Pregnancy and Postpartum · Anxiety

Postpartum Anxiety and Feelings of Overwhelm

It may seem that being overwhelmed is just a given. You’re up to your eyeballs in dirty diapers and wet burp clothes. You can’t remember the last time you had more than a few hours of rest. What even is breakfast? You run on a steady stream of coffee and fistfuls of cheerios. When you put this all together, postpartum anxiety (PPA) and feeling overwhelmed seems to be par for the course.

If being overwhelmed or anxious has been your experience for the past few weeks (or months, or years), it is not fair and it’s not okay. It does not have to be like this. Postpartum is not meant to be a painful or miserable time. If you’re struggling with PPA (or similar symptoms), here are some tips to help.

Know the Signs of Postpartum Anxiety

Postpartum mental health gets overlooked because so many of its symptoms are normalised. Unfortunately, because having a new baby comes with lots of questions, PPA can get mistaken as “normal” adjustments to parenthood. Someone out there has claimed it is acceptable that you are this tired and irritable and anxious.

Yes, it’s normal to have questions and worries. This is part of being human, and certainly a part of being a new parent. However, it’s not normal to have these worries keep you up at night, cause conflict with your partner, or make you avoid time with the baby. Anxiety is only considered “normal” when it’s within your capacity to address it (a.k.a. your window of tolerance).

Postpartum anxiety is a genuine illness that requires attention and help. Here are the symptoms to look for:

  • Inability to stop worrying
  • Racing thoughts
  • Difficulty with sleep or appetite
  • Difficulty with focus and concentration
  • Inability to rest or relax
  • Feeling on edge
  • Panic attacks
  • Irritability or rage
  • Physical cues: tightness, tension, dizziness, nausea, hot flashes

One quick way for you to check about the severity of your postpartum anxiety is through the Edinburgh Postpartum Depression Scale. This is a screening tool that is used to identify postpartum mental health struggles (including PPA). Specifically, any score above 12 on this depression scale indicates a high probability of postpartum mood and anxiety disorders.

Three quick grounding techniques

If you’re struggling with overwhelming anxiety, you likely want these feelings to calm down ASAP. Here are three quick grounding techniques that can help reduce the panic and overwhelm.

1. Butterfly Hug

The Butterfly Hug is a popular technique used in Eye Movement Desensitization and Reprocessing (EMDR) to quickly settle your body and mind.

Why it’s helpful:

  • Does not require much thinking: This approach does not need you to think through things calmly. You don’t have to “logic” your way out.
  • Helps your brain process in a unique way: EMDR uses bilateral stimulation to activate both your left and right hemisphere while addressing extreme anxieties, traumatic memories, or distressing events
  • Activates your parasympathetic nervous system (the parts of your brain needed for relaxing)
  • Reduces your cortisol level (a.k.a. your stress hormones)
  • You can use this strategy anywhere. It does not require any “equipment”.
The following video shows the steps of the Butterfly Hug:

2. Temperature Change

The temperature change exercise is a great strategy that comes from Dialectical Behaviour Therapy. This approach triggers the mammalian dive reflex. This reflex occurs when we are submerged in ice cold water. In order to survive, our body is forced to slow down our heart rate and oxygen is only sent to key organs that are needed. Everything that is considered “non-essential” is overlooked.

Why it’s helpful:

  • Tricks your brain: Your body cannot go into “survival mode” and panic at the same time. Your heart rate is forced to slow down. Your oxygen level drops, thereby making it hard to panic.
  • Provides about 5-20 minutes of calmer thinking. This gives you some time to problem solve or find alternative coping strategies.
  • You don’t have to “think through” it to feel calmer.
The following video shows the steps of the Temperature Change technique

3. Mindful conversation with another person

Using distractions is really helpful to get through a distressing moment. However, if you cannot find a distracting enough activity, your mind tends to wander back to its original anxious thoughts. Participating in mindful conversation with another person face to face is more effective in helping you stay out of the overwhelm. Rather than focusing on the anxious thoughts, you’re turning your attention to the other person, asking and answering questions, and staying present.

Why it’s helpful?

  • When your postpartum anxiety is highly activated, your sympathetic and parasympathetic nervous system work overtime. Your body turns to survival strategies like fight, flight, freeze/shut down in order to cope. Social engagement, on the other hand, activates our ventral vagal pathway. This pathway tells our brain that we are in a safe and socially connected space.
  • Focusing on topics outside of your postpartum anxiety helps your system recognize that there are still safe options in your world.
  • Gives you the option to engage with someone else outside of your baby.

