PS: You are always welcome to chat with me. I offer a free 15 minute consultation.
Body Mind Health Blog
Articles on mental health and wellness
From depression and anxiety, to stress and insomnia, practical help on a variety of subjects. Note: There is some Christian content, if that's not your thing just scroll past those thoughts. I hope you find some helpful tools. Let me know if there is any topic you'd be interested in seeing here.
Angela Poch, RPCC, CLC
Type the words “sleep & mental health” into Google and you’ll get article after article from reputable sources relating how important sleep is to our mental well-being. From medical journals to blogs by psychologists, the interconnection between body and mind play out very closely when it comes to sleep and poor mental health.
While the studies of neurochemistry and neuroscience are still in infancy, researchers are discovering some very real connections between sleep and mental stability, or lack thereof. “There are some studies in both children and adults are suggesting that a lack of proper sleep may raise risk for, an even directly contribute to some psychiatric disorders And that treating the sleep disorder may actually help alleviate symptoms of the mental health problems caused by that sleep disturbance. (Harvard Health 2009)
Depression, anxiety, ADHD, bipolar, Schizophrenia, PTSD, and psychosis, just to name a few, are disorders that have been studied in relation to sleep. Up to 80% of the people who have these disorders also have sleep problems and while it’s been long thought there was some kind of correlation, now scientists are starting to see an actual causal relationship. That means lack of sleep is actually contributing to the disorder itself. (Scott 2017) Just one statistic reports, people with insomnia are twice as likely to develop depression as those who sleep normally. (Khawja MD 2017) This is it to say sleep alone will cure all these diseases, but the more we can make a positive choice, the more we get a handle on each aspect of health, the more we can improve both our physical and mental health.
So what constitutes a good night's sleep? Is there a set number of hours you should sleep? What time is best? How do you get a good quality of sleep? The answers to all these questions are important so let’s dive into each one.
A good night's sleep is one where you fall asleep within 30 minutes of going to bed, don't wake more than a couple times during the night, more than 20 minutes awake during those periods of time, you spend 85% or more of time asleep while in bed, you don't need an alarm to wake you up, and you feel rested in the morning.
Most sleep experts agree 7 to 8 hours is the optimal amount of time for a good night's sleep. It is true some people seem fine, even appear to thrive on, under 7 hours on the pillow. I've know a gentleman who slept less than 4 hours per night most of his life and he had so much energy he thought it was ok. Turn out he was bi-polar and sadly he ended up drying of suicide in his 60's. Let this be a warning, you can't judge your sleep only by how much or little energy you have. This can be a dangerous road. People think they are the exception to the rule until poor health sets in and it's too late. Too much sleep can be indicative of a health issue was well. Generally over 9 hours on a regular bases is cause for concern. Talk to your doctor if either of these apply to you.
I know some of you night owls will disagree with this next one, but studies confirm it's best to get to bed between 8pm and midnight depending on time of the year, where you live, and other factors. Most people have a spike in melatonin around 9pm, which is the hormone to help you sleep deep and to repair your body.
So how do you get the best quality of sleep? Develop a healthy bedtime route. Routines help our bodies maintain a systematic circadian rhythm enabling good sleep cycles. Go to bed at the same time each night, get up the same time each morning, limit caffeine throughout the day, don't eat a large meal at least 4 hours before bed, have a relaxing routine 1 hour before bedtime, limit screen time 1 to 2 hours before bed (blue light affects sleep), keep the room dark as possible, leave electronics out of the bedroom, and don't do anything but sleep in bed (well, there is one other thing you can do but no reading in bed, texting, etc.). The mind and body are habitual. If you only sleep in bed it becomes a trigger to sleep just by laying there.
If you'd like to know how you are sleeping visit: www.higherpath.ca/sleep for a free assessment and hand out on sleep.
- Understanding Sleep. Mental Health Canada. www.mentalhealthcanada.com/article_detail.asp?lang=e&id=28.
- Allen, Lauren. “How Sleep Affects Mental Health | Effects of Poor Sleep on Anxiety, Depression, & ADHD.” Neurocore, Neurocore, 12 July 2018, www.neurocorecenters.com/blog/how-sleep-affects-mental-health.
- Breus, Michael. “Sleep and Mental Health Disorders. Psych Central.com, 8 Oct. 2018, psychcentral.com/lib/sleep-and-mental-health-disorders.
- Scott, Alexandar J, et al. “Does Improving Sleep Lead to Better Mental Health? A Protocol for a Meta-Analytic Review of Randomised Controlled Trials.” NCBI, 18 Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5623526/.
- Harvard Health Publishing. “Sleep and Mental Health.” Harvard Health Blog, Harvard Health Publishing, July 2009, www.health.harvard.edu/newsletter_article/sleep-and-mental-health.
- Updated: June 19, 2018
- Curtin, Cathryn. SHF Australia. “Sleep and Mental Health.” The Sleep Health Foundation, www.sleephealthfoundation.org.au/news/sleep-blog/sleep-and-mental-health.html.
