Stress, Anxiety, and Hidden Emotions

There’s been some evidence that hidden emotions are linked to some to anxiety issues.  That when we bury, or repress, negative emotions that can lead to anxiety. And since none of us are immune I thought I’d share my own story which of course, is still a work in progress.

I tend to be able to cope with major life or stressful events fairly easily. I go into a task oriented mode and deal with the situation clinically. My faith feels strong and connected with God when it’s a major crisis event. However, when small things upset me in big ways I feel disconnected, alone, even incompetent. As I did some soul searching this past year, I discovered some of the reason I have this problem is a hidden “should statement” in my brain. “I shouldn’t feel this way.” There are different “reasons” for my believing this statement but usually something like: “I should be a bigger person”, “I know better”, “Jesus would just forgive them”, “I should forgive them, I forgiven far worse”, “It’s just a little thing, this is ridiculous it's upsetting me”, “A nice person wouldn’t be bothered by this”, “I should just let this go, it’s no big deal”, and so on. I don’t know if any of these kind of thoughts ring true for you, but they’re pretty common for those of us with anxiety.  The wording may vary from person to person but the theme is similar.

One little text from a friend or family member can set me into a major tailspin, while a car crash I’m able to work through without going through any major anxiety or panic attacks. Then I begin to question my own sanity. “I’m so stupid. Why is this one little thing bugging me? It’s not the end of the world.” But still I find myself stressed over that one little sentence. Other thoughts seep in. In the past family members have been upset with me over what I believe to be very little things. So upset, in once case I never heard from again even after writing a few letters. Like things creating big conflict. Things like forgetting to call before showing up at their home, not keeping in touch often enough (not that they ever kept in touch), posting a picture on social media, or even making a pie (long story). So because it’s happened before I’m thinking FOR sure this is going to happen again. In fact it will likely happen anytime there’s any conflict. 

This is my hidden emotion, or hidden thought if you will. Fear of abandonment because I might have said or done something wrong.  In my mind I wonder what’s wrong with me? I do my best but I still screw up. I put energy into being the best I can be but it doesn’t ever seem to be enough. 

Now I don’t know about you. but I can see a lot of distortion’s, exaggerations, or untruthful thinking, just in those few sentences/questions. But even though I know there’s distortions, and they’re not true, when I’m feeling anxious I believe them 100%.

Most of the time we can crush a thought without figuring out why it’s there in the first place. BUT with hidden emotions we do have to do some digging. While knowing why we have a particular thought doesn’t usually crush it, we end up in a loop of thoughts until we draw it out.  We work on surface negative thoughts but they repeat the next time a stressor comes our way. This is deeper work. Digging down into our hearts.  

One of the ways to search out a hidden emotion is to recognize patterns between certain kinds of stressors/events and certain thoughts.  Another way is to use the “downward arrow” a cognitive technique. And lastly an easy place to start is 'niceness' since, for about 75% of those with anxiety, the most common hidden emotion is niceness.  Now, I know ‘niceness’ isn’t really an emotion. It’s a self-defeating belief.  I’m supposed to be nice (because X) and therefore I can’t be upset, angry, hurt, etc. That’s the emotion part of it. The anger, hurt, etc.  I encourage you to listen to this podcast by Dr. Burns about anxiety and hidden emotions: https://feelinggood.com/2017/03/13/027-scared-stiff-the-hidden-emotion-model-part-5/

But in any case, whatever your hidden emotion/self-defeating belief, to crush the negative thought we may need to use several tools. We need to come up with a positive belief we can believe 100%. One of those techniques is acceptance. The crazy thing about accepting a negative belief is you can actually crush it by seeing the value and truth in it. That may sound really strange, but it actually helps you to positively reframe it. Let me give you an example. So one of my thoughts regarding my anxiety when a mistake is pointed out to me is: “It’s not fair. I try really hard to honour my friends/family’s wishes and when I screw up they shouldn’t be angry with me. I’m only human.” So let’s break that down. First of all, it hinges on the fact that nobody should get angry or upset with me, ever. Is that realistic? What am I asking of those around me if they should never get angry, or hurt, or upset ever? Is that fair of me to expect that of them? Note this line of thinking is doesn’t put more blame on me or them. It’s just to see the reality of the situation as it is. If I screw up and hurt someone they have a right to get upset, hurt, angry, or even just let me know (they might not be feeling any of those things, just pointing out something I did). There’s nothing wrong with that. It doesn’t make them a bad person or me a bad person, we are all human. We all make mistakes. We all have feelings.  Getting angry isn’t the end of the world, nor does it necessarily mean the end of a friendship. I don’t need to withdraw just because I’m afraid of anger. I might not like it, I might feel uncomfortable about it, I might wish it never happened. Those are acceptable thoughts.

Now there are some truths in my negative thoughts listed above, for example I do try hard. Here’s one way to refrain this thought. I care a lot about my friendships in my family and so I try hard to be the best person I can be but sometimes I screw up and that hurts them. It’s OK for them to express this hurt however it affects them, whether that is anger or pain, and in it which ever way they want to communicate that to me. I don’t have to fix the problem in fact many times I can’t it’s something that can’t be undone.

