For couples who believe in their relationship, aspire to keep it strong, and wonder how awesome it will be to read this together in 20 years… Each of you should fill it out separately and share as a gift for a special occassion that is meaningful to you. Then, put somewhere for safe keeping.
The first time I knew I loved you was__________________________________________________
One of my favorite things to do with you is _____________________________________________
One thing I don’t tell you enough is ___________________________________________________
Sometimes, when I find myself needing you the most, I ___________________________________
One of the things I need most from you is ______________________________________________
After twenty years together, I’ve learned that you ________________________________________
When I’m sad or scared, I ___________________________________________________________
I love it most when you _____________________________________________________________
What makes me laugh the hardest when we’re together is __________________________________
If I were to be completely honest, sometimes I wish _______________________________________
Loving you has always felt easy, but one of the hard parts is _________________________________
One of the things I like best about you is ________________________________________________
One of the things I think we should do more often is _______________________________________
When we’re together, I wonder if you know ______________________________________________
My life with you is __________________________________________________________________
I love to hear other people tell me that you ______________________________________________
Since we’ve been together, I’ve gotten better at __________________________________________
I love the way you _________________________________________________________________
I need you most when I _____________________________________________________________
One of my favorite memories of us is___________________________________________________
One of the dreams I dreamt that has come true is_________________________________________
One of the dreams I dream that I hope will still come true is_________________________________
I wonder if you really know how much __________________________________________________
Twenty years from now, I hope ________________________________________________________
I am so proud of how we_____________________________________________________________
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood
What if I’m having scary thoughts?
Beyond the Blues: Postpartum OCD
5. Sample of selected research by top PPD researchers
*Disclaimer: Many of the articles listed below with Obsessive-Compulsive in the title also mention or review the nature of intrusive thoughts that are subclinical and not related to an OCD diagnosis. Red notations are ours to highlight relevance for specific providers. Some are available online as pdfs. If you are unable to find them, you can try finding access to an academic database through your local university library.
Risk of Obsessive-Compulsive Disorder in Pregnant and Postpartum Women: A meta-analysis.
Russell, E.J. Fawcell, J.M. Mazmanian, D.
(2013) Journal of Clinical Psychiatry 74(4): 377-385.
Postpartum Obsessive-Compulsive Disorder.
Speisman, Storch, Abramowitz.
Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011 Nov-Dec;40(6):680-90
Obsessive-Compulsive Symptoms in Pregnancy and the Puerperium: A Review of the Literature
Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR.
Journal of Anxiety Disorders. 2003;17(4):461-78.
New Parenthood as a Risk Factor for the Development of Obsessional Problems
Behaviour Research and Therapy 45 (2007) 2155–2163
Postpartum Obsessive‐Compulsive Disorder
Speisman, Brittany B. et al.
Journal of Obstetric, Gynecologic & Neonatal Nursing , Vol 40, Issue 6, 680 – 690
Obsessive-Compulsive Disorder in the Postpartum Period: Diagnosis, Differential Diagnosis and Management.
Sharma V, Sommerdyk C.,
Womens Health (Lond). 2015 Jul;11(4):543-52
The Impact of Perinatal Depression on the Evolution of Anxiety and Obsessive-Compulsive symptoms.
Miller ES, Hoxha D, Wisner KL, Gossett DR.
Archives of Womens Mental Health. 2015 Jun;18(3):457-61.
Diagnosis and Treatment of Postpartum Obsessions and Compulsions that Involve Infant Harm.
Hudak R, Wisner KL.
American Journal of Psychiatry. 2012 Apr;169(4):360-3.
New mothers’ thoughts of harm related to the newborn.
Fairbrother N, Woody SR.
Archives of Womens Mental Health. 2008 Jul;11(3):221-9.
Obsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder.
Miller ES, Hoxha D, Wisner KL, Gossett DR.
Journal of Womens Health (Larchmt). 2015 Oct;24(10):825-30
Obsessions and Compulsions in Women with Postpartum Depression.
Wisner KL, Peindl KS, Gigliotti T, Hanusa BH.
Journal of Clinical Psychiatry. 1999 Mar;60(3):176-80.
Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits.
Chaudron LH, Szilagyi PG, Kitzman HJ, Wadkins HI, Conwell Y.
Pediatrics. 2004 Mar;113(3 Pt 1):551-8.
Postpartum Depression: What Pediatricians Need to Know.
Pediatric Review. 2003 May;24(5):154-61.
