I’m going to keep this blog post as short and sweet as possible, as I tend to gravitate toward shorter blog posts that get to the point of what I’m needing. I’ve been asked more than a few times in the past few weeks for tips on managing the impact of grief and loss. I am providing tips I normally share concerning expressing thoughts and emotions in a healthy manner, as well as self-care. It is my clinical opinion that these are key to moving through the grieving process in a healthy manner. They are as follows:
1) Discuss your thoughts and feelings with trusted members of your support network. Grieve in the company of others.
2) Journal your thoughts freely, without limitations.
3) Move the energy associated with uncomfortable feelings as much as you can. This can be done via walking, dancing, stretching, etc.
4) Go to nature. This can be extremely cleansing and allow you a supportive space to feel uncomfortable emotions.
5) Meditate. You can also set an intention before you meditate to feel peace or experience less pain.
6) Express your experience through art, such as with painting, drawing, or music.
7) EAT HEALTHY FOOD. DRINK WATER. REST. AVOID SUBSTANCES.
8) Engage in self-identified self-soothing activities. What makes you feel good, even if temporary? Cuddling your friend? Cuddling your dog? A warm bath? A foot rub?
9) Attend grief and loss support groups. Sometimes talking to others who are also grieving provides a different type of benefit than talking with our loved ones.
10) If you are experiencing thoughts or emotions that are hindering your functioning, meaning hindering your ability to socialize, manage your health, manage your meaningful roles (such as working, parenting, attending school), or managing your living situation, seek mental health assistance (you can find therapists and psychiatrists at Psychologytoday.org).
It should be noted that it is OK to feel the difficult feelings of grief. You may have heard the phrase, “It is OK to not be OK.” I agree with this. The above suggestions may help you, but you do not need to move through the grieving process quickly. Go at your own pace. Email me if you have questions, or comment below. 🙂
What exactly is a crisis?
According to the awesome Dr. Marsha Linehan, creator of Dialectical Behavioral Therapy (DBT), a crisis is considered a highly stressful, short-term (meaning it isn’t going to last forever) situation that causes a sense of pressure to resolve the crisis immediately. A crisis situation is subjective, as not everyone views every situation the same. For example, giving a presentation in front of your boss and the team while you’re also afraid of public speaking may seem like a crisis to one person, but not another. Realizing you can’t pay your rent this month may seem like a crisis to one person, but not another. You get my point. During a crisis, we can use distress tolerance tools when we feel intense emotional discomfort (anxiety, panic, anger) which also can lead to discomfort in the body (e.g. rapid heartbeat, hyperventilating, dizziness, tunnel vision). We should especially use tools when we feel like this and still need to GET. STUFF. DONE (e.g. take your kids to school, work, attend class). Dr. Marsha Linehan calls tools to help these types of situations “Crisis Survival Skills.” One acronym she created is TIP, which stands for Tip the Temperature, Intense Exercise, Paced Breathing and Paired Muscle relaxation.
One way to sort of “shock your system” out of a fight-flight response is to use cold water with the Tip the Temperature technique. It is suggested to hold your breath and dunk your face in a bowl of cold water, but I also think putting hands or feet in cold water or taking a cold shower is effective. From my knowledge, I know that shocking yourself with cold water immediately stops whatever thought process you’re having that is contributing to interpreting your situation as a crisis (how very CBT of me lol), which can help slow down or stop the fight-flight response. It also increases alertness and helps you focus if you’re starting to panic or experience intense emotions to the point of feeling overwhelmed.
In regard to Intense Exercise, when we are in a fight-flight response (experiencing anxiety, panic, and even anger) we need to do something with all those chemicals our body is releasing to keep us safe from danger (our body is trying to do us a favor, but little does it know that giving a presentation is not an immediate life-or-death situation). Use that energy to avoid that shaky, dizzy, lightheaded feeling we can get when feeling overwhelmed. Go for a brisk walk, do pushups, jumping jacks, jog, shake about like a little kid who has heard music for the first time. Sometimes I stand on my tippy toes and pulse over and over as a way to burn off excess adrenaline. Try it. 😉
With Paced Breathing, in a nutshell you need to breathe DEEP, SLOW, FULLY, and WITH YOUR BELLY. Push your belly out as you inhale and keep going (slowly) until your lungs fill up fully, then exhale (slowly) with your mouth the size of a Cheerio until all the air is gone, and repeat. A trick is to breathe in 4 seconds every round, and breathe out longer than you breathe in (so breathing out 5, 6 or 7 seconds, every round). You will notice I state this breathing method A LOT in my posts. It activates your parasympathetic system which is key to calming down in a crisis situation.