- Khawaja, Imran, S, M.D. “Sleep Disorders and Mental Illness Go Hand in Hand.” UTSouthwestern Medical Center, utswmed.org/medblog/sleep-disorders-mental-illness/.
- "Sleep Disorders, Depression, Schizophrenia -- How They're Related."WebMD, WebMD, www.webmd.com/sleep-disorders/guide/psychiatric-disorders.
- "Sleep Matters: The Impact Of Sleep On Health And Wellbeing." Mental Health Foundation, 17 Jan. 2016, www.mentalhealth.org.uk/publications/sleep-report.
- "Find Out Your Best Hours for Sleep Based on Your Biology and Your Life." Sleep.Org, Sleep.Org, www.sleep.org/articles/best-hours-sleep.
So I thought today I would talk a bit about why I believe in an integrative approach of body, mind, and soul. And why I follow a plant-based diet as well as other lifestyle choices.
Since science can’t really articulate the separation of the physical brain and emotions/thoughts, this will be a little bit philosophical. We all have our different views that come from a combination of things we’ve read from science or the Bible or even social media posts. And while I could document the sources where I get my ideas from, the reality is, I cannot prove it and my goal is not to convince you of my believe but rather to understand a little bit more about why I do what I do. So, I hope you will read all the way through this article with that in mind.
You may have heard me say body mind health, or body mind and soul, or integrative approach, or various combinations of these. Certainly it's in the name of my blog, website and facebook pages. LOL. Obviously, when I say 'body,' I’m referring to your physical body. Mind refers your thoughts and feelings and soul is the essence of who you are or your personality.
You might be with me so far, or not, but I’m not sure you’ll be on board with my next belief which is that not only our minds, but our souls are also intricately linked to our physical brain. One of the evidence is for this is Phineas Gauge who had an abrupt personality change when a tamping bar went through his frontal lobe. There’s actually many more stories of people who had brain injuries or disease, and had personality changes, emotional problems, or even the way they think changed. Unlike alzheimer's, some dementia patient's family members will tell you this is NOT the person they remember. So we know that physical disease and injury to the brain do you change thoughts and emotions in a person, and even their personality. As a Christian I believe the breath of life comes from God, as mentioned in Genesis and in the New Testament, and goes back to God when we die. I just don’t believe that the soul and the breath of life are the same thing. I don’t think that your soul lives on without a body. I actually have a Bible study on this if you like and you can get that here. Don't get me wrong, I do believe in heaven and life after death, just not life immediately after death, I believe in the resurrection John 5:28.
You might have different definitions for these words, or beliefs, and that’s absolutely fine. I do know many things that affect one affects the other. Having a doctrinal difference won’t affect how we work together, it only explains why the body, and specifically the brain, is so important to protect. Because whether you believe the soul is a separate entity from your body or not, we can agree the mind is affected by physical health, and that one can no longer make good decisions if they get a stroke from a poor lifestyle. Our brain's can't function properly without our whole bodies working in good order. We need proper nutrition for the chemical messengers in our brains, we need exercise for circulation and delivery of these, and so much more. We’ve seen this in science many times. We know that extreme lack of sleep can cause emotional problems such as irritability and poor cognitive function. Likewise we know certain thoughts can actually reduce physical pain, reducing emotional stress can lower your risk of cancer and heart disease, and many other interconnections.
A plant based diet is one of the best ways to get on the road to optimal health. The blue zones are centuries of proof that eating lots of plant foods and limited sugar, added fat, and animal products, is the most healthy way to eat. There are hundreds of studies and books in modern research to back this up. And even some of those following a keto or low card diet believe this so much they endeavor to be vegan or close to it, which is not easy to do, but is possible.
I think in general people forget how important their overall health is to their emotional happiness. Of course I totally believe in any state of health you can have peace and even happiness. And I do believe that we can’t always determine how healthy will be by our choices. I realize there are other factors that influence our health such as DNA, environmental factors, and other unknowns out of our control. Let’s do what we can, when we can, is my philosophy. This is why I choose to walk with you on your journey, rather than dragging you along on mine.
A couple weeks ago we talked about desire doesn't equal change in the article "Empathy is Not Responsibility". I thought I’d talk more about that this week. Wanting to change and changing obviously are not the same thing, because when you actually change there is some kind of difference that happens. Now, sometimes we say, “I’m trying to ...” like "I’m trying to lose weight," but really what we’re saying is we would like to lose weight. We say "I’m trying" because maybe you’ve attempted a few efforts in that direction but the actual change has not happened yet. The problem is, every time we say something out loud, or even in our heads, we believe it and that can set ourselves up for failure. We start to think we've put in so much effort to this change and we’ve tried for so long to do this thing, that we feel like it’s never going to happen.
It’s just too hard. I've tried and tried. I often hear this from people who are struggling to break free from a bad habit or an addiction or those who desire to start a new healthy life choice. Eating better, eating less, exercising, getting more sleep, quit smoking, the list goes on. Some of these issues are quite comprehensive and they can look insurmountable as goals, we really don’t know where to start when we just look at the big picture and think I would like this. But if we were to break them down to smaller goals, that were simple and pretty easy to attain, it would be easier to make the change. Maybe we’ll talk more about goals next week, but for now will continue on this theme of desire and trying.