Detection, Treatment, and Referral of Perinatal Depression and Anxiety by Obstetrical Providers.
Goodman JH, Tyer-Viola L.
Journal of Womens Health (Larchmt). 2010 Mar;19(3):477-90
In light of the recent focus on the inexcusable ways some healthcare providers respond to acute distress in postpartum mothers, let us do some teaching here.
Please share and inform your local resources.
**NOTE TO ALL HEALTHCARE PROVIDERS**
Some postpartum women are afraid to tell you how they really feel. They are worried that you are misinformed and may overreact. They are worried you will call the cops. They are worried you will contact Child Protective Services. They are worried you will think they are unfit to be a mother. They are terrified they are going crazy. They are worried you will not know what to do to help them feel better. And still, they come to you for help.
If a postpartum woman finds the courage to speak her symptoms and put words to her pain, please be informed. Read about postpartum anxiety and intrusive thoughts. Learn about obsessional thinking. Do your research on postpartum depression so you will not be alarmed by the high rate of fierce obsessions that accompany it.
If, for any reason, you do not feel you are in a position to offer your patient the appropriate care, it is imperative that you find the words, the gestures, and the compassion to guide her to a safe resource where she will be heard and treated with responsible attention to her vulnerable state. Unless you truly understand the extent to which she is suffering, you have no idea how hard it is for her to tell you how she is feeling and thinking. She is entitled to your best professional/clinical practice.
In light of the recent focus on the inexcusable ways some healthcare providers respond to acute distress in postpartum mothers, let us do some teaching here.
Pay attention, please. There is a great deal at stake.
Please also see our article on Psychology Today addressing this issue.
This post was written anonymously by a mom in response to our #speakthesecret campaign. We thought her words would resonate with many of you:
“I want to share my personal story of dealing with postpartum depression. The reason I’m doing this now is because in the last 3 months, 2 mothers from my home town have killed themselves from postpartum depression and I strongly feel that the best way to help each other is to talk about this. We rarely talk about it when going through it and almost never talk about it once it’s over.
I found out I was pregnant on Dec. 31. My husband and I didn’t particularly want children so it was obviously unplanned. But we were both 29 and had good jobs so I said I guess we’re doing this. I tried to talk myself into being excited but I couldn’t. My mom about fell down the stairs when I called her and told her, but I just couldn’t get there. I had 3 baby showers and each one left me feeling worse. I would think ‘What am I supposed to do with all this plastic crap? I don’t have room for it.’ And ‘what do you mean I have to wash these new clothes in special detergent? They’re new. Aren’t they by definition clean?’. And then the guilt set in. Why couldn’t I be grateful? I just couldn’t. My whole pregnancy went like this and it was just one “annoyance” after another. I went into labor early and delivered at 37 weeks which was fine with me. I had a C-section because he was showing distress and ended up going to the NICU. All of which was still totally fine with me. “At least I don’t have a huge vaginal tear and at least I can sleep while the nurses in the NICU take care of him”. Who thinks like that?!?! Me. Someone experiencing a perinatal mood disorder that’s who.
I had a brief reprieve for about 2 weeks following delivery and then reality hit. I wasn’t crying all the time or feeling like I wanted to drive us into a lake or anything but I was nowhere near happy either. I couldn’t figure out how to do things like go to Target and Home Depot in the same day. Daily tasks, that I used to not think twice about, completely overwhelmed me. I couldn’t make a plan or a decision to save my life and I had previously been very much a type A/planner/decision maker. Could NOT get my shit together which then upset me even more and led to more irrational thoughts. I would tell myself it was ALWAYS going to be this hard and I would NEVER get back to normal. I became more and more resentful of everything he needed and then felt more and more guilty for feeling resentful. As time went on, my resentment turned to feelings of incompetence. I’d try to talk myself out of feeling resentful just to then be convinced I couldn’t do it even if I wanted to. It was an out of control spiral that lasted over a year. I never sought treatment and I really don’t know why other than I never identified it as postpartum depression. It started during my pregnancy so how could it be that? I am a nurse and didn’t even know depression DURING pregnancy was a thing! It is most certainly a thing. My husband knew it but didn’t call me out. To this day I don’t know why.
