Sunday, November 18, 2018

Acceptance and Anxiety

The other morning I was listening to one of Dr. David Burns Podcasts, number 88 to be exact. (Just a little plug there for him on feared fantasy expanded.)  Anyway, as I was listening to this amazing woman fight her fears of social anxiety, and as Dr. Burns talked about humour and laughter as a form of acceptance, I had a moment of clarity.  Acceptance is one of the ways to fight or negative thoughts about ourselves.

Before I share what that was, just a little background.  I’m part of a Christian group of therapists, and some who aren't that have Christian clients, that practice team CBT and we been collecting Bible verses and go along with what we are learning and what we’re practicing. So, that's been on my mind and when Dr. Burns started talking about acceptance it made be wonder how does that fit the Christian model since we are to grow in grace, do good works, be perfect as our Father in heaven is perfect, etc. We will talk about that later, as the Bible harmonizes with itself. 

An epiphany just washed over me as I thought about the Bible verse, "There is no fear in love; but perfect love casteth out fear: because fear hath torment. He that feareth is not made perfect in love." 1 John 4:18. KJV.  I can't fear (be anxious) when I accept myself and the circumstances life throughs at me. And accepting myself, or loving oneself, is a Biblical truth, "And you must love the Lord your God with all your heart, all your soul, all your mind, and all your strength. The second is equally important: ‘Love your neighbor as yourself.’ No other commandment is greater than these.” Mark 12:30-31. NLT.  

Then came to mind, 1 Corinthians 13, as it struck me as how to define love in the first place. "Love is patient and kind. Love is not jealous or boastful or proud or rude. It does not demand its own way. It is not irritable, and it keeps no record of being wronged. It does not rejoice about injustice but rejoices whenever the truth wins out.  Love never gives up, never loses faith, is always hopeful, and endures through every circumstance." 1 Corinthians 13:4-7. NLT. What does the Bible say is love? Well it’s a lot of things but a big part of love is it keeps no wrong, is not irritable, it is patient, and kind. These are things we should be for ourselves.  Keeps no wrong - accept it and move on, not irritable - accept it and move on, patient - don't be so hard on oneself, kind - don't be so hard on oneself.  When you combine all three of these Bible verses we see this high-level solution to fighting negative thoughts which is acceptance using humour piece and disarming to squash thoughts of anxiety and fear about ourselves. When we have this kind of love it casts out fear.

I’ve never been a fan of the terms self love. One Christian author puts it this way, "Those who are filled with self-esteem and self-love do not feel the need of a living, personal union with Christ. The heart that has not fallen on the Rock is proud of its wholeness. Men want a dignified religion. They desire to walk in a path wide enough to take in their own attributes." E.G. White, Christ's Object Lessons. Just accepting all your flaws and not worry about them is not only in conflict with the Christian experience of growth in moving forward, but also that selfishness or focusing on oneself too much takes our eyes off Christ.  That when we feel bad we see our need of Jesus.  Then, as I was reviewing all these principles, praying for harmony of the concepts, it occured to me, definitions and context. 

It seems rather than argue or try to twist and idea, often we have to go back to how we define something.  Not just from the dictionary, but all the weigh, emotion, and other thoughts we have about a word or concept. For example, self-esteem can mean holding oneself as important, even putting one's needs above others or it can mean, a confidence that allows that person to complete a task, or both.  This article isn't about self-esteem or self-worth or self-love, maybe I'll do one on that in the future, but obviously we need to see all the scriptures as a whole.  That we do have to love ourselves or we can't love others.  

Add to that the Bible is clear we do have worth and value, so I’ve always been OK with self-worth, in other words that all human are infinitely valuable because the God of the universe would have died for even just one of the 'least' of us. From that same author, "One soul is of infinite value; for Calvary speaks its worth." The Review and Herald, March 13, 1888. But when I was listening to that podcast on acceptance, I realized without loving ourselves as in the definition of 1 Corinthians 13, self-worth is an intellectual assent and we’re still fighting fears and anxiety about ourselves. The Bible verse and love others as yourself is a clue that God does expect us to love ourselves, not that we are placing more value on ourselves or ignoring what God as done for us, but in a way that we are not treating ourselves like garbage. Because we are to love others in an equal amount, neighbour as yourself, how can we express the beautiful love revealed in scripture to others, if we have no "love" for ourselves?

