If you’ve ever felt gutted after being left on read—or found yourself spiraling after a small comment from someone you admire—you’re not alone. The recent New York Times article on Rejection Sensitive Dysphoria (RSD) shines a light on something many people experience but often don’t name: when perceived rejection doesn’t just sting, it crashes over you.

At Catalyst Psychology, we see this emotional pattern often, especially among people with ADHD, anxiety or those who describe themselves as feeling things deeply. While RSD isn’t a clinical diagnosis, it’s a term that captures a very real emotional experience—one that can have a profound impact on how we think, work, and relate to others.

A Quick Note: It’s Not a Diagnosis, But It Is a Signal

Rejection sensitivity, especially in the form described as RSD, reflects a broader pattern of emotional sensitivity and reactivity. And for many, especially those with ADHD, that pattern isn’t just psychological—it’s neurobiological.

A 2020 meta-analysis by Beheshti and colleagues found that emotional dysregulation is a core feature of ADHD. That means intense emotional reactions, including those tied to social experiences, are often built into how a brain with ADHD processes the world.

Furthermore, the cost of this sensitivity can add up. In a longitudinal study, Gardner, Zimmer-Gembeck, and Modecki (2020) found that difficulties regulating emotions may both stem from and worsen the impact of rejection sensitivity, increasing the likelihood of anxiety, depression, and burnout.

If reading this feels overwhelming, know that effective, research-backed strategies can make a real difference. With practice, it’s possible to change thought and behavior patterns in ways that ease the weight of emotional sensitivity and improve daily life.

Real Life: The Grad Student Who Couldn’t Say No

Let’s bring this to life.

A graduate student we’ll call Maya came to therapy feeling completely burned out. She was constantly saying yes to extra research tasks, staying late to help her labmate prep presentations, reviewing drafts she wasn’t responsible for, and volunteering for projects she didn’t have time for.

Why? She was afraid her colleague might think she wasn’t smart enough, committed enough, or helpful enough. 

“If I say no,” she said, “I might be letting them down. It would feel like weakness to limit my work. The thought of someone thinking negatively about me if I say no feels so uncomfortable.”

Maya wasn’t just worried, her perception was that rejection was nearly certain. Maya’s fear was strong, contributing to her brain thinking the probability of conflict was much higher than it actually was. The intensity of fear related to these thought patterns led her to feel it was nearly physically impossible to say no.

This is a hallmark of rejection sensitivity: a brain on high alert, interpreting social ambiguity as threat, and overcorrecting through people-pleasing, perfectionism, or withdrawal.

Moving Forward with CBT: Reappraisal, Flexibility and Action

Maya didn’t need to become less thoughtful or invested—she needed new tools to respond to the emotional wave that followed perceived or feared rejection. That’s where Cognitive Behavioral Therapy (CBT) came in.

Two tools we used with her—tools we use often at Catalyst—were:

1. Cognitive Reappraisal: Offering Your Brain a Second Draft

Reappraisal helps shift your interpretation of events. When Maya’s colleague didn’t immediately thank her for help, her first thought was, “They think I didn’t do it perfectly.” In therapy, we worked to generate alternate explanations—They were distracted. Maybe they didn’t notice. Maybe it meant nothing at all.

These shifts sound small, but they can dramatically reduce the emotional charge and help calm the nervous system.

2. Cognitive Flexibility: Getting Unstuck from All-or-Nothing Thinking

Maya also learned how to catch her brain when it defaulted to extremes: “If I don’t help, I’ll be seen as lazy. If I’m not perfect, I’ll be rejected.”

CBT gave her space to explore more balanced options. She practiced tolerating uncertainty, setting small boundaries, and noticing when her thoughts were based on fear rather than fact.

3. Alternative Action: Turning Towards Your Goals

Maya found that when she began setting small boundaries with her goals in mind, she produced better work and enjoyed her work more. This gave her increased confidence to set additional boundaries to build a weekly schedule that was both ambitious and sustainable. 

Maya shared at the end of her therapy that she knows she will always be thoughtful of others and identifies as a “planner,” and she now understands that her success is defined by her, not the perceived needs of others. She said she could hardly believe how intense her fear once felt compared to how manageable it feels now.

Building the Capacity to Feel Without Drowning

Rejection sensitivity doesn’t mean you’re fragile—it means your system is wired for responsiveness, to scan, to try to prevent pain. That’s not something to be ashamed of. But it is something that can become exhausting without the right tools.

CBT helps build those tools. At Catalyst, we help adults and teens learn how to shift reactivity into resilience—through structured, collaborative work grounded in science and built around your real life.

If you experience strong emotions within your relationships, there’s a way to manage that wiring with more skill, confidence, and choice.

Catalyst Psychology specializes in evidence-based CBT for ADHD, anxiety, and emotional sensitivity. We work with goal-oriented individuals who want to feel less overwhelmed and more in control of their minds, their mood, and their relationships.

Reach out to us today to schedule your free initial 20-minute phone consultation. Let's discuss how we can help you achieve your goals.

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