Regarding the Paired Muscle Relaxation, the DBT technique indicates you tense your body muscles while breathing IN with your belly, and releasing your muscles as you exhale. If you want a different method of relaxing muscles, I suggest actually clenching various parts of your body (feet, calves, gluteus [yep, your butt], stomach, back, raise your shoulders up toward your ears, make fists with your hands, and scrunch of your face TIGHT), and hold for 15 seconds, then release. Aaaaahhhh…feels good.
I obviously added my own spin on some of these as this is all a collaborative effort. I want you all to have as much control over yourself as possible, and when faced with a crisis it is imperative to ground your body so you can GET. STUFF. DONE.
You are all amazing. Don’t forget.
I was asked to write a post on managing fear after a mass shooting. More specifically this was requested by someone in my community after learning about the Gilroy, California shooting. The Office for Victims of Crime (OVC) and the American Red Cross define mass violence as the following:
An intentional violent criminal act, for which a formal investigation has been opened by the Federal Bureau of Investigation (FBI) or other law enforcement agencies, that results in physical, emotional, or psychological injury to a sufficiently large number of people to significantly increase the burden of victim assistance and compensation for the responding jurisdiction as determined by the OVC Director. (U.S. Department of Justice [DOJ], Office of Justice Programs [OJP], OVC & American Red Cross, 2005, p. 3 as cited by SAMSA, 2017).
1. Consider Counseling
Although this post is meant for those that learn of a mass shooting either in their own community or somewhere in the world, if you are reading this and were a direct victim of the tragedy, directly witnessed the shooting, you are linked to someone directly impacted by the shooting, or you experienced repeated or extreme exposure to the details of the shooting (such as if you were a first responder) some of the information in this article may be useful to you, but I have a stronger urge that you seek counseling if you are experiencing signs of acute or post traumatic stress. If you are experiencing intrusive memories of the traumatic event, having nightmares or flashbacks, experience a dramatic shift in your mood, struggle to experience pleasure, feel fearful or on edge, feel as though you’re in a daze, have issues with your memory or concentrating, feel a sense of emptiness or loss, are avoiding certain triggers that remind you of the event AND these symptoms are hindering your ability to function (such as socialize or engage the community, work, engage in leisure activities, manage your health or living situation), then counseling would be my first go-to suggestion. This suggestion also applies to those that have learned of the shooting in their community if one of more of the aforementioned issues are occurring and you believe your functioning is also being negatively impacted (you, of course, may also seek counseling if your functioning is not impacted and you believe counseling may be helpful for you). I have added a link at the bottom of this post for a website that is pretty much the Google for finding therapists. If you want tips on what type of therapist to look for, please email me and I can give you a quick pointer on this.
2. Remove Added Stimuli and Reminders
Ah, our cell phones and televisions can be such handy tools, but as you may already have guessed, there are many downfalls them. If you are experiencing distress or fear after learning of a mass shooting in your community or the world (or are a direct victim) then continuously receiving reminders of the tragedy is unhelpful (to put it simply). More often than not, I prompt my clients to do this after they learn of a tragedy and are starting to experience more stress, fear and other uncomfortable emotions and symptoms. Witnessing constant reminders include visuals and replays of the aftermath, as well as witnessing other people’s emotions (online or on television) can exacerbate psychological symptoms. One study has found that those who continuously watch images or video in the media about a tragedy had higher levels of PTSD symptoms (17.4%) and depression (14.7%) than those who avoided this type of stimuli (Ahern et al. 2002, as cited by SAMSA, 2017). I normally prompt my clients to take 7 days off from social media and specific type of TV programs. That means zero Facebook, Instagram or other social media platforms as well as watching the news or political TV channels.
3. Seek Community
What I mean by seeking community is talk to your friends and family about your thoughts and emotions so you may share your experience and receive their support. I recommend finding community that will remain open minded and patient with you and provide you validation, but not add to your fear. I want you to keep going outside and living your life, so if certain friends or family are projecting their fears on to you (causing you to feel more uneasy) then they might not be the best candidates for this.
4. Get Involved
While working with my clients who have a stress response to learning of a mass shooting, a theme I’ve noticed is they feel as though they do not have control. I realize we are limited when it comes to controlling mass shootings, but getting involved in helping out with the aftermath of a shooting may provide a sense of purpose or control. This may be in the form of fundraising, volunteering for a 24-hour help line, donating to a charity (to ensure a charity is legitimate you can look them up on Charity Navigator or Charity Watch) or donating blood. Getting involved also gives you something to focus your attention on in the moment, which leads me to my next suggestions.