Fast forward 3 years to my 2nd pregnancy. This time it was planned and I didn’t have prenatal depression the 2nd time around. But the postpartum depression hit hard. Same debilitating anxiety like symptoms although I will say I was also sad with this one. Constant feelings of failure and sadness. What little of myself was left felt completely gone. When my 2nd son was 2 months old I left him in his crib during a crying fit and called my mom to come over because I had to get out. I was still on maternity leave and my older son was at daycare so I put him in his crib and left my house. Before she got there. Now granted, she lived 2 miles away and I had talked to her and knew she was able to come over. But still, people, I freaking left him before she got there!!!! Not ok. My husband was PISSED. Didn’t trust me after that and was basically like “listen crazy lady, get your ass to the doctor and get some help because I’m not doing this for a year again”. So I did and it got better.
Take home points:
1) Experiencing a perinatal mood disorder (i.e. Postpartum depression) does NOT make you a bad mom.
2) Getting professional help for a perinatal mood disorder does NOT make you weak.
3) The screening process for perinatal mood disorders is half-assed at best. Don’t wait for your doctor to just “pick up” on it.
4) But…. your family and friends may very well pick up on it. If THEY think there’s a problem, there is.
5) You don’t have to suffer, treatment is very successful.
*The number one cause of death during the postpartum period is suicide.*
Let that sink in.
Think about all the testing and monitoring that happens for complications during pregnancy. Now think about how the follow up for the issue with the highest mortality rate during the postpartum period is almost nonexistent.
Although most people aren’t suicidal, please know you don’t have to feel like this and it’s not your fault. Please know you are not alone, or even in the minority, and there is very successful treatment.”
I ask everyone who has experienced a perinatal mood disorder, or a family member who loves someone who experienced it to comment with your story and share the post. We must talk about it because it’s the guilt and shame that keeps women from getting help. In order to save the lives of these Mommas we must destigmatize this and let them know they are not alone.
“Maternal mental illness is a significant complication of pregnancy and the postpartum period. Depression and anxiety are common manifestations, with prevalence rates up to almost 20% during pregnancy and the first 3 months postpartum. As research and public awareness gains momentum, more attention is being placed on medical protocols, interventions and better access to treatment.
For many years now, Karen Kleiman has changed the face of maternal mental health for both clinicians and families. As a speaker reaching many through outlets such as The Oprah Winfrey Show and as an author, through her many books for families and clinicians, Karen is a pioneer in this field providing the mainstream community with an understanding of this devastating illness, validating the women who suffered and helping clinicians gain insight into the experience postpartum depression.
Karen and I first spoke several years ago when I called her out of the blue to brainstorm solutions. I, as an advocate in maternal metal health policy and systems change was combing the landscape to learn why women weren’t being screened, diagnosed and treated routinely by their physicians. I knew that Karen had developed one of the only training programs for clinicians in the U.S. at the time.
After speaking, Karen and I knew that more providers needed to be expertly trained so we could reach more women, augment recovery and improve outcomes. Since then my organization, 2020 Mom along with Postpartum Support International has launched web-based training to easily reach clinicians all over the U.S. and meet a growing demand to learn about this field. Though we have a long way to go, training is now available to more people than ever and Karen’s intensive postgraduate training program at The Postpartum Stress Center continues to produce expert clinicians and is recognized as a best-in-class training.
Recently the United States Preventive Services Task Force, the American College of Obstetrics and Gynecology, and the Council on Patient Safety in Women’s Health Care, joined in this mission and have highlighted the importance of screening and proper treatment of maternal depression. It is now more important than ever that we train providers.
Therapists in this highly specialized field often turn to Karen’s books for guidance when working with the perinatal population. The Art of Holding: An Essential Intervention introduces a novel strategy for treating women with postpartum depression and anxiety. At a time when we are finally paying attention to this widespread crisis in maternal mental health, this book provides a hands-on resource for therapists who are dedicated to making a difference in the lives of women seeking their help.
Clinicians, we need you now more than ever; moms and families are counting on you. Karen Kleiman, thank you for your extraordinary contributions to the field – without your work we would be several steps behind.”
Joy Burkhard, MBA
Founder and Director
Chair, The National Coalition for Maternal Mental Health
I wonder, now, why I have such conflicting thoughts about this place. A place I knew as my own sacred space before I was ready for the world or before the world was ready for me.
Warm, radiant, transparent plastic encloses the precious gap between me and life outside the box. It is, by design, both protective and isolating. A womb-like shelter to promote healing while simultaneously separating a fragile newborn from the nurturing limbs of life. I imagine this is one of life’s earliest, if not most acute, experiences of ambivalence. Has this newborn been prematurely seized from her mother’s secure haven only to be shuffled to a temporary incandescent chamber? Or, has this infant been rescued from an insufficient breeding ground to be nurtured and shielded from harm’s way until she can move forward as expected? Was it merely an interim therapeutic residence or was it, in fact, a sanctuary?
