Coping Tools for Stress, Depression & Anxiety Shira B. Wilson, MA, LMHC Psychotherapist, Licensed Mental Health Counselor
Why Focus on Our Mental Well-Being? Definition: Our mental health includes our psychological, social and emotional well-being. This includes how we think, feel, act, make choices, connect with others and feel happy. Does making changes in this part of your life impact your IBD? Possibly. Chronic Stress and IBD.
Format of Session We ll discuss four fictional patients stories. We ll focus on one key emotional challenge per patient and specific ways to cope. Talk will cover grief, stress, anxiety, shame and low motivation in depression through these fictional patients experiences. End with Q&A.
Marianne s Story Diagnosed with Crohn s a year ago while studying piano at college. Her dream has been to play professionally until getting sick. She s taking a leave from school now due to her ongoing flare. She s compliant with medication, appointments. Eliminated gluten, diary-- feels like her health right now is a full time job. She would like to socialize more, maybe date but feels like she doesn t have much that s fun to talk about. She s finding herself crying a lot. Lately even small tasks feel overwhelming and she s having a hard time concentrating. She s hoping the biologics will start working. She wishes things will go back to how they were before the diagnosis and not have everything in her life revolve around Crohn s.
Marianne s Story Who here resonates with some of Marianne s story? What key emotional challenge might she be going through?
What is Grief? Grief is normal and inevitable when you lose someone or something important to you. You can have physical, emotional, social and spiritual responses to grief: sadness, changes in sleep & appetite, avoidance of reminders of your loss, irritability, fatigue, difficulty making decisions. What doesn t help grieve? Not showing compassion for yourself hinders grief- ex. this shouldn t bother me so much.
What Helps Grief Process? Mindfulness of what you re experiencing helps to accept the reality of your loss (1 st process in grief). Definition of Mindfulness from the IBD Journal, a study of Mindfulness & IBD 3/2016: Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment. (Neilson, 2016) Make time to allow thoughts of your loss to arise. This includes exploring the meaning of your loss.
What Helps Grief Process? Next step in Grief Process is Acknowledge the Pain of Loss. Feeling the pain is how you work through the grief. Finally, Adapting to the Loss. May include finding new ways to fulfill your roles and responsibilities. This may include letting go of past dreams and reinvesting in a new direction.
What Marianne Chooses To Do She attends a support group and tells her story and begins to talk more with a close friend about what she s lost due to Crohn s. Notices her thoughts: my body feels like the enemy are keeping her stuck, she attends a gentle yoga class with a friend. She notices her worry is a way to keep from feeling her grief; this awareness is empowering.
Will s Story Will has severe UC. After biologics have failed to control his symptoms his GI referred him to a surgeon. He s not sure why, but this feels like failure to him; he thinks he should have tried harder with changes to his diet or other treatments. He knows what it s like to be really sick with UC but worries about something even worse happening as a result of surgery. He feels overwhelmed about making this decision. He hasn t talked about his dilemma with anyone outside of his healthcare team. He feels embarrassed that he s so overwhelmed with worry and indecision. He feels weak for worrying and doesn t want to admit he needs help figuring out what to do. He feels if he admits how he feels to his family, he ll be letting them down, not having all the answers.
Will s Story Who here resonates with some of Will s story? What key emotional challenge might he be going through?
What is Stress? Something is stressful if you perceive it as dangerous, difficult or threatening. We are resilient to short periods of stress. Stress can arise from both positive and negative situations. IBD causes physical stress: inflammation, pain; IBD can also cause psychological and social stress.
What is the Stress Response? The Fight, Flight or Freeze Stress Response. Physical: muscle tension, butterflies in stomach, cold hands and feet, heart and breathing rate increase. Mental: worry, confusion, not quite yourself. Tend and Befriend Stress Response Stress hormone oxytocin is released when we choose to talk with someone we feel close to. Oxytocin is anti-inflammatory beneficial to body and mind. Return-to-Normal: Relaxation Response. When you perceive stressor is gone or dealt with.
Chronic Stress Chronic stress impacts mind and body. Can impair immune response, impact mood. What helps to cope with/ buffer chronic stress? Mindfulness practices help to increase 3 important buffers: Increase sense of control/increase comfort with uncertainty. Increase sense of predictability. Increase sense of optimism: in other words, increase your sense of feeling effective, make changes.
What Will Chooses To Do Connects with CCFA Power of Two volunteer who s experienced similar surgery. Discusses details with surgeon ahead of time, such as what he ll need help with post surgery. Notices his anxiety when it arises and its trigger.
What is Anxiety? Response of worry to something real or imagined. Our minds tend to worry, focus on the negative. What does anxiety feel like? Mental: can trigger confusion, sense of being overwhelmed and helpless, irritable. Physical: anxiety is uncomfortable, can include muscle tension, rapid heart rate, shallow breathing, tension headaches, increased GI symptoms.
