Woman resting her head in her hands, exhaustedThe world is full of suffering. People committed to helping others—including those in helping professions such as mental health and medicine, activists, volunteers, and highly empathetic people—face nonstop exposure to a wide range of suffering. Compassion fatigue is a type of vicarious trauma that happens when a person is overwhelmed by the trauma and struggles of other people.

In its early stages, compassion fatigue may cause a person to be preoccupied by injustice and the desire to fix it. As compassion fatigue intensifies, however, it can lead to apathy and burnout. This can undermine a person’s relationships and connection to others. And for people in helping professions, compassion fatigue may prove professionally disastrous.

What Is Compassion Fatigue?

Compassion fatigue resembles burnout in that it may sap a person’s physical, emotional, and spiritual energy. Unlike burnout, however, it appears only in contexts where a person is providing extensive emotional support or emotional labor. In some cases, the symptoms of compassion fatigue resemble those of posttraumatic stress (PTSD).

Compassion fatigue resembles burnout in that it may sap a person’s physical, emotional, and spiritual energy.

Some other ways in which compassion fatigue differs from burnout include:

Who Gets Compassion Fatigue?

Anyone who spends significant time helping others or thinking about others’ suffering may develop compassion fatigue. Some especially vulnerable populations include:

Some research suggests that compassion fatigue is more prevalent when a person receives inadequate support for their work. A caregiver for a person with dementia may be more vulnerable to fatigue when other members of the family refuse to help or constantly criticize their caregiving.

Symptoms of Compassion Fatigue

The symptoms of compassion fatigue vary from person to person and may change with time. They include:

Strategies for Preventing Compassion Fatigue

Compassion fatigue is a common struggle, and it is not always preventable. It often comes on suddenly, even after a person has managed stress well for years. Certain prevention strategies, however, may reduce the risk and help a person better manage symptoms of compassion fatigue:

Treatment of Compassion Fatigue

Compassion fatigue is a response to chronic stress, not a mental health diagnosis. This means that treating compassion fatigue requires a person to get some relief from their stress. That might mean:

In some professions, it may not be possible to reduce the stress. For example, an emergency room doctor who treats abuse survivors may have little control over their workload, while a skilled death penalty attorney might be the only person in their region who can handle such complex cases. People in these situations may require extensive ongoing support, medication to manage anxiety and depression, and regular breaks from work.

No matter the cause of compassion fatigue, a therapist can help a person:

GoodTherapy can help you find a therapist who specializes in compassion fatigue. Begin your search here.

References:

  1. Compassion fatigue. (n.d.). The American Institute of Stress. Retrieved from https://www.stress.org/military/for-practitionersleaders/compassion-fatigue
  2. Compassion fatigue. (2017, August 23). American Bar Association. Retrieved from https://www.americanbar.org/groups/lawyer_assistance/resources/compassion_fatigue
  3. Gallagher, R. (2013). Compassion fatigue. Canadian Family Physician, 59(3), 265-268. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596203
  4. Pfifferling, J., & Gilley, K. (2000). Overcoming compassion fatigue. Retrieved from https://www.aafp.org/fpm/2000/0400/p39.html

How to Give Psychological First Aid

Infographic Text: How to Give Psychological First Aid

After a natural disaster or terrorist attack, there are likely going to be many people in distress. If you want to give emergency psychological support to survivors, remember to ASSIST:

Approach the individual.

Stabilize their emotions.

Serve their needs.

Inform them of the facts.

Support their story.

Turn them toward further services.

References:

  1. About PFA. (n.d.). The National Child Traumatic Stress Network. Retrieved from https://bit.ly/2pY5z51
  2. Psychological first aid for first responders [PDF]. (n.d.). SAMHSA. Retrieved from https://bit.ly/2NKy0Bb
  3. Snider, L., van Ommeren, M. & Schafer, A. (n.d.). Psychological first aid: Guide for field workers. Retrieved from https://bit.ly/2ZzKmSP

Child in pink dress dances outside among autumn leavesChildren often make discoveries through physical actions such as running, walking, playing, and scribbling. Their inner worlds manifest through these physical experiences. When a child is irritable, stressed, or struggling emotionally, their symptoms often appear physically. These symptoms may be seen as tension, crying tantrums, physical aggression, running away, throwing things, and so on.

Eventually, most children learn to regulate their emotions and express themselves in other ways. Emotional regulation refers to the ability to monitor feelings, evaluate emotional and physical responses, and modify emotional reactions in order to accomplish a goal. A child’s goal might range from earning screen time to not wanting to feel embarrassed in front of friends. A goal might also be a learned one, such as acting the “right” way at home.

Parents are largely responsible for regulating a child’s experience (for example, soothing a crying baby) in infancy and early childhood. When children reach preschool age, they begin to emotionally regulate independently. For youth without traumatic experiences or neurodiversity (autism, attention-deficit hyperactivity, or other neurodiverse conditions), independent emotional regulation becomes fairly stable around adolescence.

But some children struggle with the process of emotional regulation. Emotional dysregulation describes an inability or difficulty with monitoring, evaluating, and modifying emotional and physical responses. A number of factors can contribute to the development of this difficulty. Regardless of cause, the effects of emotional dysregulation may be seen in a child’s behavior. A child may also experience increased mental health symptoms as a result. [fat_widget_child_counselor_right]

What Does Emotional Dysregulation Look Like?

