# Involuntary vocalizations during negative memory recall

## Introduction

The sudden, involuntary retrieval of a socially awkward or embarrassing memory is a ubiquitous human psychological phenomenon. Frequently occurring during periods of low cognitive load or waking rest—such as driving, completing routine chores, or attempting to fall asleep—these memories seemingly emerge unprompted, bringing an acute, visceral wave of psychological discomfort. For a significant portion of the population, this spontaneous affective distress is immediately accompanied by an involuntary physical and motor response. The response may manifest as a full-body wince, a facial grimace, or an involuntary vocalization, which can range from a sharp intake of breath or a low groan to the sudden exclamation of a nonsense phrase, a curse word, or a command to "stop" [cite: 1, 2, 3]. 

Within contemporary social and digital lexicons, this experience is often informally labeled a "cringe attack." However, the scientific and clinical reality of the phenomenon sits at a highly complex intersection of autobiographical memory retrieval, the neurobiology of social pain, and motor control [cite: 1, 2, 3]. Because these vocalizations are executed without conscious intent and often involve the repetition of specific phrases, individuals frequently experience distress regarding their psychological normalcy. Many individuals erroneously conflate these benign, memory-induced behavioral tics with the intrusive thoughts of obsessive-compulsive disorder (OCD) or the phonic tics indicative of Tourette syndrome [cite: 3, 4, 5].

Current consensus across cognitive psychology and neurobiology frameworks defines these occurrences not as manifestations of psychiatric pathology, but rather as an evolutionary and neurocognitive chain reaction. The human brain processes acute social rejection and embarrassment using the same neural circuitry designated for physical pain [cite: 6, 7, 8, 9]. When an individual inadvertently retrieves a memory encoded with intense social shame, the resulting surge in affective intensity effectively overloads the cognitive system. This overload precipitates a phenomenon known as "motor overflow," wherein high-intensity neural signaling spills over into adjacent motor and language pathways, bypassing inhibitory control and triggering a vocal outburst [cite: 10, 11]. Concurrently, this vocalization serves an active psychological function, acting as a cognitive interrupter to shatter the working-memory replay of a perceived social threat [cite: 12, 13, 14]. This report exhaustively details the architecture of this phenomenon, examining the mechanisms of memory reactivation, the anatomical mapping of social pain, the physiological genesis of motor overflow, and the cross-cultural display rules that modulate these responses.

## Mechanisms of Autobiographical Memory Retrieval

To comprehend why a physical reaction accompanies an embarrassing memory, the fundamental mechanisms of memory retrieval must first be differentiated. The cognitive architecture governing how memories are brought to conscious awareness dictates the intensity and immediacy of the affective response. 

### Spontaneous Reactivation and Temporal Compression

Memory retrieval is broadly categorized into two distinct operational modes: voluntary, goal-directed retrieval and involuntary, spontaneous retrieval [cite: 15]. Voluntary memory retrieval relies on conscious search processes governed by the prefrontal-medial temporal lobe. It is essentially a top-down reconstruction attempt. During this process, the brain actively searches for and pieces together temporally compressed, item-specific representations [cite: 15]. Because voluntary retrieval recruits executive control regions in the lateral prefrontal cortex, the individual is cognitively prepared for the memory; the affective load is modulated and contextualized by the conscious intent to remember [cite: 14, 15].

Involuntary autobiographical memories operate entirely outside of this top-down framework. They lack any preceding reconstruction attempts or executive preparation. Research utilizing electroencephalography (EEG) and visual half-field paradigms demonstrates that involuntary memories are characterized by a highly rapid retrieval process, triggering a posterior event-related potential that can occur as early as 170 milliseconds after an internal or external cue is encountered [cite: 15]. 

When an individual experiences an involuntary memory of a socially humiliating moment, the memory reactivates sensory feature-dependent representations via temporally extended memory replay [cite: 15]. This replay is frequently accompanied by rapid mid-frontal theta-power increases, which are primary indicators of memory interference [cite: 15]. Because this rapid retrieval mechanism bypasses the lateral prefrontal cortex, the executive regions responsible for emotional regulation cannot buffer the impact. The individual is essentially ambushed by the memory's original, unmitigated sensory and affective load [cite: 6, 15]. 

### The Amygdala and Threat Tagging

The persistence and disproportionate vividness of embarrassing memories are the result of the brain's evolutionary imperative to prioritize threat detection. When a social misstep occurs—for instance, freezing mid-sentence during a public presentation, or making a severely inappropriate comment in a peer group—the amygdala tags that specific episodic event as a critical threat [cite: 7, 16]. The amygdala, functioning as the brain's primary alarm system, does not strictly differentiate between the threat posed by a physical predator and the threat posed by acute social humiliation [cite: 16]. 

Because the event triggered a strong autonomic and emotional reaction, it is encoded with heightened specificity. Psychological research consistently indicates that humans remember the specific details of negative events much more vividly than positive or neutral events [cite: 2]. However, this perceived vividness does not equate to objective accuracy. The threat-detection system selectively amplifies the most distressing elements of the interaction—such as the duration of an awkward silence or the perceived disapproval on the faces of onlookers—while simultaneously filtering out neutral or mitigating context [cite: 2, 16]. Consequently, when the memory involuntarily surfaces years later, the brain does not replay objective reality. It replays a heavily edited, neurologically enhanced version of the event with the affective contrast turned to its maximum setting [cite: 16].

### Reconsolidation and the Rumination Loop

The frequency of these intrusive memories is heavily influenced by the brain's Default Mode Network (DMN). The DMN is a widespread network of interacting brain regions that exhibits high levels of activity when an individual is not focused on the external environment, such as during mind-wandering, resting, or self-referential daydreaming [cite: 6]. During these periods of low cognitive load, the DMN frequently returns to unresolved moments of social embarrassment, replaying them in high definition [cite: 6]. 

A critical biological mechanism in the persistence of these memories is "reconsolidation." Every time a socially painful memory is recalled and elicits an intense emotional or physical response, the memory is effectively rewritten and stored again [cite: 6]. If the recall is accompanied by intense shame and anxiety, the neural pathways associated with that specific memory are structurally strengthened. This creates a self-sustaining neurological loop. The more an individual dwells on an embarrassing memory, the stronger, more easily triggered, and more painful the neural representation of that memory becomes, transitioning from a passing discomfort to a source of ongoing distress [cite: 6, 16].

## The Neurobiology of Social Pain

The transition from a silent, internal memory to a violent physical recoil or vocal outburst is rooted in the anatomical overlap between physical and emotional suffering. When an involuntary memory is triggered, the amygdala retrieves the threat-tagged event. This activates a specific neural pathway that essentially tricks the brain into experiencing physical trauma [cite: 6, 7, 17].

### Functional Overlap in the Pain Matrix

Historically, emotional pain and physical pain were classified as separate physiological phenomena, processed by disparate systems. However, decades of functional magnetic resonance imaging (fMRI) studies have fundamentally altered this paradigm, demonstrating that the brain processes physical injury and social pain using highly overlapping neural circuits [cite: 6, 7, 8, 9].

When an individual experiences physical tissue damage, the "pain matrix" is activated. This network includes the dorsal anterior cingulate cortex (dACC), the anterior insula, the somatosensory cortex, and the right ventral prefrontal cortex [cite: 17]. The somatosensory cortex and the insula are primarily responsible for mapping the sensory location and objective intensity of the pain. The dACC, conversely, is responsible for the subjective "distress" or the emotional suffering component of the pain experience [cite: 17]. 

Neuroimaging reveals that social exclusion, interpersonal rejection, and severe vicarious embarrassment activate this exact same distress circuitry. In landmark experimental models where participants were subjected to simulated social exclusion (e.g., being suddenly left out of a virtual ball-tossing game known as Cyberball), fMRI scans showed intense, immediate activation in the dACC and the anterior insula [cite: 7, 9]. Similarly, when an individual lies awake replaying an embarrassing interaction, the medial prefrontal cortex and anterior cingulate cortex light up precisely as though the feelings of shame and humiliation were occurring in real-time [cite: 6]. To the dACC, there is minimal neurological distinction between a sudden physical blow and the sudden recall of acute social embarrassment; both register system-wide as critical distress requiring immediate reaction [cite: 7, 17].

### Evolutionary Origins of the Shame Response

The sheer intensity of this social pain response is an evolutionary inheritance [cite: 7]. In early hominid history, survival was entirely dependent on group cohesion and tribal inclusion. Ostracization, banishment, or significant loss of social standing equated to certain death by starvation or predation [cite: 6, 7]. Consequently, evolutionary pressures co-opted the existing physical pain circuitry to serve as an immediate, unignorable alarm system for social threats. 