I try now, with the wisdom of adult retrospection, to see if from both sides. How scary, it must be, to be whisked out-of-womb with seven vital weeks of development remaining. Wait! I’m not ready. (Though my mother insists it were she who was not ready and I who was so hasty and impatient– so true to my nature – with my arrival). I’m tiny, I’m crying, I’m red with the tension of copious blood vessels bursting with disappointment. I’m cold and alone, even confused, perhaps. I suspect when babies of any species are separated from their mothers, there is a flood of panic. Where are you taking me? Why? In those days, mothers were knocked out, as they euphemistically referred to it, anesthetized to oblivion, so even if my mother were able to hold me, she wasn’t aware of it, which takes all the pleasure away from me.
Scooped out of this unfriendly transition, I’m then ever-so-gently wrapped in a very pink and very tiny blanket that was, I am certain, not a fair substitute for my mother’s loving arms and hungry heart. She missed me, I know for a fact now.
I’m sure I knew that then, too.
But let’s face it. This was over 60 years ago. What if, the medical community of that time was right? What if, that instrument that embraced my feeble self was, indeed, the optimal environment within which I could thrive? What if, without that intervention, however detached it may seem or be, preemies would die? Without which, I would have died? What if, as frightened as I might have been, I knew I was safe and free from the assault of unkind forces that were way beyond my control? What if, nothing could hurt me as long as I was secure within the confines of this clear plastic home?
Or, what if, I spent the rest of my life trying to free myself from this box so I could step into the world while trying my best to stay within its protective walls at the same time? What if this primal ambivalence persisted and shadowed every step I took? What if, I were to spend much of my adult life trying desperately to grow up despite a profound desire to stay put or go back, perhaps, to put closure on that which was left undone. A raw, unfinished innocence. Organic anxiety.
Premature intrauterine development. Eager, I dare say anxious, and at such an unripe age, to embark upon the challenges that lay ahead. I suspect I had little choice in the matter and consequence of prematurity, though primal therapists (who may believe that any early trauma could cause repressed pain and subsequent neurosis) would claim I knew exactly what was happening, on some level.
So many risks. Low birthweight. Thermal shock. Cyanosis. My mother recalls the day her nurse reported that overnight I had experienced a cyanotic attack. Apparently I turned an alarming shade of blue, and then, everything was fine.
“Wow. That’s scary. Were you worried?” I asked, as I gasped for a deeper breath, doing my best to resemble that same shade of blue.
“No. I wasn’t worried at all.” My mother claimed, with a smile I could actually feel through our long-distance phone connection. “By the time she told me about it, it was over, and I knew you were fine.”
“But I stopped breathing. Weren’t you afraid that could happen again?”
“Truly, no, I wasn’t. I knew everything was fine. Really.”
And it was. To be sure. So why did my chest feel so tight and my breath feel so shallow while we recreated this 60 year old story?
Respiratory distress syndrome.
I think I had that then.
Or is it now?
Sometimes, I wonder what the difference is.
The Secrets Women Keep
This thread is amazing. Needs to be turned into a list and handed out to expecting moms by every ob/gyn. They tell women everything under the sun about what to expect for 9 months; why not this?!
I think it’s wonderful you’re making this list for new moms. It would have been reassuring for me to know I was “normal”
“Scary Thoughts” is an expression used to encompass any and all categories of upsetting thinking that can interfere with the well-being of a new mother. Scary thoughts refer to negative, repetitive, unwanted and/or intrusive thoughts or images that can bombard you at any time (Kleiman & Wenzel, 2010). Scary thoughts are anxiety-driven, they are extremely COMMON, and most new mothers admit that have, at some time, imagined or worried about harm coming to their babies. The shame of having these thoughts can prevent women from speaking about them. In response to women telling us they feel isolated and ashamed of their thoughts, we asked women to share their scary thoughts in an attempt to help them express these distressing ruminations, so they can get relief and also help other mothers understand how universal this phenomenon is.
The objective of our PPSC project #speakthesecret is to obliterate the stigma attached to scary thoughts which are so common in new motherhood.
Our page is an ongoing list of the thoughts that brave women have chosen to share in the hopes of helping women know they are not alone and that having scary thoughts is common during pregnancy and the postpartum period. We will add thoughts as they are submitted.