One of the keys to going from desire to change, is figuring out where you’re at right now. What is it about the state you’re in that makes you want to stay there? What are some positive aspects about your situation right now that you wouldn’t want to change? Let’s take my example of trying to lose weight. Well, first of all, it requires me to set aside more time for exercising and creating healthier meals. Time is a pretty precious commodity and I’d have to give up something else I’m doing, like cleaning my house, sorting through books, organizing photos on my computer, and so on. Note, these are all important things and they mean a lot to me. Some of them are I would even say are necessary.
What do those things say about me? I like to be organized, is that a good thing? I need to keep stress down for my health and these things help me do that, Isn't that good? I could make a really long list here. Do you have any suggestions? I'd love to here them in the comments section. The more you participate the more relevant and helpful you'll find this.
Now, let's also look at what does it say about me that losing weight is really not that important to me (since I haven't done it yet, it must not be THAT important)? I’m not as worried about self image as I am keep my life organized. That’s a pretty good character trait to have. Again, I wonder if you could come up with some ideas of your own (put them in the comments)?
What is it that you would like to change and why would making a change be a problem for you? What positive thing does it say about you? These idea were inspired by Dr. David Burns concept of paradoxical agenda setting. That we really have to find the positive things about ourselves even for the negative things that we have decided we’d like to change.
Let’s do one more example. Let’s say you don’t get enough sleep because you don't get to bed on time. A VERY common problem for many of my clients. Notice I just made something general, not getting enough sleep, to something specific, not getting to bed on time. Being specific makes it easier to break down so we will get even more specific. Why aren’t you getting to bed on time? Perhaps because you’re visiting with friends on social media or the phone, you are enjoying a movie, you’re finishing chores it didn’t get done, maybe that’s when a particular family member calls you. Each of these I’ll say something positive about you. For example visiting with friends isn’t a bad thing. We all need social interaction and it shows you care about others. Isn’t it good to care about others? Of course. Enjoying a movie, well this is you know how to take a break and it shows you’re not afraid to relax. Isn’t that a good thing? I’ll leave the others for you to ponder. And this will work much better if you can list your own.
Once you see the benefits of not changing AND the positive things this says about you, it actually helps you to see it from a new perspective. That you are not a BAD person for not changing...yet, LOL. It even helps you see ways you can change and still keep all the benefits you currently have.
The reason we don’t change is ultimately because there’s something positive holding us back from making the choice. Discovering what that is will be far more effective than forcing or punishing yourself. The effort is not correctly directed. A wise writer once said we need to understand the right use of the will (Steps to Christ by Ellen White). In other words we don’t need more willpower, instead we need to make the right choice, and the only way to know what that choice is, is to fully investigate in our own minds with a neutral, non-judgmental attitude, and discover where we are at right now and how is that benefiting our lives.
Life purpose may seem like a vague concept that has little meaning or value, but research is showing it does have a real impact on health.
One analysis of over 130,000 participants over 10 studies found: "The analysis showed a lower risk of death for participants with a high sense of purpose in life. After adjusting for other factors, mortality was about one-fifth lower for participants reporting a strong sense of purpose, or ikigai. A high sense of purpose in life was also related to a lower risk of cardiovascular events. Both associations remained significant on analysis of various subgroups, including country, how purpose in life was measured, and whether the studies included participants with pre-existing cardiovascular disease." “'Purpose in life' linked to lower mortality and cardiovascular risk.” Medical News Today, MediLexicon International, 4 Dec. 2015, www.medicalnewstoday.com/releases/303569.php, retrieved 2017-10-19.
So what ikigai? Its a Japanese saying for a life worth living or a reason for being. Life purpose can also be described as being useful to someone else. We talk about volunteering and how that has been shown to increase your life expectancy by up to 7 years in our Optimal Health course, which I'm sure you've taken by now, so I won't belabor the point.
Life purpose can even help improve the quality of sleep and is being research as a drug free way to help with sleep issues. Prof. Jason Ong, Northwestern University Feinberg School of Medicine stated, "Helping people cultivate a purpose in life could be an effective drug-free strategy to improve sleep quality, particularly for a population that is facing more insomnia. Purpose in life is something that can be cultivated and enhanced through mindfulness therapies." “'Purpose in life' linked to lower mortality and cardiovascular risk.” Medical News Today, MediLexicon International, 4 Dec. 2015, www.medicalnewstoday.com/releases/303569.php.
So how do you find your life purpose? It starts with discovering more about yourself and what you enjoy. What motivates you? What brings you joy? And if you want to go even deeper, you can use your life purpose as a career. We have a step by step plan to help you discover your life purpose, book a free 15 minute consultation today! Limited seats available.
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.
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.
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). 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.
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.
(Taken from Angela Poch, 'Psychology of Grief' research project)
- Anticipatory Grief. (n.d.). Retrieved fromhttps://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 fromhttps://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 fromhttps://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.
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-CBT* 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.
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!