Embarrassment and shame evolved as low-status, self-conscious displays that communicate submission, appease dominant group members, and signal a desire for affiliation after a severe norm violation [cite: 18, 19]. When a modern individual commits a minor social faux pas, the brain's ancient survival architecture misinterprets the event as a potential prelude to social banishment. The brain files the memory as a survival threat because the interaction caused acute social pain [cite: 7]. The subsequent involuntary retrieval of the memory is the brain's maladaptive attempt to keep the individual safe: by violently reminding the individual of the pain of past social failure, it attempts to prevent any future recurrence of the behavior [cite: 6, 7, 16].

## Mechanisms of Motor Activation and Vocal Overflow

While the activation of the dACC and anterior insula explains the acute suffering of the cringe memory, it does not fully account for the motor action—the sudden urge to squeeze the eyes shut, physically wince, or exclaim a word, grunt, or curse. The transition from silent affective suffering to an audible vocal outburst is governed by a combination of cognitive interruption and physiological motor overflow.

### Cognitive Interruption and Schema Discrepancy

A sudden intrusive memory functions as a severe "cognitive interruption" [cite: 12, 13, 14, 20]. The emotion of surprise, or the sudden shock of a painful memory breaching conscious awareness, is evoked by unexpected, schema-discrepant internal events [cite: 14]. When the memory surfaces, it entails a spike in cognitive disfluency that elicits immediate, phasic negative affect [cite: 14].

This sudden internal event forces an immediate halt to whatever baseline cognitive task the individual was engaged in [cite: 12, 14]. Attention is involuntarily and entirely reallocated to the surprising and painful internal stimulus [cite: 12]. The rapid shift in cognitive processing, combined with the intense spike in autonomic arousal—characterized by sudden changes in skin conductance and heart rate—overloads the brain's standard processing capacity, setting the stage for a physical reaction [cite: 21, 22].

### The Motor Overflow Hypothesis

The most robust neurophysiological explanation for the involuntary vocalization itself is "motor overflow," also referred to in clinical literature as synkinesis. Motor overflow is defined as the unintentional movement of muscles that accompany, but are anatomically distinct from, a primary voluntary or involuntary neural action [cite: 23, 24, 25, 26]. 

Motor overflow is a highly common phenomenon. In neurotypical children and adults, it frequently occurs when the brain is subjected to high cognitive or fine-motor demands. A classic example is a person unconsciously sticking out their tongue or clamping their jaw when deeply focused on a delicate physical task, such as threading a needle or drawing [cite: 10]. Neuroimaging provides a clear structural rationale for this behavior. The region of the brain devoted to language production and mouth articulation—specifically the inferior frontal gyrus—highly overlaps with neural networks devoted to manual dexterity and complex cognitive processing [cite: 10]. 

When neurons in these regions are firing intensely due to heavy cognitive load or affective stress, the electrical signals "spill over" or overflow into neighboring neural tissue that directs the mouth, tongue, and vocal cords [cite: 10, 11]. The corpus callosum, which plays a crucial role in interhemispheric inhibition and preventing the spread of motor activity, can be temporarily overwhelmed by massive neural surges [cite: 25, 27].

In the specific context of a "cringe attack," the sudden retrieval of the memory causes a massive, localized surge of activity in the limbic system, the dACC, and prefrontal networks. This intense burst of neural noise breaks through the brain's standard inhibitory controls [cite: 23, 27]. The resulting neural surge causes motor overflow into the adjacent motor cortex and inferior frontal gyrus, resulting in an involuntary physical flinch or an audible vocalization [cite: 10, 11, 17]. Animal models strongly support this connection; physiological studies show that the dACC is critical not just for experiencing social pain, but for directly generating distress vocalizations in response to that pain [cite: 17].

### Vocalization as an Active Regulatory Block

While motor overflow explains the neurological leakage that leads to a sudden sound, cognitive psychology also views the vocalization as a highly functional, regulatory defense mechanism [cite: 4, 28]. 

When the intrusive memory plays, it completely dominates working memory and visual imagery. Because the internal experience of shame is acutely painful, the brain seeks an immediate escape route [cite: 29, 30]. Vocalizing—whether it entails shouting a random word, humming, taking a sharp breath, or muttering a self-deprecating phrase—requires complex motor planning, auditory processing, and active engagement of the brain's language centers [cite: 4]. 

By forcing the body to produce a sound, the individual effectively creates a jarring external auditory stimulus that overrides and disrupts the internal cognitive loop. It functions as a form of self-induced "thought-shouting" or sensory grounding [cite: 13, 31]. The auditory and motor action of speaking fractures the working memory's capacity to continue replaying the visual and emotional data of the embarrassing memory [cite: 13, 28]. In clinical and anecdotal settings, individuals frequently report that they involuntarily say things like "stop," "no," or utter profanities specifically because the auditory feedback acts as an immediate block against the intrusive thought [cite: 4, 28].

## Differential Diagnosis: Distinguishing Benign Vocalizations from Pathology

Because involuntary vocalizations and intrusive, distressing thoughts are hallmark symptoms of several severe psychiatric conditions, individuals who experience frequent memory-induced vocalizations often express significant concern regarding their mental health. They frequently question whether their vocalizations denote an underlying tic disorder, obsessive-compulsive disorder, or post-traumatic stress disorder [cite: 2, 3]. 

While the mechanisms of motor overflow and cognitive interruption are shared across both neurotypical and neurodivergent brains, there are distinct phenomenological differences between benign memory-induced vocalizations and clinical pathology [cite: 5, 32, 33]. Accurate differentiation relies on assessing the antecedent triggers, the functional purpose of the behavior, and the degree of controllability.

### Comparison with Tourette Syndrome

Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by the presence of multiple motor tics and at least one vocal (phonic) tic lasting for a duration of over a year [cite: 32, 34]. Phonic tics in TS can range from simple sounds, such as grunting, sniffing, or throat clearing, to complex vocalizations, including repeating syllables, words, phrases, or, in approximately 10 to 15 percent of cases, coprolalia—the involuntary utterance of obscene or socially taboo words [cite: 29, 33, 35]. 

The primary phenomenological distinction between a TS vocal tic and a cringe-induced vocalization lies in the antecedent trigger. Tourette's tics are almost universally preceded by a "premonitory urge" [cite: 29, 30, 33]. This urge is a localized physical tension, a sensory discomfort, or an "itch" in a specific body part that builds in intensity until the tic is executed, which provides temporary physiological relief [cite: 29, 30, 33]. The tic is fundamentally a response to the sensory-motor system misfiring, and is not necessarily tied to a specific autobiographical memory or emotional state, though general environmental stress can exacerbate tic frequency [cite: 30, 36]. Conversely, benign cringe vocalizations completely lack a physical premonitory urge; they are specifically and exclusively triggered by the episodic retrieval of an autobiographical memory and the subsequent spike of emotional shame [cite: 2].

### Comparison with Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is defined by the presence of obsessions, which are recurrent, intrusive, anxiety-inducing thoughts or images, and compulsions, which are repetitive behaviors or mental acts performed to alleviate the anxiety generated by the obsessions [cite: 29, 37]. While a cringe memory is colloquially described as "intrusive," it fundamentally differs from a clinical OCD obsession.

OCD obsessions are predominantly future-oriented, hypothetical, or magical in nature (e.g., "What if I left the stove on and the house burns down?" "What if I am contaminated with a deadly virus?") [cite: 5, 30, 38]. The resulting compulsion is a deliberate, highly effortful attempt to prevent a catastrophic future outcome [cite: 5, 30, 38]. An individual with OCD washes their hands repeatedly to prevent disease, or checks a lock multiple times to prevent a break-in. 

In stark contrast, an individual experiencing a cringe attack vocalizes in response to a past event that is fixed and cannot be changed [cite: 38]. The cringe vocalization is not a ritualistic attempt to prevent a future disaster, nor is it governed by rigid rules. It is a reflexive attempt to escape the immediate somatic and emotional discomfort of a past reality [cite: 29, 30]. 

### Comparison with Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) involves the involuntary re-experiencing of traumatic events through flashbacks, nightmares, and intrusive memories. While the structural mechanism of intrusive recall in PTSD shares similarities with the recall of a cringe memory, the nature of the encoded event is vastly different. PTSD is predicated on exposure to severe, life-threatening experiences, extreme physical harm, or profound psychological trauma [cite: 6, 38]. 