DISCLAIMER: This list is anonymous. You can contact us at any time if you want to modify or delete your submission. If you are worried about the way you feel, let a healthcare provider you trust know if you are worried about the way you feel.
♥ THANK YOU ♥
to all the brave women who continue to disclose their scary thoughts.
Together, we will educate many and help reduce the anxiety and stigma. #speakthesecret
Click here to SUBMIT Your Scary Thought and help reduce the stigma
Experts and postpartum women themselves have long been aware of the interrelationship between postpartum distress and some individual predispositions. We cannot make any claims of direct causality, nor do we have research to back it up. What we have is tons of anecdotal evidence that postpartum women are doing too much.
Women who describe themselves as “Type A” or “perfectionistic” seem to be particularly at risk for postpartum depression and anxiety. Responding to the overwhelming responsibility of caring for a newborn can catapult vulnerable women into hyperdrive, kicking off a compulsive response to conceal how they really feel or think. Efforts begin to focus on making sure they look good and appear to have everything in order.
The effort it takes to present this pretense that all is good, if they are severely stressed or in need of immediate support, can be grueling and unsustainable. And yet, the fear of making a mistake or doing something wrong, keeps women locked into a no-win scenario while constantly bombarded by the uncertainties and unpredictability of new motherhood.
But here’s the real problem. Most of these women are, by nature, doers, high-achievers, accomplished women who have limited insight into how their successful attributes also put them at risk. This proclivity toward busyness and goal-oriented behavior keeps them focused and distracted. They simply do not always see it or feel it, when they are overdoing it. In addition, they often go unnoticed by friends and family as being in trouble or needing support.
Therefore, women who are pregnant or postpartum and have self-identified as perfectionistic by nature need to place close attention to how they are feeling and how they are doing. Literally. Sometimes, I will listen to a client describe her day and be slightly surprised by her lack of awareness that she is wildly overbooked and obviously exhausted. Often, the mention of this is met with disbelief or denial. We understand that these situations are complicated by imposing variables and intricate dynamics, but the bottom line is this:
Postpartum women are doing too much. And it is making them sick.
While we could launch into a discourse on the impact of our oppressive postpartum culture, let’s just focus on what moms can do today to help themselves.
- If you think you might be overdoing it, you probably are.
- Pay attention to your tendency to overdo, overthink, overworry, overreact, overwork. Then, do less. Give yourself permission to let go, to stop working so hard, to accept help from others.
- Making mistakes are a normal part of motherhood. Accepting this early on will protect you and create resilience.
- Think of overdoing like dehydration. You’ve heard that by the time you are thirsty, you are already slightly dehydrated and the key is to drink enough water throughout the day before your body responds with feelings of thirst. Likewise, if you are overdoing it, by the time you feel exhausted or depleted, it will be much more challenging to feel better. Intervene before you are overtired. Stop doing so much. Stop believing that your worth as a mother is defined by how hard you work and how good things look.
Take care of yourself while you take care of your baby.
photo: Dmitriy Melnikov
When you are in an anxiety-producing moment, it can be tempting to continue to focus on scary thoughts and exaggerated worries.
Accepting that anxiety is a part of your life right now and that there are things you can do to help yourself through the challenges will help you gain a sense of mastery over the anxiety.
The Six Points is a tool that was developed to help manage symptoms of anxiety by Manuel Zane in 1984.
Copy these points down or print it out so you can keep them handy as reminders. The more you practice them when you anticipate anxiety or actually feel anxious, the more you will see how they work to ease your discomfort.
I swear I was possessed. It was like one part of my brain was off on its own with stabbing thoughts that didn’t make sense to the other side of my brain. I felt like a stranger in my own body, almost like I was there and not there at the same time. It was weird. I told no one how I was feeling. Absolutely no one. I believed if I told anyone how I was feeling they would surely think I had lost my mind. Everything looked good on the outside so I just pretended everything was fine. I mean, no one could tell there was so much chaos in my head. But the thoughts would pierce through my brain when I least expected it, usually when I was bathing the baby. Bath time took only as long as I could hold my breath and get it over with. I didn’t know what else to do.
– Jen, 5 months postpartum
Dealing with scary thoughts is not just a matter of willpower, as some claim. Although willpower may indeed be part of the solution, it is more complicated than simply wishing thoughts away. We’ve all heard the truism that we should think positively, and we’ll feel better. Sounds good, doesn’t it? One of the most significant attributions for recovery from anxiety or depression seems to be the person’s belief in her ability to take control and be successful. In other words, if you believe you will be successful, you are more likely to succeed.