5. Ground When Experiencing Fear
I 100% acknowledge that experiencing fear after a mass shooting is an understandable response. A few days to a few weeks after a tragedy like this may feel out of the norm and emotions and mental health symptoms may be on high, but after some time it is important to try our best to remain in the here-and-now. To experience fear about a tragedy weeks after it occurs means we are focusing our attention on the past (thinking of the tragedy) or the future (worrying about it happening again). At that point it becomes imperative to ground your body, especially when you go back out to the community and public, crowded spaces. What I mean by this is managing the physiological symptoms associated with the fight-or-flight response (such as rapid heartbeat, difficulty breathing, sweatiness, dizziness), which becomes activated when we are afraid. I have personally talked to people in the past few days who are fearful of going to crowded places like the mall or night club. They explained to me that they do in fact want to go but after getting dressed and ready their hesitation sets in. I told them to ground so that they aren’t walking around the mall with adrenaline (among other chemicals) coursing through them and experiencing physiological symptoms of getting ready for a life or death situation when in fact they want to take their children school shopping. You can do this with alternative nostril breathing, square breathing, or more simply put breathing SLOWLY and DEEPLY, in through the nose (4 seconds) and out through the mouth (5, 6, 7 to 8 seconds or more) and repeat this 5-10 times. Make your mouth the size of a Cheerio when you exhale, and breathe with your belly. This activates the parasympathetic system in the body and helps keep you out of the physiological fight-or-flight state associated with fear.
Yes, I want you to talk to yourself. You don’t need to do this out loud (as that may feel a bit odd), but I do want you to engage in a dialogue with yourself that hits various points. Remember, we cannot tell the future (if we could, my job would be a lot easier). We only know what we know in the present moment, so if you have a fear of a tragedy happening, ask yourself 1) What exactly am I thinking is going to happen?, 2) Do I have evidence that this thought is true?, and 3) Is there another angle to view this situation from? For a more detailed description of this see my post titled Do I Have Evidence?
7. Stay Present
To put it simply, practicing mindfulness and being in the here-and-now takes us out of our future or past focused thinking, even if for a few seconds. If you continuously do this throughout the day, you’ve spent a huge chunk of your day in the present versus in your mind, which is where the narratives are created which contribute to fear. A way to practice this is to notice your five senses (or one or two at a time) as much as you can with each step it takes to get to and engage the environment you’d like to be in. Again, it’s OK if it’s a few seconds at a time, just keep trying to repeat it. So as you step out of your house, into your car (or however you would get there) and enter the surrounding you’d like to be in (e.g. mall, club, venue), pay attention to your senses. What do you see, hear, and smell? Feel your feet touch the ground. Notice your calf muscle as you walk. Feel the clothes on your back. Are you chewing gum? Focus on the taste, sensations and movement of chewing. As soon as a fearful or unhelpful thought comes in, GROUND, notice the thought, engage in self-talk, then focus your attention back to your breath, then back to your senses (and repeat).
Find a therapist or counselor:
SAMSA (2017, September). Disaster Technical Assistance Center Supplemental Research Bulletin Mass Violence and Behavioral Health. Retrieved from https://www.samhsa.gov/sites/default/files/dtac/srb-mass-violence-behavioral-health.pdf
Jumping to conclusions, mind reading (assuming you know what someone else is thinking) and catastrophizing (jumping to conclusions x10 + disaster) are 3 of the 10 unhelpful thinking styles many of us engage in (usually unbeknownst to us). As a CBT therapist I teach my clients all 10 thinking styles and how to catch and reframe these type of thoughts. These thinking styles can cause issues such as feelings of sadness, anger, anxiety, impulsivity or social conflict. Imagine Clara assumes that Gwen took a piece of candy from her desk (jumping to conclusions). Then Clara thought that Gwen thinks she won’t notice (mind reading) which infuriates her because, well, that’s her salt water taffy 🍬 and she definitely notices. Then Clara worries that everyone from the office will steal from her (catastrophizing).
Instead of engaging in these thinking styles, Clara could ask herself the following questions:
1. What am I thinking? We often have our automatic thought then run with it until it snowballs into an unhelpful narrative. Slow down and clearly identify your thoughts.
2. Do I have evidence that this thought is true? If you don’t have proof then it would be unhelpful to allow this thought to influence our emotions and behaviors. If you have to ask Gwen questions, ask her questions (posts on assertiveness coming soon).
3. Is there another angle to view this situation from? Remember we can reframe our thoughts to that of acceptance, gratitude, compassion or a narrative that better serves us, but first you need to find out if there’s any proof to your thought. Start with the initial thought (Gwen stole the 🍬) and go from there.
It’s also OK if you can’t find evidence for or against your thought. Sometimes no evidence is all we need to help us stop a “snowball narrative” in its tracks. Accept that you do not have proof, BREATHE and create an alternative thought based on your investigation (or no thought at all).
Now I want 🍭 candy. Lol thanks for reading! I invite you to share this if you found it interesting or useful.