Emotional dysregulation appears in two major forms: under-regulation and over-regulation.

Under-regulation may occur when:

Under-regulation can result in behaviors such as impulsive actions, physical acting out, frequent meltdowns, poor concentration, and irritability.

Dance/movement therapy has been found to be helpful for many children. This approach offers body-based, clinical interventions for kids who present with symptoms of emotional dysregulation, struggle with emotional experience, and/or find it difficult to self-regulate emotionally. 

Over-regulation may occur when:

Over-regulation may lead children to lose a sense of connection with their emotions and with others. It can result in behaviors such as withdrawal, isolation, compulsions, and even outbursts of anger and aggression.

Helping Children Cope with Emotional Dysregulation

A number of treatments can help a person address their emotional experience and cope in healthier ways. Dance/movement therapy is one that has been found to be helpful for many children. This approach offers body-based, clinical interventions for kids who present with symptoms of emotional dysregulation, struggle with emotional experience, and/or find it difficult to self-regulate emotionally.

The American Dance Therapy Association defines dance/movement therapy as “the psychotherapeutic use of movement to promote emotional, social, cognitive and physical integration of the individual.” Trained dance/movement therapists use large motor movement, physical gestures, nonverbal communication, problem-solving skills, and movement games to engage children in therapy. These tactics can help the children address a variety of behaviors and symptoms, emotional dysregulation among them.

An integrative approach, dance/movement therapy uses the mind, body, and emotions. This type of treatment lends itself well to addressing the major areas of emotional dysregulation while meeting children at their developmental level.

Dance/movement therapy can help children with emotional regulation by:

Children interact and experience the world through movement and physical engagement. They tend to express their fears, frustrations, joys, and challenges through their bodies. Some children struggle to manage their emotional experiences. Others may suppress their emotions and withdraw. Dance/movement therapy can be of benefit in both situations. This clinical medium for movement-based processing and coping can help children work toward independent emotional regulation.

If you’d like to learn more about dance/movement therapy for your child, a therapist or counselor may be able to provide you with more information or a referral.

References: 

  1. Ahmed, S. P., Bittencourt-Hewitt, A., & Sebastian, C. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 11-25. doi: 10.1016/j.dcn.2015.07.006
  2. American Dance Therapy Association. (n.d.). Retrieved from https://adta.org
  3. Fielding, L. (2017, December 6). Finding emotional balance: Are you an over or under regulator? Huffington Post. Retrieved from https://www.huffingtonpost.com/lara-fielding/finding-emotional-balance-are-you-an-over-or-under-regulator_b_8218256.html
  4. Matusiewicz, A., Weaverling, G., & Lejuez, C. W. (2014). Emotion dysregulation among adolescents with borderline personality disorder. Handbook of borderline personality disorder in children and adolescents, 177-194. doi: 10.1007/978-1-4939-0591-1_13

anxious dog laying downAs anyone who’s ever lived with a dog can attest, dogs’ emotions are complex and occasionally bewildering. And for some dogs, emotions are overwhelming. Whether they’re tearing up the house in sheer terror because a beloved owner leaves for a few hours, or they’re shamelessly snarling and lunging at every dog who walks by, some dogs struggle to cope with the stresses of everyday life.

The science of dog behavioral pharmacology aims to help exhausted pet owners and their stressed-out four-legged companions. Although it was once controversial to prescribe mental health medications to dogs, the pioneering work of Dr. Nicholas Dodman, a Tufts University veterinarian, has steadily moved dog psychology into the mainstream.

Do Dogs Need Mental Health Medication?

The behaviorism of the early twentieth century would have you believe that dogs are little more than machines reacting to their environment. But dogs have much of the same brain circuitry as humans, and when brain chemistry goes haywire, so too can a dog’s behavior. A recent article in The Atlantic, for example, tells the tales of dogs whose behavior miraculously changed after getting the right prescription medication.

[fat_widget_right]Veterinarians typically rely on human medications rather than special formulations for dogs. An anxious or depressed dog is almost as likely to be prescribed Prozac as an anxious or depressed human. The dosage has to be adjusted to reflect the size difference between dogs and humans, of course, and veterinarians sometimes have to do some tweaking to find a medication that works.

How to Tell If Your Dog Needs Help

Medication isn’t a panacea for everything. You still have to socialize your dog and train him or her to be friendly and obedient. Reward-based training methods often improve the behavior of even the stubbornest dogs. If your dog seems untrainable or does things that put her health and safety in danger, though, she could be struggling with a mental health issue. It’s not safe to give your dog your own medication, but if you see any of the following symptoms, it’s time to consult your veterinarian:

Not all veterinarians embrace pharmacological options for dogs’ mental health. If you want to give medication a try, you’ll need to call vets and ask whether they offer pharmacological solutions for behavioral problems.

References:

  1. Beaver, B. V. (2009). Canine behavior: Insights and answers. St. Louis, MO: Saunders/Elsevier.
  2. Fisher, T. (2014, May 02). Dogs get anxiety, too. Retrieved from http://www.theatlantic.com/health/archive/2014/05/dogs-who-take-prozac/360146/
  3. Psychological disorders. (n.d.). Retrieved from http://dogsnsw.org.au/resources/dogs-nsw-magazine/articles/health/177-psychological-disorders.html

Couple walks along beach, holding hands. “If you try to lose weight by shaming, depriving, and fearing yourself, you will end up shamed, deprived, and afraid. Kindness comes first. Always.” —Geneen Roth

Fat.