Surely it is easier said than done, but great personal power can come from shifting the focus of your energy from fear (negative) to acceptance (positive). For mild to moderate degrees of distress, women report that they feel more in control of their lives when they take responsibility for how they are feeling and identify the specific actions they can take to feel better.
Here are some specific self-help strategies you can rely on to ease the impact of your anxiety, depression, and scary thoughts.
Keep these points in mind:
- Denying the feelings and thoughts will not make them go away.
- Panicking will make them worse.
- Resistance creates persistence.
- Distraction will help for a while.
- Enhancing awareness might feel counterintuitive, but it is meaningful.
- Acceptance is hard but essential.
SO WHAT HELPS? Here are a couple of ideas for short-term relief:
1. First, acknowledge your current state
This is hard, but there is power in acknowledging one’s powerlessness. Great resiliency can be achieved when one is able to surrender, to some extent, and let go of secondary panic. It is natural to react with alarm when thoughts and feelings are scary and unsettling, but it is well-established that when one fears the fear, distress escalates. Straightforward affirmations reflecting the current state can be a self-compassionate way to regain some control.
- I am having scary thoughts. I might not understand why this is happening, but I know it is common and it happens to many mothers.
- My scary thoughts are not me. They are either a symptom of OCD or PPD or they are just a function of my anxiety right now. They will not always be here.
- I don’t like the way it feels, but I am doing what I need to do to feel better.
- I understand that my anxiety is a natural part of becoming a mother and even though it makes me feel terrible at times, I can endure it because I know I will not always feel this way
2. Distraction works!
Distraction has actually been shown to temporarily interrupt the loop of negative thinking. This is not the same thing as avoidance or denial. Rather, it is a way for you to remain in the stressful situation by coping with it.
If you are terrified of your own scary thoughts, can you really distract yourself from this uncomfortable mental state?
When you feel fear taking hold, do something that feels manageable. When you engage in work or activity that feels manageable in the present, you minimize your involvement with anxiety-generating thoughts and images and keep the mind actively focused. Your body, in response, is able to settle down a bit allowing you to feel more in control. Once you acknowlege that you are currently suffering from the scary thoughts and want to feel better, your brain will be going: I’m feeling bad right now, (acceptance) but maybe I’ll go for a walk, or call my sister (self-care) so I can feel better (self-compassion).
Here are just a few examples of distracting activities:
It can be pleasing:
- Listening to music.
- Watching TV
- Sitting outside in a relaxing environment with nature sounds/ocean waves/birds singing/warm sunshine
- Making a phone call to a friend.
It can be absorbing:
- Engaging in work-related projects.
- Planting in the garden.
- Helping a neighbor.
- Making a scrapbook with baby pictures.
- Playing computer/phone games.
- Reading a novel by your favorite author.
It can be detailed-oriented:
- Doing puzzles or playing games.
- Counting the tiles in the ceiling.
- Counting backward by 3’s from 100.
It can be physical/bodily: (It is helpful to simultaneously insert a cognitive association, like “It’s okay” or a gentle “stoooop” or “everything is good” as you use these)
- Snapping a rubber band on wrist.
- Visualizing and repeating the word STOP.
- Splashing ice cold water on face.
- Gently slapping cheek.
- Talking or reading aloud.
- Use and say your name as you comfort yourself in the third person (“you’ll be okay, Karen. Let’s go outside for a walk.”)
It can be energizing:
- Taking a brisk walk in the sunshine.
At first, this may appear ridiculously insufficient, or fleeting, at best. Sometimes, it’s even tempting to resist the distraction, almost as if it feels important to STAY WITH THE ANXIOUS THOUGHT; A sort of inertia sets in and it feels almost easier to remain anxious. But while your body may fight this, you might be surprised to discover that it really works if you stick with something and keep your mind focused on whatever you are doing.
These distraction techniques work to temporarily take the mind away from the worrisome thought and redirect it to something that feels different. This is based on the principle that there is a limited amount of functions that one’s brain can perform at one time. By keeping your brain busy as much as you can, you are less able to accommodate the anxiety. This is not as easy as it might sound. Keeping your brain busy requires a dedicated effort; it will not be enough to turn on the television and let your brain wander. Before you know it, it will meander right back to the object of your obsession. It requires a deliberate desire to absorb yourself in an activity. Count, read, paint, design, clean. Teach your brain how good it can feel to focus on something other than your scary thought. Your thinking is getting in your way right now. Give yourself permission to play and not to think.