-Dr. L 💚
What’s the difference between stress and anxiety? Welp, they definitely are connected, but there’s an important distinction. Stress is caused by outside circumstances, such as a work deadline, getting your kids to hobbies on time or a disagreement with your partner. Anxiety, however, is your RESPONSE to the stressor. To observe a stressor without creating an anxiety provoking narrative, and accept it as is, can be within your control with practice. Let’s say I spilled onion soup in my car. To think that now my car will smell like onion FOREVER and my friends will think I smell like old onions (lol what?) and never speak to me again and Ahh! Yep, that’s a reaction to the stressor that is a surefire way to spark anxiety. Many of us aren’t taught to reframe our thoughts, observe without interpreting, and ground ourselves (posts on grounding to come). I’ve already discussed a quick reframe tool (in previous posts) to adjust unhelpful thoughts to the framework of gratitude, but you can also observe and accept what is happening and forgo the reframe. I see the spilled soup in my car, I grab a rag and some cleaner, and that’s it! I know this is easier said than done, but acceptance and observation without creating a narrative takes practice, just like exercising, eating healthy, or doing any new skill before it becomes second nature.
To get in the groove of observing without creating a narrative notice your body sensations, tap into your five senses and be in the moment. Observe the situation without using words in your mind. These are typical DBT and mindfulness tactics (that I’m bringing to you here [solo clap 👏😆]). Practice mindful observation next time you go into another room or outside. Look around and notice without creating a narrative about what it all means. The more you practice this the easier it will be to observe stressful situations as they are. Look at a flower, ants walking, or people’s facial expressions and notice details. If your mind begins a narrative, gently notice the narrative, take a deep breath, and focus your attention back to what you are observing (and repeat)!
What is mental hygiene? The term “mental hygiene” has been trending over the last few years, but this term originated in the 1800’s. In 1893 specifically, the founder of the American Psychiatric Association, Isaac Ray, defined mental hygiene as “the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements. The management of the bodily powers in regard to exercise, rest, food, clothing and climate, the laws of breeding, the government of the passions, the sympathy with current emotions and opinions, the discipline of the intellect—all these come within the province of mental hygiene.” (Rossi, A., Some Pre-World War II Antecedents of Community Mental Health Theory and Practice. Mental Hygiene, 1962, 46, 78-98, as cited by Mandell, 1995).
In the 1900’s there was a strong reaction to Clifford Beer’s autobiography called, A Mind That Found Itself, which highlighted how poorly those being seen for psychiatric services were treated by professionals. This kick started a movement of trailblazers that included Beer’s as well as Adolf Meyer, Thomas W. Salmon and Dorothea Dix. These individuals made serious contributions to the unveiling and reform of these issues, and the mental hygiene movement influenced the foundations of organizations like the Connecticut Society for Mental Hygiene (1908) and the National Committee for Mental Hygiene (1909). In 1950 the National Association for Mental Health was created, and groups like this aimed (and still aim) to create higher standards of care for those being treated with mental health challenges, to use preventative strategies to reduce the onset of challenges, and to guarantee that people are properly educated and informed about these topics.
I may not be on any of these particular committee or part of these organizations, but I have the exact same mission.
For now, let’s discuss the preventative, coping and maintenance side of mental hygiene. We wouldn’t think about going weeks, months or dare I say YEARS without brushing our teeth, or washing our body or clothes (whoa). Why would we go weeks, months or years without tending to our mind, emotions (or energy) or overall mental well-being? You may have heard that our mind, body and spirit (yes, spirit) are all connected. If we ignore one avenue then we risk imbalance. If we are imbalanced, well, we may feel stressed, overwhelmed, stuck, depressed, anxious or, simply put, we may start to experience the onset or exasperation of mental health challenges. There are so many types of mental hygiene tools to engage in for preventative or maintenance care, and some you may like more than others. From specific types of affirmations, to being in nature, to mindful eating, to creating a bedtime routine, there are plenty of options to prevent and cope with mental health challenges as well as maintain balance. I’m excited to give out as much knowledge and tips as I can. My goal is to help others, and if I can help just ONE person with a post, then my purpose is fulfilled.
Now, with all that said, as my first mental hygiene tip, I encourage you now to go outside. Once you’re done reading put your phone on airplane mode (GASP) for 20 minutes, and simply go outside. You don’t need to go to a grassy mountain (and listen to the buzzing of bugs) like this picture illustrates, but going outside wherever you are right now is good. Take a walk in your neighborhood, sit in your backyard, drive to a local park, and be outside even if for a few minutes. Since this post is already sooo long, I’ll explain more on the benefits of being outdoors soon. For now, just focus on getting some air and engaging new scenery. 🙂
Peace and Love,