So how do we get this love, the love of ourselves that is within a Biblical model of selflessness and yet not unduly critical of ourselves? The same way we love others. Acknowledge while we all make mistakes and have things that really do need changing, we all still have infinite value because Jesus died for you, for me. If you’re not a Christian, you can take the view that every human being has value because they’re human. The second step would be forgiveness, "keeps no wrong" from 1 Cor 13. Pretty hard to love someone you’re angry with, or holding a grudge against, and that includes yourself. Of course, in context self loathing may have a place to give you motivation or self awareness of what you need to change, but you cannot stay in that moment. In fact, I would go so far as to say we can acknowledge our flaws without self loathing. Can you not see other people as imperfect, see their flaws, and yet not hate them or think they’re horrible, terrible, awful people? Of course, then you can do this for yourself as well.  

Remember there is an amazing paradox at work here, acceptance of our flaws can actually empower us to move forward in growth and even changing those flaws.  We are no longer fighting ourselves in an unwinnable battle, rather we see our need and are able to give that to God.

It is truly powerful when we put it all together, harmonizing all the principles we've talked about so far.  Our fear is the beginning of wisdom, it drives us to God, to self-reflection, then as we accept that we are flawed human beings, that we need God, we can embrace change and are empowered to move forward. 

Tuesday, November 6, 2018

Imagined Grief (Worry/Concern) Can Feel Just as Real


There I sat one morning, crying. Nothing had happened yet. The day was still ahead of me, same as the day before. The to do list sitting on my computer. The cat snuggled up on my lap. Me trying to wake up at 5 AM. But this morning a few tears flowed even though "nothing" had happened...yet. 

While anticipatory grief refers to grieving before an event is finalized, such as getting a cancer diagnosis or other terminal illness, we can even experience bouts of grief based on what we think the answer to a test result might be. Our brains interpret what we believe as a real event. If are thinking that this might really happen, we start processing as if it already has. Much like when watching TV, your brain doesn't know it's fake or artificial.  The emotions you experience are very real.

For me that morning, it was waiting on a diagnosis for my father. I’m still waiting as I write this. No matter, the stress is real in any case. Learning to cope effectively with these kind of events is the reality of our modern age. So much of what we experience is "artificial." I'm not sure that's even the right word since we are in uncharted waters. Gone are the days when two months later a letter came in the mail that your spouse died on the battlefield. Now at every newsflash your heart quakes with worry, was that near his/her posting? Gone are the days when you went on with life, frequently thinking about your children, hoping they were doing well across the country as they started a new life for themselves. Now, we obsessively check Facebook and worry when our texts are not returned in a few minutes. We don't have to wait for news to come by pony or even postal truck, now we are connected to the entire world 24/7. 

Stressors are at an all-time high in our artificial world. It’s artificial in the sense that the event hasn’t happened yet, we are being bombarded by information that may or may not be relevant or real.  Millions of us watch a fake, make up world on fictional television. Even our social interactions on social media is partly artificial because we don’t express exactly what is going on but rather share cherry picked pictures and ideas.   

Our brains and bodies have to adapt to whole new world in this fast modern digital age. So how can we cope? How can we take back control from the flood of information that changes our perception of reality, even if reality hasn’t changed? Step back. Give yourself time away from all the banter, the electronics, the world. Spend a few minutes in a natural, real environment. Walk the dog in a park, do some gardening, bake some cookies, have tea with a neighbor, take up sewing, the list is just about endless. Do something outside in nature adds some other health benefits, but there’s a lot you can do even in your own home. Brainstorm what would be helpful for you. The only parameters, you need to enjoy it, it must be something in the moment and physical or tangible. 

What about those moments of sadness, worry, or stress when we are just thinking of what might be? Well, those emotions are real even if the event isn’t. Embrace it for a moment, then work on your thoughts. Deal with any distortions you might be having. Make sure you’re not catastrophizing, making it bigger than it is in this moment, or overgeneralizing, i.e. this one event ruins my entire life (a future event can't take away your past). More on clearer thinking here. Right now you’re worried and you have every right to feel stressed and concerned. Whether the test results are for you or for family member. Or maybe you’re at dissipating grief for some other reason in any case embrace the moment and move through it. For more on anticipatory grief check out my previous blog article here.