Some researchers refer to the intense recall of social humiliation as a "mild PTSD response" because both utilize the amygdala's threat-tagging mechanisms and result in hypervigilance and avoidance behaviors [cite: 6]. However, the involuntary vocalization in PTSD is typically a direct reaction to a perceived immediate threat to life or safety during a dissociative flashback, whereas the cringe vocalization is a reaction to perceived social demotion or embarrassment [cite: 6, 38].

### The Convergence: Tourettic OCD (TOCD) and ADHD

The boundaries between these diagnostic categories can occasionally blur, leading to complex presentations such as Tourettic OCD (TOCD). In TOCD, individuals experience physical discomfort or a diffuse "not just right" sensation—similar to a TS premonitory urge—that is relieved by performing a tic-like compulsion [cite: 5, 30, 32]. In these overlapping presentations, even seasoned clinical experts can struggle to distinguish complex tics from compulsions [cite: 30, 32]. 

Additionally, individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently exhibit higher rates of motor overflow and diminished executive inhibitory control [cite: 26, 39]. Because their neural "braking system" is less effective, the baseline emotional dysregulation inherent in ADHD can make intrusive memories feel more intense, and the resulting physical or vocal motor overflow much more pronounced and frequent than in neurotypical populations [cite: 26, 39, 40].

However, for the majority of the population whose vocalizations strictly correlate with the recall of past embarrassing events, the phenomenon remains a benign, albeit uncomfortable, quirk of the motor and memory systems rather than a sign of psychiatric decline [cite: 2, 30].

### Phenomenological Comparison of Intrusive Phenomena

| Feature | Benign "Cringe" Vocalization | Tourette Syndrome (Phonic Tic) | Obsessive-Compulsive Disorder (Compulsion) | Post-Traumatic Stress Disorder (Flashback) |
| :--- | :--- | :--- | :--- | :--- |
| **Primary Trigger** | Episodic recall of a specific, socially painful past memory [cite: 2, 16]. | Premonitory physical urge or somatic tension (an "itch") [cite: 30, 33]. | Intrusive, anxiety-inducing thought or hypothetical image [cite: 29, 38]. | Environmental or internal cue triggering recall of severe trauma [cite: 38]. |
| **Neurological Origin** | Amygdala/dACC (Threat memory) overflowing into motor cortex [cite: 6, 17, 26]. | Sensory-motor system misfiring, basal ganglia involvement [cite: 23, 30]. | Fear circuitry driving behavioral rituals [cite: 30]. | Amygdala hyper-reactivity, hippocampal dysfunction [cite: 6, 38]. |
| **Functional Purpose** | Distraction/escape from acute emotional distress and rumination [cite: 4, 13]. | Relief of physical tension or focal sensory discomfort [cite: 29, 32]. | Prevention of a feared catastrophic outcome or neutralization of anxiety [cite: 5, 29]. | Re-experiencing trauma; avoidance of ongoing perceived threat [cite: 38]. |
| **Controllability** | Highly involuntary; an automatic reflex to affective overload [cite: 4, 28]. | Often perceived as involuntary, but can be temporarily suppressed with effort [cite: 4, 5]. | Deliberate, effortful action driven by a compulsion to comply with a mental rule [cite: 5, 29]. | Highly involuntary during acute flashbacks; loss of present-moment awareness [cite: 38]. |
| **Temporal Focus** | The unchangeable past (social) [cite: 38]. | The immediate physical present [cite: 32]. | The preventable future [cite: 38]. | The unchangeable past (survival/life-threat) [cite: 38]. |

## Cross-Cultural Dimensions and Display Rules

While the neurobiological hardware underlying memory retrieval and motor overflow is a universal human trait, the ultimate behavioral expression of the cringe vocalization is heavily mediated by cultural context. The study of nonverbal emotional communication reveals that different societies have divergent "display rules"—unspoken cultural norms that govern how, when, to whom, and where emotions can be appropriately expressed [cite: 41, 42, 43, 44]. These rules dictate whether a neural impulse is allowed to become an audible sound.

### Individualism vs. Collectivism in Emotion Regulation

Cross-cultural psychological research consistently highlights a profound dichotomy in emotion regulation and expressive suppression between individualistic cultures (predominantly Western European and North American) and collectivistic cultures (predominantly East Asian, African, and Middle Eastern) [cite: 45, 46, 47]. 

Individualistic cultures prioritize autonomy, self-expression, and direct emotional communication. In these societies, expressing internal states is often viewed as authentic and healthy. Conversely, collectivistic cultures heavily prioritize group harmony, social cohesion, and interdependence. This cultural framework requires a much higher baseline of emotional suppression, particularly for negative, disruptive, or self-centered emotions, in order to maintain social equilibrium [cite: 45, 46, 47, 48].

When an individual with an independent self-construal (typical of individualistic societies) experiences an intrusive cringe memory, the resulting impulse for vocalization—such as groaning, sighing, or muttering a curse word—is less likely to be heavily suppressed by cognitive control mechanisms, especially if the individual is in a private or semi-private context [cite: 43, 47]. The motor overflow is allowed to run its course. 

Conversely, empirical research involving Chinese, Japanese, and other collectivistic demographic cohorts demonstrates a much stronger cultural mandate to suppress sudden emotional outbursts. This is particularly true for self-conscious, social-status emotions like shame, guilt, and embarrassment, as openly displaying these emotions can be viewed as socially disruptive or inappropriate [cite: 46, 47]. Consequently, an individual with a highly interdependent self-construal may experience the exact same violent internal reactivation of a shameful memory—evidenced by the same dACC and insula activation—but their deeply conditioned cultural display rules may successfully engage prefrontal inhibitory networks to suppress the motor overflow before it becomes an audible vocalization [cite: 44, 46, 47].

### The Universality of Nonverbal Vocalized Shame

Despite these regulatory differences, the basic nonverbal vocalizations of survival and social-status emotions possess a remarkable degree of cross-cultural universality [cite: 18, 49]. Studies matching vocal signals of emotion across vastly different linguistic and cultural groups—for example, comparing emotion recognition between English-speaking Westerners and the Himba people of Namibia—show that basic affective states are communicated with nonverbal vocal signals that are consistently recognized across human societies [cite: 49]. 

Interestingly, communication research indicates that while the facial channel is the preferred modality for communicating immediate survival emotions like fear and anger, the body and the voice are the preferred channels for communicating complex social-status emotions, including embarrassment, guilt, pride, and shame [cite: 19]. 

A groan of embarrassment, a sudden intake of breath, or a muttered exclamation operates as a universal paralinguistic cue [cite: 19, 50]. Even when this vocalization occurs entirely involuntarily and in complete isolation—when the individual is alone in their car or in an empty room—it represents the autonomic misfiring of an ancient, universally understood communication system. This system was evolutionarily designed to broadcast submission, acknowledge a norm violation, and offer appeasement to a watching, listening tribe [cite: 6, 19, 49, 51]. The modern cringe vocalization is simply this ancient social reflex triggering without an audience.

## Conclusion

The phenomenon of involuntarily exclaiming or vocalizing in response to the sudden retrieval of a socially awkward memory is a highly complex, multi-layered neurocognitive event. It is not indicative of clinical pathology, nor is it a symptom of psychiatric decline, but rather a perfect storm of the human brain's evolutionary, physiological, and mnemonic architecture [cite: 2, 30, 32].

The cycle is initiated by the brain's deep-seated threat-detection system, primarily the amygdala, which tags moments of social humiliation with the same neurobiological severity as physical injury [cite: 7, 16, 17]. During periods of low external demand, the Default Mode Network spontaneously retrieves these temporally compressed, highly vivid memories. Because this retrieval bypasses prefrontal regulation, the individual is instantaneously flooded with an acute sense of social pain, mediated by intense activation in the dorsal anterior cingulate cortex and the anterior insula [cite: 6, 9, 15]. 

This sudden spike in cognitive and affective load creates a state of severe schema-discrepant interruption [cite: 12, 14]. The sheer neural intensity overcomes the brain's standard inhibitory controls, resulting in motor overflow—a literal physiological spillover of electrical activity into the adjacent motor and language networks of the inferior frontal gyrus [cite: 10, 11]. 

Simultaneously, the resulting vocal outburst serves a highly adaptive psychological function. The physical and auditory act of speaking acts as an immediate sensory disruption, fracturing the working memory's painful replay of the event and allowing the individual to temporarily escape the immediate grip of the "shame loop" [cite: 4, 7, 13]. While cultural display rules dictate the ultimate volume, frequency, and social acceptability of these outbursts, the underlying physiological mechanism remains a universal testament to humanity's evolutionary past [cite: 43, 49]. Humans vocalize their private shame because the brain is fundamentally wired to ensure social survival, reflexively responding to the ghosts of past embarrassments as if they were present physical threats.