Dont forget to:
- Eat frequent small meals to help stabilize blood sugar. Swings in blood sugar can cause symptoms that mimic anxiety, such as lightheadedness.
- Drink lots of water.
- Eat complex carbohydrates (whole grains) can increase serotonin, which is associated with feelings of calmness.
- Restrict simple carbohydrates (sugar).
- Avoid alcohol.
- Avoid caffeine.
Adapted from “Dropping the Baby and Other Scary Thoughts” by Kleiman and Wenzel (Routledge, 2010)
A CAUTIONARY NOTE TO THERAPISTS WHO THINK THEY CAN/SHOULD TREAT PREGNANT AND POSTPARTUM WOMEN IN DISTRESS WITHOUT SPECIALIZED TRAINING
This past weekend, I was fortunate to speak at Postpartum Support International’s (PSI) annual conference, whose clear and inspirational mission is posted on their website:
“The mission of Postpartum Support International is to promote awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide. It is the vision of PSI that every woman and family worldwide will have access to information, social support, and informed professional care to deal with mental health issues related to childbearing. PSI promotes this vision through advocacy and collaboration, and by educating and training the professional community and the public.”
This is exactly what they do. Like no other organization. And by all accounts and my personal observation, they do it extraordinarily well.
But they do more than this, which was brought to my attention, this past week during the conference.
It was my pleasure and honor to present one of the keynotes speeches with Amy Wenzel, PhD, my esteemed colleague and co-author. Myself, along with other perinatal (pregnant and postpartum) advocates connected with hundreds of like-minded clinicians, researchers, lay people, and various medical and support professionals who convene once a year to share, educate and inspire. Those of us who have dedicated our professional lives to this work are unquestionably impressed and inspired by their mission and the execution of their vision. We work hard to support this cause and many of us write and speak and educate on various aspects of perinatal mood and anxiety disorders (PMADs, or PPD for short). We do so to increase PPD awareness, provide access to state-of-the-art information and disseminate details of current research and treatment options.
Yet, the unique needs and nuances that are intrinsic to the perinatal population can actually put women at risk for being misunderstood or misguided by otherwise well-informed and well-intended providers. Those of us in the PPD community worry about this.
After my talk, I was greeted by a friend in the field who came up to me to tell me how much the presentation had moved her. (That is always a welcomed bonus of speaking in front of a large audience, when one person is personally or professional touched in some meaningful way and shares that with me.)
Sonia Murdock is a past president of PSI and founder of the Postpartum Resource Center of New York, Inc., where she tirelessly trains and consults professionals and non-professionals who are equally dedicated to this specialized field of practice. Sonia proceeded to share her thoughts:
“This is the missing link,” she claimed. “The missing link.”
“Thank you, Sonia. But, what? What do you mean?”
“Your talk. Your focus on her authentic suffering. This is it. This is what will save lives.”
“Wow. Sonia. Thank you for that,” somewhat stunned by her generous praise of my work and my own mission.
I thought about what she said.
And what she meant.
Some of my words in the speech made reference to the more global efforts that are being made on behalf of perinatal women in distress, such as the research, the advocacy, the legislation. Which is, decidedly, movement in the right direction, away from the shame and isolation of distant days and current stigmas, but still…
Women continue to die.
The reference in my presentation to authentic suffering was this: Authentic suffering, is defined as:
Authentic suffering is that which is obscured by what she wants us to know and what she will let us see.
It’s the pain she conceals.
It’s the terror that immobilizes her and keeps her up at night.
It’s what drives her anxiety and her fear that she will continue to fall, forever.
It’s what’s in her suicide note when loved ones cry out that, “there were no warning signs.”
As therapists, we don’t always see authentic suffering at first, especially when she doesn’t want us to.
But our job is to find it and connect with it.
Ah ha! This is what Sonia was referring to when she articulated precisely what I was trying to say. “After all,” she said emphatically, “it’s ‘what’s in her suicide note.’ THIS is what will save lives.” she said.
Yes, indeed. If women are not always revealing how bad they feel, if women continue to be silenced by stigma, by shame, by fear of judgement from others or from themselves – it doesn’t matter what legislation is passed, it doesn’t matter which screening protocol we use, it doesn’t matter how good we think our interventions are – if she doesn’t feel safe enough to disclose the nature and severity of her symptoms, she will save them for her suicide note.
And that is not okay.