Tuesday, October 30, 2018

Pain Before It Happens - Anticipatory Grief


(Taken from my Psychology of Grief research project)

Working through an impeding loss, or imminent death, gave rise to the term anticipatory grief by Lindemann in the 1950’s (Worden, 2009). Since then others have researched this topic with mixed results.  In fact, anticipatory grief is still controversial in both what it looks like and if it exists at all (Nielsen, Neergaard, Jensen, Bro, & Guldin, 2016) (“Grief, Bereavement, and Coping with Loss.” n.d.).  There are those who feel it is not possible to grieve until there is a loss (Reynolds, Botha, 2006). However since cognitive therapists believe emotions are often triggered by thoughts, how we think is ultimately our reality. In any case, there is stress associated with anticipating a death whatever the label it is given. With that preamble, the definition of anticipatory grief in this paper is: When an individual is anticipating an impeding loss, or death, and develops symptoms relating to that expected event.

Not everyone who knows someone who is going to die, will develop symptoms or go through anticipatory grief (“Grief, Bereavement, and Coping with Loss.” n.d.).  Anticipatory grief commonly affects those dealing with loved one who have terminal illnesses such as cancer and even long term illnesses such as Alzheimer's (Scott, 2009). Some believe it can also affect the person who is actually dying (Shore, Gelber, Wientzen, Koch, & Sower, n.d.). Symptoms range from physical one such as headaches, nausea, fatigue, sleep and appetite disturbances, to emotional ones like anxious, sad, helpless, disorganized, forgetful, angry or feeling discontented from others (Shore, Gelber, Wientzen, Koch, & Sower, n.d.). 

Due to the controversy surrounding anticipatory grief and the limited research on it, there are three schools of thought:
1.     It doesn’t exist, it’s a form of stress. (Nielsen, Neergaard, Jensen, Bro, & Guldin, 2016)
2.     It is pre-grieving or grieving started early (Worden, 2009)
3.     It is a separate event and has its own tasks or phases (“Grief, Bereavement, and Coping with Loss.” n.d.).
The University of Rochester (Anticipatory Grief, n.d.) lists the phases of anticipatory grief as:
1.     The person accepts that death is inevitable and there is no expectation of a cure. Feelings of sadness, anger, and depression can accompany this phase (Hogan, 2009).  This corresponds to Task 1 and starts into Task 2 of Worden’s model.
2.     Concern for the dying person.
3.     Death is “rehearsed” and preparations made.
4.     Person imagines what life will be like without the person.

While one might think knowing someone will die will enable them to process unfinished business, research shows mixed reactions.  Some grieve even harder after their loss, while others feel more closure (Worden, 2009) (Reynolds, Botha, 2006).  Variables are many, including some grow much closer to the person dying than in their previous relationship and thus the loss has an even greater impact, while others find they have dealt well with the unfinished business and are able to go through the uncomplicated grief tasks more effectively (Worden, 2009) (Reynolds, Botha, 2006).  

An additional note about complications.  Those whose loved ones have Alzheimer’s. One person shared she felt she was experiencing a new loss each time her husband forgot something else.  Unlike a terminal illness, a person with Alzheimer’s loses who they are bit by bit (Scott, 2009) (“Feeling Grief and Loss While You're a Caregiver” n.d.). 

Assessment for anticipatory grief is similar to grief in general except there is no death event that triggers it.  Instead symptoms may arise after a diagnosis or any time after.  An increase in anxiety is a common attribute of those suffering from anticipatory grief (Worden, 2009).  Questions, such as the following, can be used to assess a client (Use a scale to rate each one.) These have been modified from the grief assessment by Holly G. Prigerson, Ph.D., Paul K. Maciejewski, Ph.D.:
            Since the diagnosis of ________ how often have you felt yourself questioning the prognosis?
            Since the diagnosis how distressing has the though been you will lose _______ ?
            Has this thought been disruptive to your daily routine? How often?
In the past month, to what extent have you felt on edge, jumpy, or easily startled?
In the past month, to what extent do you feel that life will be empty or meaningless without _____?
            Do you find yourself wondering what life will be like after _______ is gone?