***

## Sources
1. [Therapy. Tourette's syndrome: a treatable tic.](https://www.ncbi.nlm.nih.gov/medgen/1813865)
2. [Vocal Tics in Adults: Exploring Symptoms and Treatment Approaches.](https://lonestarneurology.net/blog/vocal-tics-in-adults/)
3. [The neural mechanisms of involuntary memory retrieval](https://pmc.ncbi.nlm.nih.gov/articles/PMC12364361/)
4. [Glossary](https://nmoer.pressbooks.pub/cognitivepsychology/back-matter/322/)
5. [cringeworthy.pdf](https://cdn.bookey.app/files/pdf/book/en/cringeworthy.pdf)
6. [Cringe Attacks - What Are They and How Do You Stop Them?](https://harleytherapy.com/blog/posts/cringe-attacks)
7. [I keep remembering embarrassing episodes from my life and physically cringing.](https://www.reddit.com/r/mentalhealth/comments/cigexu/i_keep_remembering_embarrassing_episodes_from_my/)
8. [During some parts of the day, I seem to hate human faces. Am I ill?](https://www.quora.com/During-some-parts-of-the-day-I-seem-to-hate-human-faces-Am-I-ill-1)
9. [Hates popular kids starterpack](https://www.reddit.com/r/starterpacks/comments/krdyxw/hates_popular_kids_starterpack/)
10. [The Neuroscience of Cringe: Why the Past Still Burns](https://www.thesavvystreet.com/the-neuroscience-of-cringe-why-the-past-still-burns/)
11. [Why your brain treats embarrassment like physical pain](https://medium.com/@minddecoded/why-your-brain-treats-embarrassment-like-physical-pain-and-what-that-means-for-you-95805972abd4)
12. [The Neuroscience of Social Embarrassment](https://www.neurologylive.com/view/neuroscience-social-embarrassment)
13. [The Neuroscience of Social Pain](https://www.psychologytoday.com/us/blog/the-athletes-way/201403/the-neuroscience-of-social-pain)
14. [Social exclusion modulates mu rhythm and neural responses to physical pain](https://academic.oup.com/scan/article/19/1/nsae080/7874771)
15. [Cross-cultural Differences in Vocal Expression and Emotion Perception](https://www.researchgate.net/publication/339988042_Cross-cultural_Differences_in_Vocal_Expression_and_Emotion_Perception)
16. [Cross-cultural differences in emotion regulation in everyday interactions](https://pubmed.ncbi.nlm.nih.gov/27168184/)
17. [Cross-cultural recognition of positive emotions through non-linguistic vocalizations](https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2013.00353/full)
18. [Cross-Cultural Differences in the Early Processing of Multi-Sensory Emotional Cues](https://pmc.ncbi.nlm.nih.gov/articles/PMC4448034/)
19. [Cultural Differences in the Consequences of Expressive Suppression](https://psu.pb.unizin.org/psych425/chapter/cultural-differences-in-the-consequences-of-expressive-suppression/)
20. [Why Your ADHD Might Make Others Uncomfortable (And Why It’s Okay)](https://www.addrc.org/why-your-adhd-might-make-others-uncomfortable-and-why-its-okay/)
21. [Mechanism of Involuntary Vocalization Research](https://escholarship.org/content/qt60f0124n/qt60f0124n_noSplash_83cf66472d89440a9878adebe7c510f2.pdf)
22. [Surprise! Understanding the nature and consequences of surprise](https://scholarlypublications.universiteitleiden.nl/access/item%3A2957263/view)
23. [The Bounded Systems Problem](https://medium.com/@boundedsystems/the-bounded-systems-problem-hcar-400f1162054e)
24. [Surprise](https://www.researchgate.net/publication/288174512_Surprise)
25. [The Neuroscience of the Shame Spiral After a Bad Presentation](https://winningpresentations.com/shame-after-bad-presentation/)
26. [OCD and Tourette Syndrome](https://iocdf.org/expert-opinions/ocd-and-tourette-syndrome/)
27. [Obsessive Compulsive Disorder and Tic Disorders](https://pmc.ncbi.nlm.nih.gov/articles/PMC3401067/)
28. [How are mental tics different from intrusive thoughts?](https://www.reddit.com/r/Tourettes/comments/uzwabg/how_are_mental_tics_different_from_intrusive/)
29. [Obsessive-Compulsive and Related Disorders](https://www.mountsinai.org/care/psychiatry/services/ocd-tics)
30. [Tics vs. Tourette’s: What’s the Difference?](https://www.treatmyocd.com/blog/tics-vs-tourettes)
31. [The Evolution of Pride and Shame](https://pmc.ncbi.nlm.nih.gov/articles/PMC4238347/)
32. [Perceived Social Support and Shame as Mediators of Psychological Distress](https://pmc.ncbi.nlm.nih.gov/articles/PMC12798500/)
33. [The Complexity of Shame](https://cdforskning.no/cdf/catalog/view/126/628/4601)
34. [Crying and mood change: A cross-cultural study](https://www.ehps.net/ehp/index.php/contents/article/download/ehp.v9.i4.p68/929)
35. [Shame PDF](https://library.oapen.org/bitstream/handle/20.500.12657/47499/Shame_PDF.pdf?sequence=1&isAllowed=y)
36. [OCD Types: Tourette's & Tics](https://www.ocdtypes.com/tourettes-tics.php)
37. [Obsessive Compulsive Disorder and Tic Disorders Overview](https://pmc.ncbi.nlm.nih.gov/articles/PMC3401067/)
38. [OCD and Tic Disorders Services](https://www.mountsinai.org/care/psychiatry/services/ocd-tics)
39. [OCD and Tourette’s Syndrome: Differences and Overlaps](https://www.treatmyocd.com/what-is-ocd/info/related-symptoms-conditions/ocd-and-tourettes)
40. [A comparison of Tourette's disorder and obsessive-compulsive disorder](https://pubmed.ncbi.nlm.nih.gov/3477103/)
41. [Does rejection hurt? An fMRI study of social exclusion](https://sanlab.psych.ucla.edu/wp-content/uploads/sites/31/2015/05/LiebermanEisenberger2005.pdf)
42. [Emotional Contagion and Pain Responses](https://pmc.ncbi.nlm.nih.gov/articles/PMC10600148/)
43. [The effects of prior pain experience on neural correlates of empathy for pain](http://biorxiv.org/cgi/reprint/2023.02.02.526780v1)
44. [Psychosocial Correlates of Interpersonal Sensitivity](https://www.researchgate.net/publication/226100549_Psychosocial_Correlates_of_Interpersonal_Sensitivity_A_Meta-Analysis)
45. [Mother-Infant Synchrony and Neural Correlates](https://www.jneurosci.org/content/43/43/7213)
46. [Hyperkinetic Movement Disorders](https://www.cambridge.org/core/books/international-compendium-of-movement-disorders/hyperkinetic-movement-disorders/AA98F0615154BB1A83F4B5D0F7CD7F5C)
47. [OCD vs Tourette's Analysis](https://iocdf.org/expert-opinions/ocd-and-tourette-syndrome/)
48. [OCD and PTSD Fact Sheet](https://www.mirecc.va.gov/visn16/docs/ocd-and-ptsd-fact-sheet.pdf)
49. [Mount Sinai Psychiatry Services](https://www.mountsinai.org/care/psychiatry/services/ocd-tics)
50. [Tourette's vs Tics Comparison](https://www.treatmyocd.com/blog/tics-vs-tourettes)
51. [Other Concerns and Conditions Co-occurring with TS](https://www.cdc.gov/tourette-syndrome/other-concerns/index.html)
52. [Understanding Emotions Notes](https://www.blackwellpublishing.com/content/oatleyunderstandingemotions/Emotion_Notes.doc)
53. [Universal and Cultural Elements in Facial and Vocal Expression](https://escholarship.org/content/qt80h3z863/qt80h3z863.pdf)
54. [Vocalization in Labor: A Cross-Cultural Perspective](https://pmc.ncbi.nlm.nih.gov/articles/PMC12524220/)
55. [Nonverbal Channel Use in Communication of Emotion](https://www.researchgate.net/publication/51214348_Nonverbal_Channel_Use_in_Communication_of_Emotion_How_May_Depend_on_Why)
56. [Emotions Development Encyclopedia](https://www.child-encyclopedia.com/pdf/complet/emotions)
57. [The impact of online disruptive ads on users' comprehension](https://www.researchgate.net/publication/267776028_The_impact_of_online_disruptive_ads_on_users'_comprehension_evaluation_of_site_credibility_and_sentiment_of_intrusiveness)
58. [ADHD and Intrusive Songs](https://www.quora.com/Do-people-with-ADHD-tend-to-have-songs-repeat-in-their-heads-more-often-than-people-without)
59. [Concepts Book Cognitive Interruption](https://stop-abuse.ru/wp-content/uploads/2016/05/Jonathan_S._Abramowitz_Arthur_C._Houts_ConceptsBookZZ.org_.pdf)
60. [Display Rules in Expressing Emotions](https://www.psychologytoday.com/us/blog/emotions-in-our-lives/202405/display-rules-in-expressing-emotions)