Adipose. Flesh. Avoirdupois. Chub. Paunch. Flab. Corpulence.

It’s difficult to think of an aspect of the human body more complex and controversial than fat, aside, perhaps, from sexuality. During medieval times, when famines could and did occur, corpulence was valued because fat symbolized wealth, or the possession of resources that conveyed invulnerability to life’s ups and downs. As such, it was seen as if not desirable, then at least neutral (Vigarello, 2013). For peasants and members of agricultural societies, obesity was practically unheard of.

In modern Western culture, however, the tables have (mostly) turned. Today, for the most part, wealthier people tend to have access to healthier, more nutrient-dense foods. The higher nutrient density keeps total calorie intake much lower, since more nutrients and fiber satiate the body quickly with fewer calories (Furman, 2011).

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Less economically fortunate people, on the other hand, tend to not have much fresh, healthy food available in their neighborhoods. Even when fresh food is available, they may lack sufficient income to purchase it. Social justice activists have coined a term for when a community lacks access to healthy food: “food desert”. With fast food or junk food being much more economical and widely available to people living near or below the poverty line, it may be easier for people living in poverty to put on pounds.

The issue remains complex, with many different variables. As far as modern social attitudes towards extra fat go, many dislike it, even loathe it. Certainly, many people don’t like it on their own body, but some even become angry when they see abundant adipose tissue on someone else’s body. For some, fat is part of a truly vicious cycle of self-loathing. Geneen Roth writes that when she was in her twenties, she hated her fat so much, she wanted to slice it off with a knife. Then she would have been standing there, trembling and bleeding, but at least she would be thin.

As far as modern social attitudes towards extra fat go, many dislike it, even loathe it. Certainly, many people don’t like it on their own body, but some even become angry when they see abundant adipose tissue on someone else’s body. For some, fat is part of a truly vicious cycle of self-loathing.

Others passionately defend fat and its hosts. The fat acceptance movement has risen to defend people from fatphobia, or the unwarranted ostracism, contempt, and bullying frequently experienced by heavier people. Still others may fetishize fat, forming a subculture around the care and feeding of those too large to get out into the world and fend for themselves.

Medically speaking, fat tissue has been implicated in its associations with cancer, heart disease, diabetes, arthritis and other inflammatory diseases. Some people debate the validity of these assertions, pointing to research showing that in some cases, being what’s considered “slightly overweight” may in fact lower mortality rates. Further, movements such as the Health at Every Size movement point out that body shapes and sizes are diverse, describe the harm restrictive dieting can cause, and work to promote health without focusing on weight loss.

The Issue of Fat

As you can see, the issue of fat is very complex. In this article I am emphatically not taking any position as to the goodness or badness, nor as to the beauty or ugliness, of this embattled tissue. Rather, I want to explore: What is fat, and what is it doing for us? There are high levels of vehemence, vitriol, and medical admonishment against fat, yet many people carry what is considered by current medical standards to be excess poundage. There must be some function or functions powerful enough to override the tremendous social forces against it. What is going on here?

First, let’s look at the overall somatic context. The human body consists of multiple types of tissues, which tend to occur in layers.

Muscle tissue comes in two types: smooth (usually involuntary, like intestines or uterus) and striated (voluntary skeletal muscles that move our limbs and support our core).

Bone, though often ignored or underrated, is an amazing part of our bodies. Living bone has a pinkish tinge and is more flexible than the rigid, white bone that comes more readily to mind. It gives structure and support, and provides “spacers” for the muscular system (without it, the muscles that attach to and move the bones would contract into tight little balls). The marrow of bones produces blood and immune cells.

Our skin (which itself comes in several layers) is a vital part of our sensory system. It blocks water loss, UV rays, and germs; regulates temperature; and provides a boundary between our bodies and the greater world.

The fascia is a connective tissue that penetrates all other tissues and binds us together. Muscles slide over its smooth surfaces, and it prevents our organs from sloshing around inside us like a big bag of goo.

Our nervous system (brain, spinal cord and peripheral nerves) controls the body via nerve impulses and signals to release hormones.

Our fluid system includes blood, lymph, digestive fluids, and interstitial (between-cell) fluids. It transports oxygen, cellular wastes, hormones, glucose, and other nutrients.

And then there is fat.

Fat does many things for its host organism. As most people know, it can be considered a kind of “energy savings account” in case of famine or illness. Fat provides insulation, particularly against cold, and padding, so our bones don’t grind on the surfaces we sit or lean on. Fat forms part of the breast tissue, allowing mothers to feed their infants, and is also involved in hormone production

Some believe fat stores toxins in a way that makes them inert, or prevents them from damaging the vital organs, though I must point out that I don’t know whether this claim is backed by scientific evidence. I do recall a long-ago evening in which a friend and I took a long walk (of about three hours) to the beach. He had recently quit using marijuana and hadn’t used any at all for several months. The walk was long enough that metabolically, we both switched from running on blood glucose to primarily burning accumulated fat stores. By the time we got back to my house, he was, as they say, high as a kite—without having taken a single hit of marijuana.

And then there is another function of fat, one that’s not so commonly discussed. I don’t know whether or not it has been demonstrated in any medical literature, but eating disorder therapists (and many who overeat, binge eat, or experience a related type of disordered eating) will know this one: Fat is an emotional insulator.