Coping with Anxiety Avoidance and denial do not help anxiety. What helps reduce anxiety? Breath awareness and other mindfulness-based actions. Social support: feeling alone or isolated increases anxiety, feeling supported decreases anxiety. Tone of your self-talk : self-critical voices increase anxiety, encouragement and normalizing voices decrease, e.g. I can do this, this will pass too.
What Will Chooses To Do Takes effective action: makes a living will. Normalizes his own feelings of fear of surgery. Stays more in the present with his emotions: e.g. He notes how the unknown is triggering his anxiety and labels his feelings as they arise as worry of the unknown rather than spinning a story of what might happen in the future.
Eleanor s Story 28 year old Eleanor was diagnosed with Crohn s a few years ago, is a married Mom to 2 young children, has had flares on and off; when flaring always feels tired and often cancels plans to be near a bathroom. She keeps impact of Crohn s to herself-why would talking about them help anything? She used to manage difficult feelings and stress through comfort eating and can t eat those foods anymore without a lot of pain. She feels a constant sense of not being a good enough Mom when she s ill, of letting her husband down in both the family business and in their intimate life. She constantly feels guilty for being sick and dreads asking family for help and finds herself feeling irritable pretty much every day.
Eleanor s Story Who here resonates with some of Eleanor s story? What key emotions might she be experiencing?
What is Shame? A definition from author Brene Brown: Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging. IBD symptoms can trigger shame. Your own expectations of yourself and others expectations can trigger feelings of shame.
What Worsens Shame? Often the ways we have of dealing with shame, of not feeling shame, worsen shame. When we re experiencing shame, we re much more likely to respond in ways that increase shame: We hide, withdraw--go off the grid. Respond with it s my fault, let me people please and make it better. Fight shame with shame, such as: that person didn t deserve my trust anyway, or I didn t want that friendship anyway.
What Reduces Shame? Brene Brown s term shame resilience in 4 steps: Recognize shame and understand its triggers. Reality check the messages and expectations for yourself and from others that fuel this shame. Shame =I am bad. Guilt=I did something bad. Reach out and tell your story to someone who won t judge you. Shame doesn t survive Empathy. Empathy is feeling understood and validated. Call shame-shame mindfulness of shame.
What Eleanor Chooses To Do Listens to her husband s Edward s own feelings about Crohn s-his anger toward the illness. Speaks to her pastor and gets guidance on how to explore her beliefs behind all her shoulds. Reality checks these beliefs with her husband and family, and most importantly, with herself. Where did this belief come from? How does it serve her? What would change if she didn t believe it anymore? What would she lose by letting go of this belief? What would she gain?
Brandon s Story Brandon, diagnosed with UC while deployed in Afghanistan as a combat medic, is now working as a 911 operator. He wants to make a career change, but can t get the motivation to figure out how to translate his military training to a different career. Describes himself as without any motivation or willpower anymore. Takes more pain meds than he needs to chill out at night, not think about things. He used to love working in his carpentry workshop but has no interest in that now. He usually doesn t reply to friends texts asking him to meet up like he used to. He isn t sleeping much and is always tired and fatigued, has no appetite and often goes the whole day without eating as it s just easier to not deal with food.
Brandon s Story Who here resonates with some of Brandon s story? What key emotional challenge might he be experiencing?
Low Motivation/Willpower What is Willpower? Being motivated to do the difficult thing. A quality or ability we can strengthen. Ideal Willpower mode vs Stress-based mode. What sabatoges Willpower? Being self-critical-shame, guilt, our inner critic. Not knowing our goals, what s important to us in the long-run: mindfulness of what s important to us vs what we crave in the short-term.
Increasing Willpower What helps build willpower? Focused breathing (mindfulness-based relaxation practices). Energy management (regular eating and sleep) Self-compassion and not guilt or shame. Breaking overwhelming tasks down into doable steps.
What Brandon Chooses To Do Reads about Pete Caroll s coaching methods of the Seahawks which includes mindfulness and decides to see a counselor for help with depression who uses mindfulness practices. He decides to focus on his low motivation as a starting place in therapy. Writes down his long-term and short term goals. Focuses on one situation which sabotages him: being alone on the weekends and makes changes: Commits to plans financially ahead of time so he can t back out of social plans. This leads to regular eating on the weekends and a regular routine of sleep to be on time. Commits to 5 mins a day of mindfulness practice: leads him to be more in the present moment, and to notice that if he allows sadness to arise it won t last as long as he think it does when he tries to avoid it or numb it.
Discussion and Q&A What s one take-away for yourself from today s talk?