Working with your anxiety

So now that you’ve coped more effectively in reducing the anxiety, you may be wondering about your next steps. After all, these earlier coping strategies only resolve things for a short time. They’re not actually fixing the issue, and instead, providing brief respite. This is where the hard work of listening to our anxiety comes into effect. In order for you to gain more clarity, you will need to work with your postpartum anxiety.

Internal Family Systems Therapy (IFS) explains that there is always a positive intention to our worries (even though it rarely feels “positive”). It’s challenging to slow our body and mind down enough to hear what your postpartum anxiety has to say. But, we can break down the steps to better support our mental health.

Step One: Find where your anxiety is in your body.

Daniel Siegel coined the term “name it to tame it”. Basically, when you are able to find the feeling in your body and label it, you can get a bit of space from that feeling. Rather than “being” the emotion, you can observe it. So, call out what and where you are feeling things: “I am feeling scared… There is a ball of anxiety in my chest… my shoulders are feeling tense and stressed.”

Step Two: Stay curious

In this step, you will use a bit of mindfulness to approach your emotions. Now that you’ve noticed the emotion, keep your awareness on this feeling. Be aware of the thoughts, sensations, memories, and whatever else comes to mind as you focus on this feeling.

This step involves staying curious about your anxiety is telling you without judging it, trying to get rid of it, or needing it to change. Your anxiety will start to share more as you stay open to it.

As a word of caution, your anxiety may not share the nicest feedback. It may share beliefs such as: “Get me away from this baby! I can’t do this! What was I thinking? I need this to stop!” Stay aware of these thoughts so long as you are within your window of tolerance.

Step Three: Understand what your anxiety is trying to protect

IFS recognizes that our anxious parts are trying to help out in some way or form. Because they tend to communicate in harsh and overwhelming ways, it’s often difficult to understand what our anxieties are trying to achieve.

As you complete step one and two, you will start to identify what your anxiety is telling you. Then, ask yourself, what would happen if these anxious thoughts stopped? What is your anxiety trying to prevent? For example, if your anxiety is often saying, “Get me away from this baby”, what would happen if this warning was no longer present? You might presume that you’d be calmer. While that’s true, what else would happen? Would you suddenly be considered calm enough that others encourage you to parent independently? Would you spend more time with your newborn and make a mistake? What if your baby keeps screaming and you’re reminded that you’re not cut out for this whole parenting thing?

Sometimes your anxiety gets triggered, and it forces you to escape the circumstances. Your brain says, “This is too much, I can’t cope,” and you turn towards avoidance, drinking, zoning out in front of your phone or some other strategy. I’m not saying that these are effective ways to manage things. In all likelihood, this form of “self-soothing” will create new problems. But, as far as your anxiety is concerned, it is satisfied that it has reduced your distress and gotten you away from the “danger” (e.g. time alone with baby).

Step Four: Befriending

Have you seen “Beauty and the Beast”? The Beast is known for being a lousy character. He’s rude, ill-tempered, and scary. But, we see that meeting the Beast with compassion (mixed with assertive boundaries) helps him shift out into a kinder character. (For those who are cringing reading this example, humour me. It’s an analogy. I’m not trying to condone Stockholm syndrome).

In many ways, your anxiety is like the Beast. It’s loud, frightening and has awful manners. However, what happens when you approach your anxiety with compassion or confidence? Have you ever shown any desire to get to know this part of you? What happens when you acknowledge what your anxiety is actually trying to do? Imagine what it would be like to approach your anxiety by saying: “I get it… I get that you’re really scared of me making a mistake… I know this feels like the only way you can help me.” How would it respond to you?

Becoming kinder to yourself

IFS brings in a different level of self-compassion. We are not only meeting our inner system with kindness, but we’re also identifying what our anxious parts are attempting to achieve. When we treat ourselves in this manner, our anxieties will soften. These steps don’t cure postpartum anxiety. We have to address the actual issue, whether it’s the fear of making mistakes, feeling insecure about parenting, or addressing our own childhood traumas. But, meeting our anxiety in this way will reduce the overwhelm.

Curious to learn more?