How Fat Can Help Insulate Us from Emotions

Having extra fat on the body can help protect against feeling the intensity of unprocessed emotions. It’s like a thick coat of insulation on an extremely high-voltage wire. In this regard, it helps keep us in some semblance of balance, able to exist and function without becoming completely obliterated by our own emotional charge.

We have to live life on life’s terms, and these terms are not always kind. At any moment, even when we are young and vulnerable children, life can hand us events that are just too big for us to deal with in an efficient or comfortable manner.

We have to live life on life’s terms, and these terms are not always kind. At any moment, even when we are young and vulnerable children, life can hand us events that are just too big for us to deal with in an efficient or comfortable manner. The emotional aspect of our survival energies tends to be unbelievably strong. Repression may cut us off from old, unprocessed emotions, but blocking or repressing emotions may only work up to a certain extent.

What might happen if a person carries such large emotional charges without insulation of some sort, or other cut-off strategies such as substance abuse? I have heard many people making statements similar to these:

Still others have talked about the sense that their experience with psychosis or other mental health issues began in part because their systems just couldn’t contain the terrible traumas they had experienced. I believe this sheer intensity is the true meaning of the word overwhelmed and, in my experience, sufficient to explain why some people find themselves overweight.

These days, many people are talking about the Adverse Childhood Experiences study. A physician treating obesity at Kaiser noticed that his most successful patients—those who had lost the most weight—were dropping out of his program. Intrigued, he arranged for follow-up with the ex-participants, who shared that their weight loss brought up old traumatic emotions from childhood. It was easier to live life with morbid obesity, despite any pain and inconvenience it might cause, than it was to face those old feelings.

That is testament to the power of old trauma, and of fat as a semi-conscious strategy to help contain it.

Certainly, the issue of excess body fat is very complex, and so are the people who carry it. Genetics undoubtedly play some role in a person’s predisposition to weight gain. Others may live in food deserts or, out of choice or necessity, fall into habits that support weight gain. Athletes who get injured and don’t change their food intake are prone to gaining weight. Some people also tend to overeat as a way of bolstering their overall energy when tired (Dr. Judith Orloff calls this “energy defensive eating”).

In short, if you have a lifestyle where you are constantly running on fatigue and overwhelm and/or neglecting your own needs for the needs of others, it can be easy to gain weight—particularly if you have a “sit-down” job. Researchers and medical experts have begun to point out that sitting for long periods of time can negatively impact health. Some have even called it the “new smoking.”

Society exerts tremendous pressure to conform to a thinner body standard. This social pressure often contributes to internal pressure. But all people, regardless of their size, deserve compassion and kindness—from themselves as well as from others—not judgment or ostracism. If someone is insulating their feelings with a layer of fat, then the more cruelty they experience, the more entrenched their defenses are likely to become. Even if their size causes them distress, they may find it all the more difficult to lose weight.

Our bodies come in all shapes and sizes, and we cannot completely control the way they look. We really never know what life will end up bringing us, and to some extent, we must accept what life has already handed us. As with any aspect of the human condition–there but for the grace of luck, circumstance, and the genetic lottery, go all of us.

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Those who struggle with difficult emotions and/or overwhelm and desire to lose weight but haven’t been able to (in other words, if this article speaks to you) might consider working with a compassionate therapist trained in helping people increase affect tolerance and move gently into and out of old feelings.

“Fat-bashing in all its varied forms–criticism, exclusion, shaming, fat talk, self-deprecation, jokes, gossip, bullying–is one of the last socially acceptable forms of prejudice. From a very young age, before they can walk away or defend themselves, women are taught that they are how they look, not what they do or what they know.” —Robyn Silverman, Good Girls Don’t Get Fat: How Weight Obsession Is Messing Up Our Girls and How We Can Help Them Thrive Despite It

References:

  1. Afzal, S., Tybjaerg-Hansen, A., Jensen, G., & Nordestgaard, B. G. (2016). Change in body mass index associated with lowest mortality in Denmark, 1976-2013. JAMA. doi:10.1001/jama.2016.4666
  2. Brown, H. (2015, November 17). The obesity paradox: Scientists now think that being overweight can protect your health. Quartz Media. Retrieved from https://qz.com/550527/obesity-paradox-scientists-now-think-that-being-overweight-is-sometimes-good-for-your-health
  3. Furman, J. (2011). Eat to live: The amazing nutrient-rich program for fast and sustained weight loss. New York, NY: Little Brown and Co.
  4. Gerstacker, D. (2014, September 5). Sitting is the new smoking—7 ways a sedentary lifestyle is killing you. The Active Times. Retrieved from https://www.theactivetimes.com/sitting-new-smoking-7-ways-sedentary-lifestyle-killing-you?utm_source=huffington%2Bpost&utm_medium=partner&utm_campaign=sitting
  5. Roth, G. (2011) Women, food, and God. New York, NY: Scribner.
  6. Scutti, S. (2017, September 22). Yes, sitting too long can kill you, even if you exercise. CNN. Retrieved from https://www.cnn.com/2017/09/11/health/sitting-increases-risk-of-death-study/index.html
  7. Vigarello, G. (2013). The metamorphoses of fat: A history of obesity. New York, NY: Columbia University Press.

Water pouring into glass from above and overflowing down the sidesSomatic psychotherapists often use the informal metaphor of a “container” in describing a person’s state of overwhelm or resilience.