61. [Display Rules of Nonverbal Vocalisations Across Four Cultures](https://www.researchgate.net/publication/383878278_When_to_Laugh_When_to_Cry_Display_Rules_of_Nonverbal_Vocalisations_Across_Four_Cultures)
62. [Cross-cultural recognition of basic emotions through nonverbal emotional vocalizations](https://pmc.ncbi.nlm.nih.gov/articles/PMC2823868/)
63. [Cultural influences on emotional display rules](https://bura.brunel.ac.uk/handle/2438/18418)
64. [Culture, Display Rules, and Emotion Judgments](http://www.davidmatsumoto.com/content/001-017%20Matsumoto%20et%20al..pdf)
65. [Why stick out tongues during concentration?](https://www.livescience.com/why-stick-out-tongues-concentration)
66. [Motor overflow in children with ADHD](https://pmc.ncbi.nlm.nih.gov/articles/PMC7167373/)
67. [Overflow Movements Predict Impaired Response Inhibition](https://www.researchgate.net/publication/8678847_Overflow_Movements_Predict_Impaired_Response_Inhibition_in_Children_with_ADHD)
68. [Motor Overflow and Executive Function in TBI](https://pmc.ncbi.nlm.nih.gov/articles/PMC6956647/)
69. [Subtle Motor Signs Report](https://s3-ap-southeast-2.amazonaws.com/figshare-production-eu-deakin-storage4133-ap-southeast-2/49773750/fuelschersubtlemotorsigns2024.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIA3OGA3B5WOX2T3W6Z/20260430/ap-southeast-2/s3/aws4_request&X-Amz-Date=20260430T194533Z&X-Amz-Expires=86400&X-Amz-SignedHeaders=host&X-Amz-Signature=576c593585a8e90f01f1089dab6a5c36a47da8c41a8167301715f30804b7f0bb)
70. [Signs of Emotional Manipulation](https://feeds.podcastmirror.com/btr)
71. [Can mania help study?](https://www.quora.com/Can-mania-help-somebody-study-for-a-test)
72. [Reading and Comprehension Cognitive Enquiry](https://dokumen.pub/reading-and-comprehension-in-the-african-context-a-cognitive-enquiry-1nbsped-9789966040534-9789966040169.html)
73. [Half Life Excerpt](https://web2.mlp.cz/koweb/00/04/30/22/02/half_life.epub)
74. [Scientology Dictionary Archive](https://www.xenu.net/archive/dictionary/)
75. [Cringe Attacks Mechanics](https://harleytherapy.com/blog/posts/cringe-attacks)
76. [Neuroscience of Cringe](https://www.thesavvystreet.com/the-neuroscience-of-cringe-why-the-past-still-burns/)
77. [Vocal Projections in Documentary](https://dokumen.pub/vocal-projections-voices-in-documentary-9781501331251-9781501331282-9781501331275.html)
78. [Theatre Aurality](https://www.scribd.com/document/457715182/Lynne-Kendrick-Theatre-aurality-pdf)
79. [Anthropology through Levinas](https://www.academia.edu/39665481/Anthropology_through_Levinas_further_Reflections_On_humanity_being_culture_violation_sociality_and_ethics)
80. [Ethnomusicology Journal TOC](https://cdn.ymaws.com/www.ethnomusicology.org/resource/resmgr/journal_toc/00.etm_64_2_nc.pdf)
81. [Vocal Displacement Analysis](https://www.diva-portal.org/smash/get/diva2:189903/FULLTEXT01.pdf)
82. [Self and Other Exploring Empathy](https://dokumen.pub/self-and-other-exploring-subjectivity-empathy-and-shame-9780199590681-0199590680.html)
83. [Expressive Universality Tests](https://escholarship.org/content/qt80h3z863/qt80h3z863.pdf)
84. [Women's Vocalizations During Labor](https://pmc.ncbi.nlm.nih.gov/articles/PMC12524220/)
85. [The Social Psychology of Emotions](https://ppw.kuleuven.be/cscp/documents/mesquita/2012thesocialpsychologyofemotions.pdf)
86. [Role of Parenting in Emotion Regulation](https://research.sabanciuniv.edu/52158/1/Role%20of%20parenting.pdf)
87. [OCD and TS Associated Features](https://iocdf.org/expert-opinions/ocd-and-tourette-syndrome/)
88. [Tourette Syndrome Criteria](https://www.ncbi.nlm.nih.gov/books/NBK499958/)
89. [Spectrum of Tic Disorders](https://tourette.org/spectrum-tourette-syndrome-tic-disorders-consensus-scientific-advisors-tourette-association-america/)
90. [OCD vs Tourette Details](https://www.mountsinai.org/care/psychiatry/services/ocd-tics)
91. [Tourettic OCD vs. Tourette Syndrome](https://lightonanxiety.com/ocd/tourettic-ocd-vs-tourette-syndrome-understanding-the-difference-getting-the-right-assessment-and-finding-the-best-treatment-path/)
92. [Social behaviors and ADHD](https://www.reddit.com/r/adhdwomen/comments/16wpccl/what_social_behaviors_have_you_learned_arent_the/)
93. [Creaky Voice and Frequency Code](https://pmc.ncbi.nlm.nih.gov/articles/PMC12365360/)
94. [Universals in Emotional Expressions](https://espace.library.uq.edu.au/view/UQ:dc084a0/s4262214_phd_thesis.pdf)
95. [The Anatomy of Cringe](https://www.samwoolfe.com/2022/02/the-anatomy-of-cringe.html)
96. [Auditory Preferences](https://mcdermottlab.mit.edu/papers/McDermott_2011_Auditory_Preference_chapter.pdf)
97. [Cultural Cringe Definition](https://pedestrianobservations.com/2018/08/31/cities-and-cultural-cringe/)
98. [Tourette's Broadened Conversation](https://www.aconsciousrethink.com/55366/do-you-actually-know-what-tourettes-is-i-thought-i-did-until-it-arrived-in-my-family-its-time-we-broadened-the-neurodivergence-conversation/)
99. [Shame Filter in Meaning Making](https://epublications.marquette.edu/cgi/viewcontent.cgi?article=2094&context=dissertations_mu)
100. [Motor Overflow Causal Influences](https://pmc.ncbi.nlm.nih.gov/articles/PMC8637062/)
101. [Tongue-out concentration and motor overflow](https://www.reddit.com/r/adhdwomen/comments/1q5f71a/a_herculean_genetic_study_just_found_a_new_way_to/)
102. [Startle Reflex and Motor Overflow](https://www.researchgate.net/publication/5393878_Interaction_between_startle_and_voluntary_reactions_in_humans)
103. [Right Prefrontal Activation and SICI](https://www.researchgate.net/publication/351287938_Right_prefrontal_activation_predicts_ADHD_and_its_severity_A_TMS-EEG_study_in_young_adults)
104. [Asperger Syndrome Assessing](https://hmk.am/wp-content/uploads/2021/04/Asperger-Syndrome-Second-Edition_-Assessing-and-Treating-High-Functioning-Autism-Spectrum-Disorders-PDFDrive-.pdf)
105. [Vicarious Embarrassment Autonomic Activation](https://www.researchgate.net/publication/230619335_Increased_autonomic_activation_in_vicarious_embarrassment)
106. [Startle Response to Sounds](https://pmc.ncbi.nlm.nih.gov/articles/PMC3709327/)
107. [Psychological Basis of Cringing](https://www.quora.com/What-is-the-psychological-basis-of-cringing)
108. [Recreational Fear and Startle](https://pmc.ncbi.nlm.nih.gov/articles/PMC11155347/)
109. [Misophonia QA](https://www.reddit.com/r/IAmA/comments/z11u8r/i_am_heather_hansen_osutrained_cognitive/)
110. [Tongue-out motor overflow response](https://www.reddit.com/r/adhdwomen/comments/1q5f71a/a_herculean_genetic_study_just_found_a_new_way_to/)
111. [DCD Neuroimaging Review](https://www.academia.edu/39901408/Wilson_P_et_al_2017_Cognitive_and_neuroimaging_findings_in_Developmental_Coordination_Disorder_New_insights_from_a_systematic_review_of_recent_research)
112. [Translation-dependent associative memory](https://pmc.ncbi.nlm.nih.gov/articles/PMC8637062/)
113. [Tongue protrusion as motor overflow](https://www.livescience.com/why-stick-out-tongues-concentration)
114. [Motor overflow in DCD](https://centaur.reading.ac.uk/82655/1/DCD%20Chapter%20-%20Brady%20%26%20Leonard%20-%20Pre-Print.pdf)
115. [Motor overflow and synkinesis](https://www.psychologytoday.com/us/blog/envy-this/201707/adhd-a-bundle-of-deplorable-problems-masked-in-plain-view)
116. [Neural overflow and tongue movement](https://www.psychologytoday.com/us/blog/theory-and-praxis/202504/why-do-we-stick-out-our-tongue-when-we-concentrate)
117. [Adventitious motor overflow](https://www.cambridge.org/core/books/descriptive-psychopathology/disturbances-of-motor-function/483CFFF43B2CBFF4953033CB3F6B9C2C)
118. [Motor Overflow in Live Science](https://www.livescience.com/why-stick-out-tongues-concentration)
119. [Motor overflow and facial expressions](https://www.reddit.com/r/explainlikeimfive/comments/6uo8ax/eli5_why_do_we_make_faces_when_we_are_doing/)