Answers to these questions can help provide insight as to further testing for depression and anxiety, and of course use the standard rating scales (At each session, in addition to suicide ideation exploration. These questions also help determine how the client is processing the tasks of grief, such as Task 1, do they accept this event.  As such anticipatory grief lends itself to really working on Task 1 and 2 of grief (Worden, 2009).  Some of the treatment suggestions recommended include:
·       Normalize the clients emotions. What they are feeling is common, ok, and real (Scott, 2009) (Hogan, 2009).
·       Help client find resources as needed. Hospice care, support network, etc. (Scott, 2009).
·       Teach the client to deal with the extra stress and strain. CBT, relaxation techniques, stress management, etc. (Scott, 2009).
·       Work through any depression or anxiety symptoms. (Hogan, 2009)
·       Start working through the tasks of grief (Worden, 2009)

While experts disagree on whether or not anticipatory grief exists and if it exists what it really is, individuals do experience real emotions and stress when faced with an impeding loss of a loved one.  These specific symptoms can be dealt with using various psychotherapy tools and techniques regardless of the label attached. 

Bibliography:


Feeling Grief and Loss While You’re a Caregiver. (n.d.). Retrieved from https://www.webmd.com/palliative-care/caregiver-grief-and-bereavement#1

Hogan, Marty, L. M. (2009). Anticipatory Grief. Ashland: Sacred Vigil Press.

Nielsen, M. K., Neergaard, M. A., Jensen, A. B., Bro, F., & Guldin, M. B. (2016, March). Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26796738

Reynolds, L., Botha, D. (2006), Anticipatory grief: Its nature, impact, and reasons for contradictory findings, Counselling, Psychotherapy, and Health, 2(2), 15-26, July 2006.

Scott, P. S. (2009, August 07). Anticipatory Grief: How to Cope With the “Living Death” of Alzheimer’s. Retrieved from https://www.caring.com/articles/anticipatory-grief-alzheimers

Shore, Julia Carl, FNP-BC, ACHPN, Gelber, Marianne Wientzen, GNP-BC, ACHPN, Koch, Lauren M., ANP-BC, ACHPN, Sower, Emily, ANP-C, ACHPN. (n.d.). Anticipatory Grief: An Evidence-Based Approach : Journal of Hospice & Palliative Nursing. Retrieved from https://journals.lww.com/jhpn/Abstract/2016/02000/Anticipatory_Grief__An_Evidence_Based_Approach.5.aspx

Worden, J. W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner. Springer Publishing.

Thursday, October 25, 2018

When You’re Angry At Someone Because You See It In Yourself

Monday morning I was eating some raspberry greek yoghurt and a thought cross my mind, I wonder how much lactose in it.  I am on a low FODMAP diet and lactose, a high FODMAP, is often a trigger for those with bowel issues. I find I can have quite a bit of lactose without having any symptoms but I was still curious since I LOVE facts and numbers. So, anyway, I Googled it, as I do when I’m researching, and as I was looking for a good source I came across a question, "If you are lactose intolerant can you still have a little cheese or yogurt?"

My immediate thought was why would you want to? I mean there’s so many other options out there that are far more healthy than dairy. Especially cheese, which is really hard to digest to begin with. Granted I am thinking this as I am eating yogurt, dairy, myself. It struck me, why did I have that thought?  I stopped to do a little self-reflection and I realized it was because I find myself eating foods that I would not normally choose to eat because I’m so limited. I found myself frustrated with those who choose to eat whatever they want because they enjoy it even if they could make better choices because I don’t have that luxury. 

There is a name for this in psychology, if you were in a therapy session would be called counter transference. I have to do a lot of self examination, counter transference work, in my assignments as a student, I thought it was kind of interesting.  I don't have counter transference with my role playing "clients" but I do have bias triggers, like this, people who make poor choices when they have better options available.  Which of course is a judgemental thought and not helpful.  I make poor choices when I have better options available too!!!  