It’s a simple concept: If Janelle is experiencing a lot of stress, and/or her system isn’t very resilient, then one can say her container is overflowing, or close to it. On the other hand, if she successfully deals with her feelings and the external situations that cause them, she would create more “room” in her figurative container and she wouldn’t be so vulnerable to becoming stressed out. She could also work with a therapist in order to develop affect tolerance and self-regulation. She would then be making her container larger and less brittle, increasing her resilience across many life situations.

The container can be filled by our response to events earlier in our lives that we’ve repressed and not dealt with. Researchers and clinicians working with intergenerational trauma believe our containers hold the trauma passed down to us from the experiences of earlier generations. Such experience includes but is not limited to systemic racism and oppression. The field of epigenetics looks at changes in gene expression (which pieces of our DNA strands are being expressed, and which aren’t). These changes are thought to be responses to the environment, either current or historical. On the other hand, our containers can also be filled by present-day, acute stressors that we’re all too aware of. In practice, it’s usually a mix of both, and they can be interrelated.

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Sometimes it isn’t immediately evident how full the container is becoming, because we are experts at hiding this from ourselves and the world. When talking about this with a person in therapy, I’ll often use the metaphor of my coffee cup. It’s a metallic travel mug, and when I hold it up, you can’t immediately tell how full it is. It could be nearly empty, or it could be close to overflowing. (It’s just a visual example. No fair trying to gauge my mood in order to figure out how much coffee is inside me rather than still in the cup!)

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

Psychology is the study of human thoughts, feelings, and behaviors. It shares some overlap with sociology, political science, anthropology, etc. However, most clinical psychology focuses on the individual and their cognitive, developmental, marital, or family dynamics. After many years in this field, I would guess that the majority of what’s discussed in therapy rooms does not focus on larger cultural, sociopolitical, large-scale economic, or environmental factors. Or such factors may be acknowledged, but therapeutic interventions usually focus on the micro (person/family) rather than the macro (environment). In that sense, therapy can be a bit myopic at times.

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

However, just because we’re repressing something doesn’t mean it’s not affecting us and filling our figurative containers. The emerging fields of ecopsychology and ecotherapy assert that humans have an ecological unconscious. That is, since we are born of earth and our entire existence depends on our fragile biosphere (and the other species we share it with), anything threatening our planet causes stress and anxiety in us. Just about everyone I talk with has tremendous anxiety about the future of our environment, and for good reason. This often invisibly adds to the total “volume” inside our containers; and since people often tend to feel helpless about large-scale events, it may increase their tendency toward immobility and dissociation.

For some people, it might be a useful exercise to write out a list of all the things they can think of that could be impacting their stress levels. However, for many other people, if their container is filling up, then the exercise of looking at everything at once could send them into depression, immobility, or even panic (“Oh, my god, it’s so much worse than I’d thought!”). Somatic therapists are trained to gauge a person’s autonomic stress response on a moment-to-moment basis and intervene as needed, coaching the person in taking on a manageable amount at any one time, and using that experience to grow stronger.

In my opinion, the goal of therapy is to increase a person’s self-regulation, which increases coping, health, joyfulness, and myriad other desirable outcomes. People who are able to self-regulate tend to be more aware of their overall stress levels, including “whole-world issues.” They may be less prone to anxiety, depression, and immobility, so they can engage in effective self-care, including taking action to better their lives and the greater world.

References:

  1. Bell, A. (2016). What is self-regulation and why is it so important? Retrieved from https://www.goodtherapy.org/blog/what-is-self-regulation-why-is-it-so-important-0928165
  2. Sashin, J.I. (1985, April). Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures, 8(2): 175-202. Retrieved from http://www.sciencedirect.com/science/article/pii/0140175085900089
  3. Shulevitz, J. (2014). The Science of Suffering. New Republic. Retrieved from https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids
  4. Smith, D.B. (2010). Is There an Ecological Unconscious? New York Times Magazine. Retrieved from http://www.nytimes.com/2010/01/31/magazine/31ecopsych-t.html
  5. Weinhold, B. (2006, March). Epigenetics: The Science of Change. Environmental Health Perspectives, 114(3): A160-A167. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392256/

Two hands hold tea on wooden table. Tea has thyme leaves and lemon slices in itHave you ever felt like your emotions are so overwhelming they will never stabilize? Maybe you have an intense urge to return to unhealthy or risky behaviors to make yourself feel better. Dialectical behavior therapy (DBT) has a whole module that focuses on crisis survival skills. These are skills that help you hang in there, or cope, when emotions are overwhelming. It doesn’t make the feeling go away, but these skills can help you get through the intensity of these emotions.

Here is a brief overview of DBT’s crisis survival skills.

Distraction

These strategies are used to distract yourself from distressing thoughts, feelings, or situations that feel overwhelming. The acronym “ACCEPTS” can help with recall in the moment.

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Self-Soothe with Six Senses

These strategies can help you feel better and in control by using your five senses (and a sixth: movement) to ground you to this person, place, time, and situation.

IMPROVE the Moment

You can’t necessarily change the fact something is happening, but you can change the way you feel, think, or react using these skills.

Pros and Cons

Considering the short- and long-term pros and cons to a decision can be helpful in deciding how to react to a situation or feeling.