Postpartum anxiety is treatable. If you found the above examples helpful in reducing your overwhelm, please let me know. If you have any questions about the above steps, or want to work with your own unique circumstances, reach out.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Anxiety · Depression · Mental Health

Five Ways to Challenge Negative Thoughts

After writing my last post about common anxieties during the postpartum period, I wanted to provide some strategies to help challenge these negative thoughts. Irrespective of whether you have a mental health diagnosis or not, it’s easy to fall into unhealthy thinking styles when you feel vulnerable. I hope these five strategies can help you refute negative thoughts and shift into a calmer frame of mind.

1. Finding Evidence

Cognitive-behaviour therapy uses the term hot thought (a.k.a. “automatic thoughts”) to refer to thoughts that pop into our mind after we are triggered. These hot thoughts are often mean, disheartening and self-deprecating. They often express a vulnerable belief we have about ourselves or the world. For example, if you have had a difficult conversation with your partner, a hot thought might be: “My partner is going to leave me” or “My partner is sick of me.”

Because these thoughts make us feel fragile, it is easy to fall into an emotional spiral rather than address the truth of these statements. This is where the strategy of finding evidence for and evidence against a hot thought can be helpful. There is a part of you that truly believes this critical thought to be true. Rather than pretending this part doesn’t exist, it’s more helpful to consider its perspective (don’t worry, we don’t stop the exercise at this step). Write down every fact (statements that are objectively true) that helps argue the validity of this negative thought. For example, if your hot thought is “I’m a crappy student”, then your evidence might include: a poor test score, a lower grade on your report card, your friends’ grades, or difficulty grasping teaching material.

5 ways to challenge negative thought patterns. Kasi Shan Therapy: Counselling support in Kitchener, ON
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Now, pretend you are in a court trial. In order to fairly assess your hot thought, you need to also consider counter arguments. This involves spending time looking at every evidence that refutes this negative thought. It is when we start assessing this counter argument where most of us recognize the fallacies in our hot thoughts. For the most part, our negative thoughts come from a place of emotional reasoning, rather than actual evidence. When we are forced to identify the evidence (or lack thereof) behind our thinking, it becomes clear fairly quickly that our hot thoughts are not valid.

Example of hot thought: “I’m a crappy student.”

Evidence For Evidence Against
– I did poorly on my last test
– I didn’t get an A on my report card
– My friends have higher marks than me
– I didn’t understand the last lesson
– I have a B average on my report card. I am meeting the expectations.
– It takes me a bit of time to review material on my own before I understand a concept fully
– There are some kids who are getting higher grades than me, and there are some kids who are getting lower grades than me
– This is not my strongest subject, but I am doing well in other classes/activities
– When I study with my friend, I’m able to see where I understand and don’t understand concepts fully. This has helped me get better grades in the past.
– I am able to ask the teacher questions if I don’t understand the material
– I take notes in class, do my homework and try my best.

2. Checking for Double-Standards

5 ways to challenge negative thought patterns. Kasi Shan Therapy: Counselling support in Kitchener, ON
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When it comes to giving advice or offering feedback to others, we are usually gently and generous. However, when the same problem happens to us, we become the meanest critics. When we have negative thinking patterns, it’s important to step back and consider how would we talk to a friend in this situation. If the same thought of “I’m a crappy student” was stated by a friend, how would we respond? Would we agree and voice other criticisms, or would we look for evidence that shows a more balanced perspective? Checking for double-standards refer to assessing whether we would respond differently if the same circumstances were happening to someone else.

3. The Survey Method

5 ways to challenge negative thought patterns. Kasi Shan Therapy: Counselling support in Kitchener, ON
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Sometimes our negative thoughts escalate because we feel we are the only ones to be thinking or feeling a certain way. There are times when this assumption is accurate, and there are also times when this assumption is false. By asking others for feedback, we’re able to assess whether there is any truth to our beliefs. The survey method normalizes our beliefs because it helps us recognize we are not alone in feeling or behaving in this manner. The survey method also helps clarify how some of our difficult thoughts are coming from unrealistic expectations.

Let’s consider a scenario where a child isn’t listening to a parent, and the parent snaps. In this case, the hot thought may include: “I’m a terrible parent for getting snappy” or “I’m not allowed to be angry at my child.” If we were to take a survey and ask others whether they also get snappy with their child, what kind of answer would we get? Chances are that other survey takers would acknowledge that they also have moments of frustration while parenting. If we were to share our beliefs that it is not acceptable to be angry with our children, many individuals would question the feasibility in pushing away a normal emotion like anger.