Bias trigger is one of those things that we need to be self-aware of.  Others around us can trigger negative thoughts and feelings within us.  Add to that we can never be truly bias free. We’ll always have opinions and ideas, and those were shape and form or thoughts and feelings. We may even find hints of racist, sexist, or ageist thoughts and having to admit that may frighten us or make us feel guilty.  The challenge is not to make yourself the most politically correct person in the world, but rather to be aware the feelings and thoughts you have so that you can address those in your own mind. If we pretend they don’t exist we will never deal with them.  We have to admit our failings and faults, even embrace them and accept them.  The paradox, once we accept we are human and fail, we then can make real change.  

Sometimes just accepting it, changes it. For example: If I am deceiving myself or blind to a fault, and then I recognize and admit I am blind, just admitting it dissolves it and I see more clearly who I really am.  That doesn't work for all issues, but recognizing it then accepting it are the first two steps. Then you can work to adapt to it or crush it.  In my case, with the yoghurt and the forum participant who wanted to know if they could have a little dairy, I started to ask myself what is it like for this person?  They are a real human being with struggles, frustrations, cares, worries, and loss in their own life.  How is it that I assume they have it easier and they should just choose better.  Soon as I said "should" I remembered the 10 cognitive distortions (untruths we tell ourselves).  If you'd like to learn more about telling yourself the truth click here.  

Angela Poch, certified life coach, certified level 1 TEAM* practitioner, and certified nutritional counsellor. 

*TEAM-CBT, developed by Dr David Burns, is an evidenced-based approach to psychotherapy with Cognitive Behavioral Therapy (CBT) at its core, recognizing the connection between thoughts and emotions, and behaviour, but inclusive of various techniques across many approaches. TEAM is an acronym: Testing, Empathy, Acceptance (paradoxical Agenda setting) and Methods. 

Tuesday, September 25, 2018

Checking In - Put People FIRST!

Just checking in since it's been awhile since I've posted.  You'll find I'm pretty busy this fall and it's likely I won't be posted regular until I finish my schooling in December.  I plan to take a month off then I'll open my office doors with full services of licensed therapy and certified health coaching.

Tomorrow I fly out to Nova Scotia where I've been asked to speak at the 2018 Health Summit on Health Coaching. I had to cram my already busy life into an even shorter work week.  In the midst of this I had a call from a reader.  Now, I'm not big on the phone at the best of times and I avoid it like the plague at others.  This reader had called before a couple times and wanted my free newsletter, which is mentioned on a TV show I did many years ago.  As In no longer do mail outs of my newsletter but rather use only the e-version (sign up at the top right of this page), I found myself reluctant to call back.  I did try a couple times and when it didn't go through crossed it off my list of To Do's.

Well, they called again yesterday and this time when I called back I got through and it was a blessing to both of us.  We talked about nutrition, extremes, stress, and enjoying our food while trying to eat as healthy as probably, not necessarily possible.  I would have missed out on this blessing had I listened to my feelings.  I didn't feel like it.  I was so busy getting an assignment finished, packing for the tripo, finishing handouts for the seminar, and I needed to pick my apples in the orchard!   But I wouldn't take back that 45 minutes now.  I still got everything I needed done and a blessing of touching someone else's life.

Don't miss out on the blessings of relationships and people because of tasks.  Task's can usually wait, people matter NOW!

Blessings,
Angela Poch

Wednesday, July 11, 2018

The Most Important Benefit of Gratitude


I missed posting last week because I was at the 4-Day TEAM CBT Intensive in Whistler with Dr. David Burns.  It was an amazing event, learn more about dealing with anxiety, depression, procrastination, and more at www.FeelingGood.com.  Anyway, I said we'd look at the benefits of gratitude so that's what this week is about.

There are all kinds of blogs, articles, and studies on gratitude.  An article in Forbes lists 7 Scientifically Proven benefits including: Building social relationships, improving physical health, mental wellness,  enhances empathy and reduces aggression, helps with better sleep, improves self-esteem, and lastly improves mental strength. https://www.forbes.com/sites/amymorin/2014/11/23/7-scientifically-proven-benefits-of-gratitude-that-will-motivate-you-to-give-thanks-year-round/#50d3eb92183c

Perhaps that last one is the most important benefit of gratitude, it improves mental strength, or one could say is a powerful coping skill. Don't get me wrong, we all want better relationships with those we love and who doesn't want to have great physical health. But, with our body systems so interconnected having the ability to cope with things life throws at us is one of the keys to not only happiness but also our health.