TIPP the Scale

This is a newer skill set introduced in the latest update to the DBT Skills Manual for Adolescents. These skills are used when managing extreme emotions or urges. Using these strategies may help adjust your body chemistry.

It is important to note that one skill might not be enough depending on how intense your emotion or urge is. You might need to try a few to find what works best for you. As with anything, it’s also possible that something might work in one moment and not in another. Have a willing attitude as you give these skills a try, and partner with a therapist trained in DBT if you want support.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. New York: The Guilford Press.

Hand choosing a hanging keyHow do you know what to commit to in your life, or what choices to make? What romantic interest, job, friend, trip, or task do you choose? There are so many options. How do you know how to make the right choice? What does choosing “right” even mean? Options and choices can lead to feelings of overwhelm and confusion. Feeling confused, in turn, can lead to stagnation because of indecision. Lately, I hear smart, driven people say they are so nervous about making the wrong choice, they’re making no choice. This is a problem in and of itself. When you are not making choices in life, you can’t make progress. Your choices create the flow in your life.

No choice, no flow.

I have held, and still do hold resistance to commitment. My natural tendency is to live more as a “free bird,” meaning I desire to go with the flow, take off on a whim, adventure, and sway away from a concrete plan. I love when choices reveal themselves to me. I love the organic nature of how life shows me what direction to go, although there are times when a straightforward decision is called for. So, what do you do then? What do you do when you need to make a clear choice?

Focus on the Now

When I’m making a choice and I look into the future of how the decision can affect my future and everyone in it, I begin to feel paralyzed. The fear that arises from focusing on the hypothetical future if I make a choice is just not a healthy approach. Instead, focus on the now and how that choice is going to affect you in the present. Your present reality is all you have, and all you need. Do your best to get in tune with what you are feeling and make the best choice you know how to make in the now considering what feels right.

[fat_widget_right]Ditch the Past

The past is generally a good predictor of what to expect and what is to come. However, sometimes there is no relevant connection from the present to the past, and it’s not productive to seek one. Looking at each choice you make with current and fresh eyes is a centered and more realistic approach. Being mindful not to bring the past into your current experience is a more positive way to approach life. Living in the “what used to be” or the “what might be” is a surefire way not to live in the now.

Take a Step Back

Breathe. Take a break. Remove yourself from the situation. Focus on something totally different. Get a good night’s rest. Have fun. Take a trip. Very often when you are unsure of what move to make, allowing yourself to step away from the decision-making process can help you see things with more clarity. I’ve made the most monumental decisions in my life just after returning from trips. I go into the trip confused, unsure, and stressed about what to do. Magically, sometime during the trip or in reflection when I get back, I feel clearer about what I want to do. I’ve moved cities, quit jobs, and pressed some major reset buttons for my life after giving myself time away from the issue.

Trust Something Bigger

I know this is easier said than done, but try not to put so much pressure on yourself toward “figuring it all out.” Yes, you have choices and decisions in life to make, but there are also outside, higher-power forces that are bigger than you and your decisions. These forces show up as coincidences; missed trains, planes and buses; ironic happenings; etc. Letting go of the perspective that you have to do 100% of the action toward making something happen goes against the natural flow of life. Sometimes things, opportunities, and people fall into our lives without any work on our part. Trust that. When you do your best to live a life that feels good, these happenings occur with a lot more frequency.

Recognize Very Few Things Are Permanent

As we make decisions, it’s easy to get caught in the permanence of it all. The thing is, very few things in life are permanent. Many choices can be revised down the road and changed. For example, if you moved cities and it’s not the life you envisioned, move again. You’re dating someone and he/she is not what you initially thought, break up and switch it up. You started a career and it’s wearing on you to show up each day, start something different.

I understand, with compassion, that it’s far more complicated than those easy-breezy solutions. The point to take away from this is that it’s not impossible. People make major changes every day and survive. Very often, when you gain the confidence and trust to jump into the unknown, wonderful things are waiting for you once you land. I’ve yet to meet someone who moved away from a draining situation and regretted it.  Very often, it’s not one choice that will make or break you. Choices, usually, are small. You get the freedom to make choices for yourself all day long. One positive choice followed by another will lead you in a positive direction. By practicing decision-making with small choices, you have already carved out a positive path to walk. This lessens the confusion around a decision and leaves you with the control to make the best decision you know how to make at the given time. After you complete that step, you get to sit back and allow life to show you the way. Your awareness of who and what is around you will help you with your decision-making.  You got this.

Side view of woman working at table with coffee and laptopBy nature, humans are emotional creatures. When things are going well, you are likely to experience positive emotions that often lead to increased motivation and productivity. However, in times of hardship or stress, it can be challenging to leave negative feelings at home and keep them from impacting your work.

Whether you work in an office or from home, staying productive in times of personal crisis is no easy task. When a loved one is diagnosed with an illness, a pet passes away, or your partner loses a job, the added stress, grief, or anxiety can be distracting and sometimes even debilitating.

At some point, you may face a time when life stressors come up, and you may not be able to put your professional life on hold. Here are 11 tips to help you stay focused and remain productive in a time of personal crisis.

1. Adjust Your Schedule

In a time of crisis, you may need to adjust your schedule to accommodate personal matters. Time management is key to maintaining your professional life when your personal life requires more attention than usual.

Take a look at your schedule and see how you can adapt it. In medical situations, you may need to attend health appointments in the mornings and work later in the afternoon, or vice versa. Try to plan your day efficiently to maximize the value of the time you are able to put in at work. Consider scheduling your time in blocks with frequent breaks. Taking a break can help you reset and prevent emotional overwhelm.

