T., & Oshio, A. (2022), Development of the Japanese version of the Revised Unmitigated Communion Scale [in Japanese], Japanese Journal of Psychology 93(2), 120-128, https://doi.org/10.4992/jjpsy.93.20216; Shih, J. H., Barstead, M. G., & Dianno, N. (2018), Interpersonal predictors of stress generation: Is there a super factor?, British Journal of Psychology 109(3), 466-486, https://doi.org/10.1111/bjop.12278; Lee, E., & Choi, B. (2026), A phenomenological study on the formation factors of the good child complex in middle-aged women [in Korean], Studies in Humanities and Social Sciences 69(2), 151-170, https://doi.org/10.17939/hushss.2026.69.2.007; National Institute of Korean Language (n.d.-b), Nunchi, Standard Korean Language Dictionary [in Korean], https://stdict.korean.go.kr/; Le, B. M., & Impett, E. A. (2013), When holding back helps: Suppressing negative emotions during sacrifice feels authentic and is beneficial for highly interdependent people, Psychological Science 24(9), 1809-1815, https://doi.org/10.1177/0956797613475365; Twenge, J. M. (2001), Changes in women’s assertiveness in response to status and roles: A cross-temporal meta-analysis, 1931-1993, Journal of Personality and Social Psychology 81(1), 133-145, https://doi.org/10.1037/0022-3514.81.1.133; Walker, P. (2003), Codependency, trauma and the fawn response, The East Bay Therapist, January/February 2003, http://www.pete-walker.com/codependencyFawnResponse.htm; Walker, P. (n.d.), The 4Fs: A trauma typology in complex PTSD, http://www.pete-walker.com/fourFs_TraumaTypologyComplexPTSD.htm; Algarin, A. B., Lee, J. Y., & Zhan, X. (2026), Fight, flight, fawn, freeze: Rethinking substance use through a stress response lens, Current Addiction Reports 13(1), 21, https://doi.org/10.1007/s40429-026-00723-5; Curry, O. S., Rowland, L. A., Van Lissa, C. J., Zlotowitz, S., McAlaney, J., & Whitehouse, H. (2018), Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor, Journal of Experimental Social Psychology 76, 320-329, https://doi.org/10.1016/j.jesp.2018.02.014; Weinstein, N., & Ryan, R. M. (2010), When helping helps: Autonomous motivation for prosocial behavior and its influence on well-being for the helper and recipient, Journal of Personality and Social Psychology 98(2), 222-244, https://doi.org/10.1037/a0016984; Righetti, F., Sakaluk, J. K., Faure, R., & Impett, E. A. (2020), The link between sacrifice and relational and personal well-being: A meta-analysis, Psychological Bulletin 146(10), 900-921, https://doi.org/10.1037/bul0000297; Zimmerman, M. (2023), Dependent personality disorder (DPD), MSD Manual Professional Version, last updated January 2026, https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/dependent-personality-disorder-dpd; Peng, S., Zhou, M., Yue, L., Hei, X., Li, Z., Kong, F., et al. (2026), The relationship between fear of negative evaluation and social anxiety: A systematic review and meta-analysis, BMC Psychology 14(1), 1458, https://doi.org/10.1186/s40359-026-05211-z; Molina, E., Taiwo, A., & Grey, B. (2026), Co-dependency revisited: An integrative review of conceptualisations and mental health outcomes, Clinical Psychology & Psychotherapy 33(2), e70265, https://doi.org/10.1002/cpp.70265; NHS (2026), Domestic violence and abuse: getting help, https://www.nhs.uk/live-well/getting-help-for-domestic-violence/; Givi, J., & Kirk, C. P. (2024), Saying no: The negative ramifications from invitation declines are less severe than we think, Journal of Personality and Social Psychology 126(6), 1103-1115, https://doi.org/10.1037/pspi0000443; Schlund, R., Sommers, R., & Bohns, V. K. (2024), Giving people the words to say no leads them to feel freer to say yes, Scientific Reports 14(1), 576, https://doi.org/10.1038/s41598-023-50532-3; Santé publique France (2026), S’affirmer (et résister à la pression sociale) par l’assertivité et le refus (S2.1) [in French], https://www.santepubliquefrance.fr/docs/outils-dintervention/fiche-cps-sociales-saffirmer-et-resister-a-la-pression-sociale-par-lassertivite-et-le-refus-s21; Ministry of Health, Labour and Welfare (n.d.-a), Kokoro no Mimi 5-minute training [in Japanese], https://kokoro.mhlw.go.jp/fivemin/; Texas Juvenile Justice Department (2025), DBT DEAR MAN, https://www.tjjd.texas.gov/wp-content/uploads/2025/07/DBT_DEAR-MAN.pdf; Leicestershire Partnership NHS Trust (2018), Assertiveness (leaflet 492), https://leicspart.nhs.uk/wp-content/uploads/2022/07/492-Assertiveness-2.pdf; Speed, B. C., Goldstein, B. L., & Goldfried, M. R. (2018), Assertiveness training: A forgotten evidence-based treatment, Clinical Psychology: Science and Practice 25(1), e12216, https://doi.org/10.1111/cpsp.12216; ElBarazi, A. S., Mohamed, F., Mabrok, M., Adel, A., Abouelkheir, A., Ayman, R., et al. (2024), Efficiency of assertiveness training on the stress, anxiety, and depression levels of college students (randomized control trial), Journal of Education and Health Promotion 13, 203, https://doi.org/10.4103/jehp.jehp_264_23; Lee, S. E., Kim, E., Lee, J. Y., & Morse, B. L. (2023), Assertiveness educational interventions for nursing students and nurses: A systematic review, Nurse Education Today 120, 105655, https://doi.org/10.1016/j.nedt.2022.105655; Taylor, C. D. J., Bee, P., & Haddock, G. (2017), Does schema therapy change schemas and symptoms? A systematic review across mental health disorders, Psychology and Psychotherapy 90(3), 456-479, https://doi.org/10.1111/papt.12112; Xu, V., & Brockman, R. (2026), The impact of schema therapy and its basic and mode treatment models for depressive disorders: A systematic review, BMC Psychology 14(1), 1349, https://doi.org/10.1186/s40359-025-03103-2; Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., et al. (2015), Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis, JAMA Psychiatry 72(5), 475-482, https://doi.org/10.1001/jamapsychiatry.2014.3039; Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015), The use of dialectical behavior therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature, Journal of Clinical Psychology 71(1), 1-20, https://doi.org/10.1002/jclp.22114; Im, M. (2026), A developmental understanding of adult depression: A counseling case study on the good child role and emotional suppression [in Korean], Studies on Humanities and Social Sciences 8(3), 1095-1114, https://doi.org/10.62783/SHSS.8.3.65; Ministry of Health and Welfare (2025), Community mental health welfare centres and the mental health crisis line [in Korean], https://www.mohw.go.kr/menu.es?mid=a10706040100; NHS (2025), Find NHS talking therapies for anxiety and depression, https://www.nhs.uk/nhs-services/mental-health-services/find-nhs-talking-therapies-for-anxiety-and-depression/; Ministry of Health, Labour and Welfare (n.d.-b), Kokoro no Mimi: Where to get support [in Japanese], https://kokoro.mhlw.go.jp/agency/; Service Public (2026), Consultation d’un psychologue ou d’un psychiatre : quelle prise en charge ? [in French], https://www.service-public.gouv.fr/particuliers/vosdroits/F34917