Therapists with specialized training in perinatal mental health are obliged to consider the best and immediate way to access her authentic suffering. While I shameless promote the Holding approach (Kleiman, 2017), I will be the first to proclaim that I do not care how or where clinicians obtain the necessary information; I only ask that therapists who find themselves sitting face-to-face with a pregnant or postpartum woman in severe and acute distress make sure they do what they need to do to become informed and capable of responding appropriately and urgently.
The stakes are very high.
Passion and devotion to this work is a bonus, but expert training is essential. On-going supervision/consultation/mentoring is a clincial imperative. The board of directors and staff at PSI know this only too well and continue to train scores of professionals who can positon themselves to catch vulnerable women when they fall.
So, in addition to the love and giggles that permeate the otherwise informational and educational nature of the very serious subject at hand, PSI is saving lives. All too often we are thrust into a rapid and excruciating response to a perinatal tragedy. Those of us who work in this field know that at any moment, we are just a heartbeat away from a woman in despair losing her battle with depression.
This is why we do this work. This is why it feels so important. This is why it is not okay for perinatal women who are bone-tired and weary from hopelessness, to traipse from one misinformed provider to another.
If this is an area of interest for you, study the literature. Read the books. Go to trainings. Be informed before you sit with her. Get in touch with your best professional self and work hard to access her authentic suffering. She is not going to offer that up to you. She will withhold it. She will disguise it. If her pain is unendurable, she will pray you never find it.
Make no mistake about it, she may not know it yet, but she is counting on you to help save her life.
image credit: 123rf.com/orkidia
While sitting with palpable pain in therapy, I am often moved to find some tool, some intervention, some words of comfort, to ease the suffering. When I’m lucky, I find a way to express hope, in some form or another.
But today, I could not find the hope. So I sat with the pain. I thought about his history of trauma and loss. I recalled the trauma-informed literature which teaches us that resilience is an antidote to trauma. One way to cultivate resilience is to find meaning in the loss or purpose in recovery. It turns out that finding purpose is a key factor in one’s ability to cope.
Together my client and I explored caretaker anguish; The guilt of having fierce, negative emotions when you are not the one dying; the heavy load of day-to-day management of grueling, thankless, tasks that take you nowhere but back to where you started. We both spoke with somewhat of a scholarly tone, about the darkness, the heartache, the meaninglessness and the existential agony. We had nowhere to go.
This is when we sit with suffering.
So I brought my mother into the conversation, as I tend to do when I am thrust into unfamiliar yet familiar despair. I told my client about my mother’s history of profound loss and how the Holocaust had become a measure, for me, of what excruciating suffering looks like, feels like is like. I told him how hard and how well my mother works to devote her life to finding joy, for her own sense of sanity, and on behalf of the love she sprinkles wherever she goes, making this world a better place, to be sure.
I told my client that now, my mother finds herself confined by her love and devotion to my father who suffers from Parkinson’s along with its cruel pain and suffering. His days begin with tedious attention to detail colored by pervasive distress and debilitating physical symptoms. My siblings and I observe from afar, as my mother dances, sings, and whispers sweet nothings in his ear, hoping against hope for a flash of a smile or, a thank you.
She will wait.
She dances and sings in the meantime.
My client and I share a smile at her persistence. Her impressive devotion. Her hope. This is when I told him what she said to me one time, when I asked her, “how do you do this? Every day. With no complains. Asking nothing from anyone. How do you do it?” I asked with full knowledge that I am not made of such self-sacrificing DNA. And while I may share her kind heart, I DO ask for help and I DO ask for attention when moved by a generous moment of my own.
She told me it makes her feel valued. It makes her feel necessary. It makes her feel useful. She found purpose in her day-to-day struggle. She found meaning. A key to resiliency.
And she smiles.
She had, unknowingly, used her unwavering determination to master her environment. In doing so, she embodied the brilliant words of Viktor Frankl, a concentration camp survivor:
“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
My client listened intently to my words with a tear in his eye. “There is nothing I would rather do, on any and every single day, than take care of my Laura. Absolutely nothing.” he said warmly.
“I know.” I smiled, with a hidden tear of my own.
Mastering our environment is something that can feel impossible when the odds of anything getting better are slim. The chronic wear and tear of grief and loss paralyzes any prospect of hope. Still, if we can summon the strength to confront the anguish and do our best to find bits of joy in the face of unrelenting grief, it might pay off.
This is one way to find purpose. And finding purpose provides meaning to the suffering, it creates resiliency, and it inspires hope.