2. Practice Self-Compassion

Be gentle with yourself. Don’t beat yourself up for not performing as well as you think you should. Remember: you are human. If you’re grieving the loss of a loved one, anxious about a medical diagnosis, or stressed about some other personal matter, allow yourself to recognize your emotions as a normal part of the experience.

Feeling distracted or foggy during stressful times is not uncommon. It may take time to bounce back, so give yourself a break. Honor your feelings and do the best you can under the circumstances. Praise yourself for what you do manage to accomplish rather than feeling frustrated by any difficulties you may be experiencing.

Amy Armstrong, LPC, suggests embracing difficult emotions rather than suppressing them.

“For many of us, it’s tempting to tamp down those unpleasant feelings and hide them. This usually just increases your stress levels,” Armstrong said. “Confide in friends you trust. Get professional or peer support, if you are comfortable with that. Go for a run. Have a good cry. Most importantly: feel what you need to feel and let it out. I’m not advising anyone to freely cry at their desk because that can be problematic in other ways, but it’s important to own your feelings and give yourself an outlet. If you can do it in a fairly controlled way, those emotions are less likely to just pop up in places where they are less helpful to you—like in the middle of a stressful meeting.

3. Share with Discernment

[fat_widget_right]When times are tough, talking about your situation can provide you with support and help you process your emotions. However, it is important to use discernment when sharing personal details.

Depending on your situation, you might be obligated to share some information with your supervisor, but you may want to be more cautious when sharing information with coworkers.

Ask yourself how sharing this information could impact the relationship and your personal situation. Do you work in the type of workplace that is friendly and open with personal concerns? Are you prepared to hear any advice or input your coworkers may have about your situation? How might telling your coworkers impact your performance at work?

In some instances, sharing your situation with your colleagues may make things easier for you. In others, it could become more challenging. Consider the effects and use discernment before you choose to share.

4. Practice Living in the Moment

Meditation and mindfulness practices can help you embrace the moment and find feelings of inner peace and acceptance even during the hardest of times. By practicing being present, you can prevent yourself from ruminating about your problems, dwelling on the past, or worrying about the future. A daily meditation practice can help you to remain mindful and present at work and help you stay focused on the task at hand.

It may also be helpful to reframe your time at work as an escape from what is happening in your personal life. Focusing on another task can provide temporary relief from any turmoil or crisis you may be dealing with at home.

5. Use Your Support System

Sometimes it can be tough to ask for help from others, even when it is needed the most. If you are dealing with a crisis, it can be very difficult to stay productive without a solid support system. Seek out the people in your life who you can count on during times of hardship and reach out to them. Perhaps you need someone to take your child to school, prepare meals, clean the house, or just to listen to you. If you try to maintain everything on your own, you’re more likely to experience emotional overwhelm, which will not only increase your stress, but it can wind up making you less productive in the long run.

6. Prioritize and Delegate

Recognize that your productivity potential will likely be lower during times of crisis. So make the best use of the productivity you have by prioritizing your tasks. Create to-do lists and prioritize the most important tasks first.

“Even though it’s difficult, this is a time to be diligent about saying no to extra commitments to people in your personal and professional life,” Armstrong said. “You’ve gone the extra mile for others when they were having difficulties, and you can do so again, but this isn’t the time.”

Delegating tasks to others can also be helpful. Look to your co-workers for assistance when possible, rather than trying to conquer everything on your own.

7. Practice Self-Care

When you are under a large amount of stress, it can be easy to forget about the importance of taking care of yourself. In times of crisis, people tend to be more vulnerable and self-care may be more important than ever. Do your best to take good care of yourself. Remember to eat healthy foods, exercise, and take time to rest.

“Self-care during times of personal crisis is crucial,” Armstrong said. “Don’t skimp on things like sleep, baths, workouts, walks, massages, or just time spent kind of zoning out for 10 minutes. Taking the time to take care of yourself is the best investment you can make during difficult times. It helps you maintain your resilience (and your sense of humor) when you need it the most.”

8. Acknowledge Difficult Days

Remember you are human. You are allowed to feel emotions. Some days will be more difficult than others. There may be days when you don’t have the strength to get out of bed. Even when you’re trying so hard to focus on what’s important, some tasks may slip your mind, and that’s okay.

“Even though it may sound selfish and may seem like everyone says this, if you are going through a personal crisis, you need to make sure that you put yourself first and are honest about what you can and cannot do,” Armstrong said.

Don’t berate yourself for your feelings. Instead, allow yourself to feel the emotions at the surface, knowing that everything passes in time.

9. Choose Positive Coping Skills

Stress often makes it easier to reach for a vice. Whether it’s smoking cigarettes, drinking alcohol, overspending, gambling, or some other addictive habit, everyone has weaknesses. While vices may relieve some stressful feelings immediately, they usually wind up making things worse and increasing stress over time.

Rather than engaging in a bad habit, use positive coping mechanisms to deal with your stress. These might include spending time with loved ones, exercising, eating a healthy and delicious meal, napping, meditating, trying a new hobby, or working on a creative activity.

10. Take Some Time Off

As much as you might want to be productive, sometimes it is necessary to take some time off to heal. If things get too challenging to maintain, use some of your vacation or sick days and take some time away from work.