**Sources:**
1. [bookey.app](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQH95l1Q5S-eDBIWhKo0a3LpkqMjvaX-LZzor-9FxFpcvFLsdq1AxTFLsA6qyE0TlIN-3IavkDan24Oo3uyonJY_apxtqZDvt-_8ytR-2DkMCGIKHFSvoC_EUdAPUgIUg47dxhcCjQtDJEduHbSxqjQ=)
2. [harleytherapy.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEF3U6CotYIeiggJEk4xvig2hWk0p1vPzOsYd5tVKKmo4xxIInBtieLf6UuGdYJDkE4-gmCTy-Bu8fjVNOa1nM235C8D25qeU6JNJhj9YgtxqYoKWvtbdMarJFiRGHX3Id7lkx2SH1IqoU=)
3. [reddit.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEYAYlzroaeeZHLSN_qJkSK0fJMk-iU4xf-f4fW5i1Zt9NfyHYMQ0e7lRZCXkSkPZlGbNDZWkNhAhaBnLL_sc3bdmcZx0UisKUAsf600mX3Eqw7WD9vJgnDRElhb2CLaOuAOXezzL0pCWRLA1gkjC704PZlp8Q37S4qWXxIY80-jZAV5Aa5Rp8kh4EHbaRVRBrFQAcv4NdV29MNNb3P)
4. [reddit.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEhtEiPkNtDqSyyxKTENfrUWLPCVbtJYqGg4vZzrZbi86zSIrZmS3l6vhoz1relcfJ54llNWYKYpQG216MrOgP5SgJHoVtFRhM5tp2X7I7wDmGrZ8_lZEeHXhilJ2vdc3VFuAB8MBoYNjhopuzKrf3dKHZIzhT0PtoVVeJVOZQfEZ1TNU6yqEvKrg76uNWsKiOyRPNeDKc=)
5. [treatmyocd.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFFa41IwSGnGFOnwUCfGtRLmI4Q5NqwOdsgPTdtlP4SsWpZ7NqFPd_QujdY324RnjTcccdQYFNqFDyw3aefT075QDP5Uc9fGlhiAFCnxL1sYvQhrtBC4-mIIYhI8dwPmR6liw_6HZ-y)
6. [thesavvystreet.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHyV2_eV80sSJ8Ty12gOsbsQCYBKteOZn_QTHOOAYixMGYnNvVSH8NAsxeok0lJRctZ60Ch-gYr3hOTFzhBjQOZmkkWNaQoobrOdi2VXQ2pXBfwsPgN2sH-MP1FNFpUTlfAipcXkZ8zrdYXLgAluP-CBuTbWNMYB0aJDTBuls2xALiD1Vqz9B9OFQ==)
7. [medium.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHh_pUJW8SMmubSbjbqYQViSGsN-zQ-Rvr4bCQg1XNGAxxZPeumXVLU0libcNKwnuUTTMgKgmc8UAx-9FE5Q71_LEgNKgxS5S6S5Mbo3oX1qgM4hnJUcnF6fGe8I5uQ-mJISrPRMdSoKoNIc8esUwN2h33QyEOmNsSTGlSgv9MfY-j1sC5hF8qnvhXBchFBL9eU0sIL3CrXhvFgynM8bsZh4GMHIcWns5S3cOOwhx5V3hpEBY7R)
8. [psychologytoday.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHXY3F-6q91l5jN9oOAm8PFOKTaTVrLZ2oFtBbaZ3QkasnXSyVe9P0GEVi1znR_e8JGzmRTRGfwmyuMATCxhXNhKH7ZWZ8zHSjMc9YsFtexlojbaueWTvceHXmlXLCPklmOlQoog-X33pzwPAQEXyC07lxSTLX14k5imiCOSQ7SCcLUsEiRJkpms6o9_2zszTiEJgnWiA==)
9. [oup.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHNcrSCbr4UFDqrf8r49zcjiGKDWqvLNuSJLACurwe5J_s_3VLw04VwsW7qxPVp52b9FPPJNNxcrXc5GE9_eTHZtWh5_U33z-M4WVfmx9sw773yBHVFk3kjeoapheP4QGQHMqkKyjR785fGyyV9Xqbu)
10. [livescience.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGCA4WVLzsVeC0Lyf8QROKEyJhBd4SsC68ipRV64TSTC-8dsB8B1NZXox47R27SOOw9MCB9WCNqNplvZxLK8o4MY8dDy9CvT53qDAYjk3cG2rqAvPz0ERL1q-yBBRiFKunMRZi80NZyFldwHatjtc3okP1rw7M=)
11. [psychologytoday.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFrQJ2bBRyLxlot2b_c5aN1i8ZpGfVCzKgIddM5YhnD8LLEX4-GALJ1jwAnEIrtMVhyZGTzo6bV3NSiksfhrenuPyiX3gJhozfIBtuKvtXebw0EXtJSVJT1Bj3bsuwj48qzjAhJ43Urj2vqfdquei5JgbSS_owd5W4qR1lQjvaQloV-J-E5GJpnDnmxAJlVWXia8wM0ylQ-lO_yqotiXKHESMatAaoHomSt)
12. [universiteitleiden.nl](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQENOplO2IepiCAeZeUWTz-lhuZ07tiImHqyj94YXmBLV7ItK-kOmICa-qGMbUDow7PfuQj3TnkJhkrp_8hubNaisHdRHATjre66kRxpP4se_2hL4lmvgOoW6J1sWtkCym2rbTsq67MYARtyE_9pnMuMD9mBIc6TovbvAW58-ezEQvRi-sc=)
13. [medium.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFtH_MvCg730_HoDrXsZTbawS2Z92DnuyouNzT0ioIGSFT719ZdHc5wtQNyWl32bKhXPWd8yCbqFZXod376GPWCy8T4iLSP0lFfKNPFXVDt-rZRGgnCjkpabHcPcihOdRNUmR_6Q0rSsd-hCpWnrQ73syHTkeZFGlm9LM07ZhbHyDdx_rN9jg==)
14. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHBxizZ3BjyDSR3Z81qgAfi5dvsdArGyv1sEmmSPc15m0H13d2TWKoWRq5s-myVZkOtB3dj0cUoRa6xyM8NdxS4tqPLAmSUyC-0XaDvKPlNN4LKr_LNTr4MKWwov0iCu1jpgn_ifT1gq6-gZAkTdbiN-w==)
15. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEibCRLAI7JRxC9Bz9v3HOWoZFNrQImyeJHDcNz-V6YHXY1_-PhbYCOidN27pTqNizM_13DISx4N4IxiJx2drF3L9XxvcAN3BWhDrhhYAqkxpAs8zpvEaHIc_CqCVkzAv0XZ9misQOpkw==)
16. [winningpresentations.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHQpN1qgaomE11GeYa5iGTGaP0zLuq2QbrSRGg5GOXGknlrYQ1Vq6RwdDWyOgXlXcquyp3E1UD9SUX4xVwbToPiONsl_AEyXyMtchBqWjeTsqBSelXHhGNuI4KacEHuqdZNrWJF25499JC5y8ouXvdmsbRigg==)
17. [ucla.edu](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEQl-66UL77mhq1cOWgou0sIUQoJd3O2H-pnUHhBqgknJnFs1t17cIfp3yNm95Sl9qe6r94XHxiBp8M5vw9oswq-6y0CfhhSS-jYAgXTO7nKTgEqdwTIltAcNoNwnOmCj0V5pBXJ-a8PtvLq7JCotW1RwApbQxrU8Bc6XmgdP4AeLmt-xiVWmezYWDZQwL2ANQqtKNn)
18. [escholarship.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQE7NmMcFRCR2HdojwLC2KfwtrgEWeh1q2ltCB38zJMoZYEwsdEO7wIMx2U8uHktPsQHfvBaoEDJRSyB4PgD1zWzwYeeWu49eOXMjkTl-ylOgf7LOOBkYadNVDLKb73M29DAbgs-PLh703CvUmeXGU9u)
19. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFchaAGY0iu3dNdty9fCf8EAzEpziQ6rUbVFLVwbBtuqd85BU9ssm64J0YRXAnB8I2Q0Bmdu9fPavw7W-r6C5V8S8mbKLJbNxLgvJGBENsJCJ7RZ7B_yTgyVCYb3JVK9j4XgObV95jGgTVWG-8i2_ss8CIJhg1gRDb-8o7NZDcTvb29H0xOgnpdgtRhAe1HdebjLbbcZP3F1RW5NHq9ACFwpOYdLYAmfbmSRYqH05du)
20. [escholarship.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHOCLhGjbEUF_S928x_nXOuGyC8U1Nm2WUuA11FHN9wvDibF7kxVnqpfqL7l67IarzE9JLB8vak-goQq4el3IMCY78irD8yABYHmwfSAPYovwFCezCgImUEW_hfOMeS4S1SVDPUQg58ZX55-lMCgZI5UfhOFl5prAgAQbVj-DjVrREm5LK-zk7_byePTHHFjIteg-Y8z0krC1C6)
21. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGCUswwrXdjAm3uMYtUXu-kgSWDq2taYfWcF5kMhaImp35oOemcL2sqXBAgIDxo8QTp3sKIzp9jj5v9mMmUS-lljMlne5m_3AL70pDqQCIoHADLH4aayqUeKeOCx-JXY1oYYp5UBg8fl5ZsB3VoJj4jduSqOLny8EPdd3bSz04I3IlOa7cy_vrV2rM66rjmkz2ZL9nLd_EAkANFDfu-t5-_iLlgFw==)
22. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQH-sskRS6rM-IUi4gAKxBo65Cad4Bif1n5_s0UmXyIPDNXR4YD-LO43VuoDj1mR39liS1_CtmqmyJboekSb5Pc0JqzOOnedYDX2BJe8YdTAygPx5XhIViQFFd7-6bGoXd7CVMHtKh-m4_xRYYh8KBk5NHFBVPNqTqBDo9UdXb2PlquV_JlwKhYncLpNf1OOmLj5mWnN9nekz1UNdDY3sSs1z9E=)
23. [cambridge.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHYBS5TuLw6yFIEtqsHS8RHK1DP9722ATnVpJyd4epbrGQAI_ZrcsJX4XKPk3MYzn_pwGF8L3hdvmI7btTCWWII1-IaOHhEg5STo3yHBNWgUNCC-ysF2ArVcRK7Rc7z87k1e_mokQCWsygzvh3ceaDGM53qzd3cQp9Mi3w2ACIAaZjAt6JKmhXtsn3Z2zkHx2r4C5UIA9ApwsIUqYchkVGJs1fDWEZOnb9oGXkTKTDlX-c2KKVWdmj6Ni-yrqq_n5asGNTzhrrFVEsYMg==)
24. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEGWE825V2UdvlbpZLKny11W9ghzxbDDIo65w882Ac30HrVi_Vk4cfx_yP8VFdPkk9KQd9aIrYtuVx7cjN_EIY-8o9uZI2OrcgO0CLOFw3WhbkPP2bppyaiGGSey1k6mIE7qMciD9jv)
25. [amazonaws.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEC4RVKW22v_u00RV4IPA3JqiqgViX2SYqHIXoKICPp9bvKkIxlf_ClfSCYDkUvXIkbxXIIoWkPkIaIhcP8_6AZlT4aXeqIqqXTRM5LPDPj4CG5nFHPvbJzMs7HXJjZwpF5a2fPtOza_dfyNSczDaVABfANy6lNlIcPhFRENlOYqwYqGcInMHfYyJiLHUJmrbDO7GzQryk_4npxozooX1V3wQ5nnTXcAUMOc91wExgEXj3ueEvZz3yxA7ciuNdydvw9Vzb4jGXPYNXQJ_K-pUpr5-3lPeDSZlIHC-UMwRXK0GQKGZDoCljOKTf-TXMbQ4DtYBRtJ9vyEPDUiUaPSj6utl8KxsTq4036e8DwH1HHSPrS1oOEd0Jn5GP-7aHdDzzkyNsTRUiU63NtB4fh1UFm5tb_DI75QkV1nXukzdXMM5P2BabEUFYdGGHgXiJMlT37USD5x_pfSv-_rCFgzDJe9OeYH_VKDJWMCIfXlbtqNeLVwxM4O6BZKmS0yIHsmXczwkLLRWQ_M1sIfaJJ8z1O5m--WSieb2uR9779rhdiJHkGdTc5xzJVCrdS1sIHB5PvqEOvMiEP834hi3fCVwQSodrEJaZA1igTtVU=)
26. [psychologytoday.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG_mLmIF8P3skAf3_-1gIlgU1NzVdEVFqLlQZ8a1ZWnYZoGaIhTLrs_17N2cuhRvCcWOFzJjZwdqt-ySq16j4ozV_MjXzEz8UKNIp0VOga8Ne2nPW9zhRMXc9X7wRqyCsLWpLB_fEefcjQahgEsfYVcrGQlGNgm4Y91n0jLOivTpXy0xPwXbbFXqfLe3szSeHOj44XBBWZ2ynYszKDntQxNlLTSnsedDMs=)
27. [reading.ac.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEY4YWBOlGSQzHVdNwozBIoqyTRuab3dnq4FjzHZNGylN5y5trmA993yXZQeJdFwI2bXICBa6k5I1ZB2WoMYKWaJTefLIxy7JZRG79MOG3arTdojEAYEhjsgt49D8vL08zWPNFR9roSuG-a2ZYEqK41LcMt4ix3f53y9xdlKEE8otfJhH7gf2NXlPslm2M_NZ-b2CB53lKK2Z4=)
28. [reddit.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHvXuFEapWM4Z-0dPDod_-J9hSfR-ObuDADYnkVXWRQGa_9-4gyQ-_r5nazxQjVco9uk7aPXohzgc61GkH5_7htbIbaLEFk6nNhhFF3HGelt7InicyvM6lPDJBJ74Ycm_GlGh6oWdwZDpa-cPhDfxsvlMNtzE2C67jmRRoMv0uBlxE7ODFGFY2Nirct1v3O7D9HLKGSrWnGfp82XA==)
29. [treatmyocd.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGSKJxnjUuADaKsus5hY2w8GbdKYtES0jURLs28HwonR8zQLQTS76fIysSca4adByPo-9MTifD2IdgjqbykOLQEc22J0f7n_1R5veoqvdaGfV8UbxmwyLodVJEB1YsNGyRtZWkpXvDV-knoOS9lfsRi4n5p3oFMZ1_Vet2Hnhw_GWThUy5XLQHNR0eNG7vnRQ==)
30. [lightonanxiety.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQE1nNKHOxyeBo9Z1X7Lh4G3pneTjNpDKVfUupqpxH5_FDMywLpmnhQJAbJkbvWhOQd1NnZQrFFv_MdGMxxQbEChDlme0hUTzWx08NmJ3VbnB2i7TVZXkhkpbHlKIMG28V60iJMEFY4DJIfRWi-NUI6r9hkrHJS_YrYFU0ctgdznpYsEeKpucR2FfOB88u_zNOLkIepo2hTQvS_71TI-PANf7NqHNd-tT-BBlVxVIEjqQgoRy2APt-Pk4-bSoQfg6eokbq8rNfUsGPIrcR-7_mZf_H_dEIoUpQ==)
31. [xenu.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHZlULw5gRaDx85T2t0BU_I3azZFSpTjst8fmD17pCq4Ih8INCs6uDCPFw3zS3ZHqMecNJflnuY1ph9TlC1p9tj1om5XVelERDsG8Hj7EqwAWLEcQwN9obwpg2rHIix)
32. [iocdf.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQF2vYY_OGzLBB2YrT39LtXNTq6h2BYhP4mwltdA_1t4sodpuuOND2O3i5msDNuc-M5-w_Ra9O-WGxxogI9yPHBG_6WirJGRXeOTWUqriJq--jucgs8EFpfaFMDqLB70VjWPeHQMkXPgZO7nYf4zWTY4Szw=)
33. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG7CR37bh0iF0KvNCHW3AJ87H59h_dPkNq6eHf4j6pRLIDXl9t_U9DxzcAsxrslSo9fSpA3Dbb80tun8w3r95EjuH95mxHD3AemqTvWYKv6rnujjXxztI_aqb2OHPODNIPJhIV7osUd)
34. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQE-AHiLyP0v-Dmy5PcyYNT-XZr8iPDp3-1KRP2buCdHcHmTxbU2ITGt7kJHcMLoL3Wk46e_jikhZWFO3mXlg4EOEeEnHdMs7hZZF8PM6gdh-7KNUw12zgPmUEdiQuGooeP6NGo=)
35. [aconsciousrethink.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEfNTgZdLQTDZ2Do-rHfBOdjOW-4vSt3hLljeAPdvj_Q8xh8m20D_wmq33pXhCIy1cJTctIgi2BqRW-R66PChl4q0gCm8JBY0a3qeC_eIlpwVsXyD05tsAVS_Kiuoj9qXONvlP3qJV0vz_bZrlEncSYsENT6p82iQ0QLN-xucltDvwQgI1cn_tsrruizjqsmIk3pCa_Unnbk4mlsH4qec5NgfkPSs67X3t6T6rwQCYVGR4jia0dzWBJQ8_n0gL1gWiUlq9ikaeDMlLEKJkedvUPrdBgyuq79cHnEdebDlRByZIfk8QtH5_BsuVv)
36. [ocdtypes.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG1fG3Z67C_cdgJp2HELWRjIGzuGXqmjyv8jneuG7bDqGjJdN3xN9gOano7pRfzM3dAooNfWcWnPFbeKW6yPBPcgAANx9nC6ZaIxHzhD6L-SdX-PPZG8Qq8zuXE4ayGz8kl)
37. [mountsinai.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFBVvCLlF1h1MkDRxBtq7Xx0ffyq4h4v-0lNe6BIKdBYSsVu41AWt3rTg4SEnEYnpBQrzCElCyENVzNk6pmljVUz46y397WmNxUWrfz5s_vyg6VvEb6Ex8OEsOeMbn0Y7JmwhCDBx0IqHBhg9P0f6k5s38=)
38. [va.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFbqyDP_s46F-1nINyNdIlB_IV3qyy70WgrITs5kHB0fpigY6ukMznXbIxSAuCaZ-MIvFipeI7O-zjzIpWDRCHxcVYp0yJZ4NZQAsXcX6eOsgCNm9k4w2OCgx0-opYk9vkmsZEXtgj9DeeuIjHKjgaTZBkoZ7B7dA==)
39. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEoCmVy4k8UzSoKiJ8zyRkpmmzbmEnOiomwh3AI7hoLSg6jsSgE0zCc5TISQ0NPEWeKNtu4opOafzCIZpYC9f8cldbHW4NNJqYYAzWUPMDlkfupXJTz6FZGxkPOc9jrBaz9ABIVpM9xzEQ1GJJlcHEPYa_mwG2uV5m6OGQ_E6fZp0GnWvSLF-gTAZZUf15k4VWq2-GnD1IUnLTCxVWNLz1_DRGWdf7PwJdwkf1N2ib4c_x8XXc=)
40. [addrc.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGmX_F2lEtFh3lQxrevoyPZvxliE-M3d4A1GiMHXIE1zkEX7Ptn1ff2cx7Wbcw0eD-jQIxn7AZMsfc0yIqkD3Ewj9rNETaLxjmvnHpYUd3b8rMlXJoATyPCCyXR_YO0Shue_Zg7OP0MfKC1HX-5JAygWkQm_xc5xHyngExnTooj-XPpe0HbsR8D_e1K)
41. [blackwellpublishing.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGIxyBHkUIBN_y_uIqfF-7QKTUN3BByOszfq2xWEk7XhMCT7KYRnc2Ri1wv87o6rD5RZ1YPfNBV-bkg-2at0EphgtlwqoFyV6dXkHXvbDA3_C1i7XWHQ13pUOf8WaboRFwc2h-KAVZlqWvgRT21xxExaLoNIn3piGl5JfpWnqZ_FcV9PHPVeaap9_pRONM4YA==)
42. [psychologytoday.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQENC6CVG2XDDeppGFLchZ1KVGmCnL7e5nT8_CO50xnz0EaGnT5jPOsVs5ugCPtGQaXaHTBkVR-c1af5pvvDQte43MmGQ4NeWj1mLOfm8gEiba3iVaCMnwRPz0hrs_xLaZFTaZOubFyIIVwGkA7FGWtGR2UuwBOe8Ps3BWRS4eN7rSewMwQc1rwJ9EtBwktm4ewxi98EtSE3g7DlqQac1ck=)
43. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQF7EX1aoFDx_pbGbIdm6y6WG9kxseVXub_CfyZCh40MEisKAJi8LVXY523rxzWSMC-ul3-UXQLku1wDTMbeRr6uKLMoHOcxlhoh6tyRMOqGKB9qeuSr9bRAHkFvimp_Mq5XvXp95Ph1fwXeoyGTKkPOu7_V_vtavcqNQZeeAQixcsikpZ0_odacsNmFYTFAiOXjTvNXnsdJcWdyG4DPpuZgNT7pGsuHGXSRYZxpmzDiDOWz4RnMWPD7lHCQ05c90RD6)
44. [davidmatsumoto.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEIvjHIloB4jOH-t31WzvfutJHOSwb2qtTzLXR1ayoW28tRyR881OIA7XEad8FDnfLd6wk1oYz5drENQAKOkUGKLF0BxeOyyob8m44xU2lmsqVWPm5oSBlPifDj_St1bqu2aKU0Mrn4dhL7gFm7vol_gpLCU7H7sQop6y7BS2c=)
45. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGiMsfBd_I9Jb5yQOzoHhzEDhJGgyE5ORcFoYVJe1vXoAfenjtOJY8RnnOkqNYbkuMB47wi12LFYXhXJi-GTFJOidP4NnOUcbigp5Ky47_BrDA7IfnGL6xbwB3eysGRAENw2FjYAa-acBb0OjVbFfFLiz97prhDtxj3p1b8u1X2L9CcM1IWc82F1UZ-4t_Pxn5JqD8V3RBloTOWmYAKhtagCaRtl84Ddy0iujoWQGw=)
46. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGtKCFR3FBYiT0iSMvGk1DKfnUTuf5D9Ev8hpz6qmQCYVvyVURfsDpN8i7GoFLHy7ZGVRLsrAKEbW6nHtctlNHwuKAqS6U-iwjrsPBHLxo4nxV7cdPdCnrDB5tmetlAMA==)
47. [brunel.ac.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHtF_ABbRNPdZNse1DcGlfRYdJ2LX0vcsnCO5sfhsa9-cnxyUvawb0jVWDHdQlDrSwDx_L0NeinJoEp22qIJY9BsMK3ZGuiTWp5OuJYrfmkQglZ3laVo5TnmWNkvaYZoa_6)
48. [child-encyclopedia.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQH4Cev1k0dMHSoUmx6-EbOq0pKPfqmkuJx5RMYaRyH7NH9zCGhvraJiO1se6ACYswUXIJ4dPbwSE37lBRbcEOHYDNt5arF9_N6VfXnCZD7zLPkgRvuujMYNjhl1ESiY7GupEHLQl-lx8ds8bnqM)
49. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG0NtgzCMQqnofOFvZyCPefUW_WlZZZl0hTxunKB9Ri2buaOI0_43nsgsBC0jD8vjW1yPhoR6uneZ60j-VlhVaMIUSLZzICkApebw2iveXIcllCYtZ1E0LhhKuMLBPwHQUac61TG_j4)
50. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGjnOsPvOrG0z0ic36nxZcQL8lFWJGrNUqbSoYCNhNxYFdUSxNhyTRl4sXoBiynsE-yT9MfJm61HdaUBaCQ1JUeW-6lWjhk29xXsabuQb0Ty6J23KJT37xdyJUEPrjhGRzyESTLDB0uIg==)
51. [samwoolfe.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGQWnvkr_wkujWu6xmGzATK-k-DJcS3mg7TSNhuh1wp22IW7vtirohNu4lWciFjKpcDpx1hb9kNNnqFCqcj0bUZX9BDjDkYEggMG0Gc5DBMJyKm6TE8uYyVMhEa1F0OeYl27kXtztQ-zwloIgnREKyIKBA=)