Counting my blessings has helped me cope with many stressors in my life from moderate irritations to full blown anxiety attacks.  While listing 10 things I'm grateful for didn't cure my intense anxiety, it did help me to calm down long enough to use the appropriate cognitive techniques (several listed in Dr. Burn's podcasts on itunes if you are interested).  When I have had IBS attacks, reciting things I am grateful for makes the time pass so much faster and it lessens the pain significantly.

What are some ways you use gratitude to cope? I'd love to hear from you.

One last thing I wanted to share, is something I am truly grateful for and that is.... drum roll.... people who are willing to agree to disagree.  Over the years, I've met some pretty mean people on the internet.  I'm sure in 'real life' they aren't as bad as online, but there is an awful lot of criticism out there. Whether you are trying to go plant based, just eat a few more veggies, or go all the way vegan it can be disheartening to have your mistakes plastered by others.  One blogger who is as kind hearted as she is determined to help save the planet and the critters on it is Tully Zander. She has some wonderful recipes that you will find absolutely delicious along with blog articles.  Check them out on her website: www.vegansfirst.com


Wednesday, June 27, 2018

When Crying Feels Good -- 5 Benefits To Tears

I once heard someone say crying is like a celebration of that which you've lost. That was such an amazing revelation to me. That's often exactly how I feel. Like I'm enjoying a piece of history.  Emotions are not as cut and dry as we'd like to think.  Life is fluid why should we expect our emotions to be static as if they are box in neat little packages.  Reality is our lives and our emotions are dynamic and integrated with each other.  We can be happy and cry, sad and laugh, or even bemused and angry, all at the same time.  Embracing this dichotomy is healthy.

Have you ever tried to avoid crying, holding it all back, distracting yourself to keep the tears in, only to feel an immense release once you allowed yourself the freedom to let it all out?   I know I have. In fact, I find from time to time I need a good cry. It's like a cathartic release of stress, grief, anxiety, and in that moment I actually feel good.

Did you know there are benefits to crying.  Here are five:1
  • Part of healthy grieving
  • Helps with emotional balance
  • Restores body balance
  • Improves mood
  • It can dull pain
Crying is part of a healthy grieving process.  I already mentioned it's like a celebration of what you've lost.  That loss can be a person, job, dream, or even goal.  It can be part of life transitions for example your child who is now all grown up. These can be happy celebrations or real struggles. Granted we don't have to cry to grieve, each person has their own unique ways of dealing with loss, but often tears are a catharsis that is beneficial.

"'Crying activates the body in a healthy way,' says Stephen Sideroff, Ph.D., a clinical psychologist at UCLA and director of the Raoul Wallenberg Institute of Ethics. 'Letting down one's guard and one's defenses and [crying] is a very positive, healthy thing. The same thing happens when you watch a movie and it touches you and you cry... That process of opening into yourself... it's like a lock and key'... Stress 'tightens muscles and heightens tension, so when you cry you release some of that,' Sideroff says. '[Crying] activates the parasympathetic nervous system and restores the body to a state of balance.'"2

Not only can crying work with the parasympathetic nervous system, but it can also trigger endorphins like oxytocin and opioids.  These chemicals produce a reaction in the body to produce a sense of calm and ease pain.1   This ability to dull pain might explain why children or even adults cry when injured.  Here you thought it was just to get sympathy.

So, the next time you feel a dampness around your eyes, don't hold back.  It's not only ok to express yourself, but it's healthy!

Next week we'll look at gratitude and the benefits of being thankful.

Sources:

1. “9 Benefits of Crying.” Healthline, Healthline Media, www.healthline.com/health/benefits-of-crying. 

2. Govender, Serusha. “Is Crying Good for You?” WebMD, WebMD, www.webmd.com/balance/features/is-crying-good-for-you#1.

Acceptance and Anxiety

The other morning I was listening to one of Dr. David Burns Podcasts, number 88 to be exact. (Just a little plug there for him on feared f...