Though Armstrong advocates for a combination of an improved self-care routine, increased exercise, and therapy, she suggests people do an honest self-assessment on how they’re coping with everything.

When you are under a large amount of stress, it can be easy to forget about the importance of taking care of yourself. In times of crisis, people tend to be more vulnerable and self-care may be more important than ever.“If you are seriously considering taking a leave of absence from work, talk to your doctor and mental health professional as soon as possible regarding appropriate documentation. Also, contact your Human Resources department regarding the Family and Medical Leave Act (FMLA),” Armstrong said. “Do not tell your manager or co-workers about your personal crisis. It may seem tempting, but if you are considering a leave of absence, it is crucial that all of your information remain confidential and that starts with you. Even the Human Resources department should only be provided with the minimum amount of documentation required to substantiate your request for leave, and all of that should come from medical professionals, not you. It’s important to remember this because even though nobody is supposed to press you for details, they often do.”

Armstrong suggests the best time to request a leave of absence is before a personal crisis starts to affect your work performance. Don’t be afraid to ask for what you need from your employer. Oftentimes, people will be willing to work with you to come up with a solution that works for everyone. Many people may feel guilty for missing work, but remember emotional crises can sometimes be as debilitating as physical illnesses, and some time off may be the best way to start the healing process.

11. See a Therapist or Attend a Support Group

Therapists and counselors play an important role in helping people cope with a crisis. Psychotherapy can help individuals assess their situation and create positive coping skills to manage their stress.

Support groups can also be a valuable means of support. They are widely available for those facing many different life challenges, from cancer to divorce to drug addiction. Whatever you’re dealing with, being able to talk with another person who can empathize with your situation can be helpful.

scissorsEditor’s note: If you or someone you know is in crisis, please click here for information about seeking help.

Cutting is a popular way for teens to self-injure without the intent of suicide. Using scissors, razor blades, pins, pens, or other sharp objects, some teenagers puncture or cut their skin in various places on the body. If you’re a parent, you are probably wondering, “Why would they do that?” The answers may surprise and scare you.

Simply put, cutting is a maladaptive coping mechanism during times of stress and anxiety that is rarely accompanied by suicidal thoughts. According to the American Association for Marriage and Family Therapy, self-harming behavior such as cutting has no single cause. It does not discriminate across cultural and socioeconomic levels, but the behavior is predominately carried out by females.

Reasons behind teen cutting are varied. Often it can be categorized by those who already feel numb as a way to experience intense emotion and pain. Numbness may be due to being emotionally overwhelmed for too long, which almost short-circuits the system into a feeling of dullness—neither happy nor sad. Teens who feel numb often identify that the only way to feel alive is to cut.

Another way to categorize cutting is as a release of emotions, similar to a drain when the sink is overflowing. Teens who feel burdened by stress, anxiety, depression, and other emotions may use cutting to vent the unwanted leftovers of those difficult feelings.

Other reasons for cutting include an intense and overriding feeling of aloneness, feeling helpless, and feeling the need to punish or blame for something that happened.

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The theory behind why teens use cutting as a coping mechanism reasons that endorphins play a major role. When teens cut, endorphins rapidly invade the bloodstream, resulting in a feeling of pleasure and relief. For some teens, the cutting and the endorphin release make them feel “high.”

Take for example, a 16-year-old girl who is a high academic achiever, member of the elite volleyball team, and a positive role model for her younger sisters. She is an all-around overachiever, earning money babysitting and as a lifeguard, striving to excel in school to make sure she gets into a prominent university. Her volleyball team travels on the weekends, and she is looked at as a leader to the other members. In addition, she volunteers at her church and with her community. She dresses well and in fashion, and is always attempting to make sure her hair is perfect. Although she doesn’t love her body, she knows it could be worse, since she’s an athlete and in somewhat decent shape physically.

Emotionally, however, she’s not in shape, nor positive, nor excelling. She is overburdened by academia, struggling to achieve all A’s in her advanced classes. She has to study from the minute she gets home from school until volleyball practice, and then more upon returning. She is not sure her grades will get her into a “good enough” college. She is worried that her best friend is mad at her, and she’s certain that her father hates her. To make matters worse, her right knee has been bothering her, but she doesn’t tell anyone for fear that her team will be mad at her. She has had to cancel when invited out because she had too much homework and she promised her best friend she’d be available if she needed to talk.

At first glance, this teen seems to have a full and rich life, with opportunity abounding. However, she’s so overwhelmed that at night she uses her desk scissors to slice her wrists repeatedly. To make sure no one suspects anything, she hides the bloody tissues at the bottom of the trash can. She wears stacks of bracelets to cover the damage so no one asks. She doesn’t know what else can release the pressure she feels from school, family, friends, and her team. She heard about cutting during lunch a few years ago, and now uses scissors to pour her emotions out.

This is real life for some teens. As much as parents are disgusted by the idea, and instinctively react with shock about what their child has done to their body, it is an unwanted aftereffect of overworked, overscheduled, overwhelmed children. Never before have we put the same amount of pressure on our children and teens to succeed academically, socially, and beyond.

While it may not make sense that they cut their bodies, it makes sense that they find a way to release the pressure. Without learning new coping skills and understanding their triggers, teens often end up alone in their pressure-cooker lives. Through counseling, teens can learn how to handle distress, how to prioritize in their lives, and how to communicate about their feelings.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.