Positive reframing is only one way to deal with a negative emotion and it works even better if you can dig deep and find the hidden emotions and self-defeating believes underlying this anxiety. Unfortunately positive reframing doesn’t work all the time and sometimes you need other tools where you can talk with someone else through them. I went through this with a negative thought about being a failure as a mother.  I did some of the CBT tools by myself which helped quite a bit. But I still had anxiety on and off until I did a short role-play technique with a peer. That 10 minutes cured months of anxiety and it’s been gone for a year now. Now we do get relapses, that’s guaranteed. But we know the tools to use to help squash those painful anxiety feelings by crushing the negative thoughts. We use the same ones that gave us the first victory. So if your dealing with anxiety, try the self-help books they are very powerful (especially “When Panic Attacks” by Dr. David Burns) and if you still need some support look for someone you can talk to who is willing to work with you using these tools. You can even find a friend who read the book as well, and practice together or look for a therapist near you. Let’s face it we are all defective human beings and it times we need a helping hand. How critical are you someone else who says they need help? I bet you’re more critical of yourself. So if it’s OK for some people to get help why not you?

If you’d like to work with me on an anxiety issue, book a free 15 minute consultation session here.

Empathy is not responsibility.

Wow, I thought I'd take a month off to finish up my school and have a holiday before starting my private practice. That month turned into TWO and boy the time off felt so good!

As my peer world expands to include more and more counsellors, therapists, Pastor’s, teachers, and others in the helping profession, I think this topic is really relevant. Add to that those hundreds and thousands of people who are compassionate and empathetic, and there are a lot of us who have empathy, not only as a core value, but actually part of who we are.

Of course empathy and compassion are similar, but empathy goes deeper. Empathy is where you really put yourself in that person shoes, at least in terms of how they feel. Of course we can't put ourselves in someone else's shoes in terms of how they got there, their particular circumstances, because we're all so unique. We’ve all experienced anger, we’ve all experienced pain, we've all experience happiness and joy. But how we experience those emotions, the intensity of the emotion, and what leads to those will be different for each person. Example you’re sitting in an airplane beside someone who is terrified of flying.  Empathy doesn’t mean you have to be terrified of flying rather empathy gives you that awareness of what that person is going through emotionally and how hard it must be for that person sitting beside you.

When talking about empathy, it occurred to me maybe we should talk about what it is not. As just mentioned, empathy is not feeling exactly the same way about certain circumstance as another person would feel.  And empathy is also not taking on responsibility for the other person’s choices. I think this one really hit home for me as I was watching people struggling with weight loss. In a particular episode, I watched how hard the doctor tried to explain what was going on and the person was in complete denial about the circumstances. This person kept saying, "only I know it’s right for me," "the scale had to be wrong", "I can figure out how many calories are in something and I’m not eating that much."  This person just completely denied reality.  I thought to myself, wow how would I help that person if they came to me as a therapist? And I realized I couldn’t. As much is I could empathize with this person's pain (aches and pains are an ongoing battle for me too) and struggles (I've been wanting to loose weight for 2 years but I don't really try to lose the weight - desire doesn't equal trying, but that's another blog), empathy doesn’t give me the ability to change someone.

Empathy also doesn’t make me responsible for someone else or to force a person to change. Empathy opens up our heart to someone and then we have to move on from that at some point. Each individual person, as much as we influence each other, still has to make their own choices. No a matter how hard the circumstances, or what else is going on around us, we are still alone responsible to choose the path before us.

This means those of us with empathy really have to embrace the concept sitting with open hands. This concept by Dr. David Burns, is basically it’s offering someone a resource (friendship, tools, advice, help..... whatever.) and then you completely, 100%, accept their choice to take it or not.  I think this is super hard for those of us with a lot of empathy because we know their life could be so much better. It’s so hard, we can just feel it. We can feel where they’re at right now, we can feel where they could be at, and we just want it so bad for them.   

Here's the thing, your desire for them cannot turn into any kind of responsibility because it always comes down to free will and their choice.  This is so important for those who are dealing with friends, clients, and family that are struggling.  It is NOT your responsibility to make anyone change.  Not even your spouse or kids or clients.  Yes, you are responsible as far as you are able to influence, guide, and encourage, but it stops there.  You can't choose for them, therefore you are not responsible for their choice.

So next time you feel yourself so drained and arguing with someone, maybe pause and ask yourself: Is my empathy causing conflict because I feel responsible for this person and I wanna force them to make the better choice?

PS: You are always welcome to chat with me. I offer a free 15 minute consultation. 

 

Anticipatory Grief: Experiencing Pain Before The Loss

(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:

Anticipatory Grief. (n.d.). Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P03043

Grief, Bereavement, and Coping With Loss. (n.d.). Retrieved from https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/bereavement-hp-pdq#link/_167_toc

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.