4. What other factors are involved?

five bulb lights
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This technique is referred to as “re-attribution”, and it can be very helpful to challenge thoughts about personalization. Rather than assuming that you are solely to blame for a scenario, re-attribution helps us step back and consider all of the factors that could have contributed to a situation. There are many points of influence such as environmental, cultural, physiological, psychological, financial, or social factors.

Many times parents personalize their children’s behaviours. While parents play a pivotal role in their children’s upbringing, they are only one influencing factor. Let’s consider a scenario where a child get into a fight with a classmate. If a parent personalizes this behaviour, hot thoughts may include: “I didn’t teach her the right ways to talk things out… Am I too aggressive at home?… I’ve been too lenient when she’s rough-housed with her siblings.” While these points may be valid, it does not acknowledge the impact of other influencing factors. For example, this child may have gotten into a fight because her classmate was egging her on. This child may have watched a TV show that modelled fighting, or seen peers manage conflicts in this way. Or, this child may have felt threatened, and went into a more subliminal fight/flight mode.

5. Test out your belief

A lot of times or our worries involve catastrophizing that negative things will happen. Unfortunately, because these negative consequences seem so frightening, we give up or give in to our worries. By testing whether your negative thought is likely to happen, you’ll either learn (a) the feared outcome didn’t actually happen, or (b) it did happen, and you were able to survive it.

brown eyes of scared young person
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For example, many of us feel nervous on a first date. We worry about not liking the person, or whether we’ll do something awkward. Rather than avoiding the date to prevent any negative scenarios from happening, we can actually test out our theory by going on the date. Afterwards, we’re able to make a more informed decision of whether that fear had any evidence to back up its argument. This strategy of challenging our negative thoughts through testing is the hardest to manage, and it’s helpful to connect with a therapist for additional support, such as the use of exposure therapy.

What works for you?

I’m describing these fives tips as if they were simple, and they aren’t always this easy. That’s partly because when we’re anxious, we are so caught in our emotions, that it’s hard to hear that logical part of our mind. However, what I’m hoping this post will offer you is the chance to try something different. You may end up picking one of these strategies and actively trying it, or simply pausing before an anxious moment and assessing if there is any evidence to it. Whatever you choose, I hope that the distress in challenging your fears are short-lived and that you start to see positive turns.

As always, please feel free to reach out or ask any questions.

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Anxiety · Pregnancy and Postpartum

Common anxious thoughts during the postpartum year

Cognitive-behaviour therapy has taught us that there are certain themes to our anxious thoughts. These themes are referred to as “cognitive distortions” or “thought traps” in CBT lingo. Anxious thoughts can happen to any of us, irrespective of whether or not we have a clinically diagnosed mental health issue. More often, they tend to pop into our minds when we feel vulnerable. Unfortunately, during the postpartum year, there are numerous vulnerabilities that new parents face. Examples of these vulnerabilities include lack of sleep, hormonal shifts, adjustment to a new life, changes to routine, and an increased sense of responsibility. The following are a list of common thought traps, and examples of how they may show up for postpartum parents.

Common anxious thought patterns that new parents experience:

Over-generalization

common anxious thoughts during postpartum
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When we over-generalization, we are making assumptions based on limited information. This means we come to a conclusion about someone or something from a single piece of evidence. In future circumstances, we overestimate the likelihood that the same set of events will happen again. The following are a few examples of how over-generalization can show up during the postpartum stage:

  • “My baby is not latching right away, I’ll never be able to breastfeed.”
  • “This baby has been fussing for nearly an hour. I am never going to be able to get to sleep.”
  • “My spouse was so tired and cranky when he came from work yesterday. I don’t trust him to take care of the baby on his own in the evening now.”

Catastrophising

woman in black long sleeve shirt lying on gray couch
Photo by cottonbro on Pexels.com

This anxious thought pattern basically means we are magnifying an issue into something awful and disastrous. We may do this by exaggerating the meaning or importance of certain events. Often times when we catastrophise, there is a sense of dread in facing uncertainty. We don’t feel we have the skills or confidence to manage in this situation. Examples of catastrophising during postpartum care include:

  • “My spouse and I argued this morning. We must be heading towards a divorce.”
  • “I got angry with the baby. We are never going to have a good relationship. I’m not cut out to be a parent.”
  • “Sleep training was so hard yesterday. I can’t imagine that it’s going to get better.”
  • “My daughter freaked out at the doctor’s office. The staff must have been pissed that I couldn’t calm her down. I can’t go back there.”

All-or-nothing

anxious thoughts during postpartum
By Itati Tapia from Pexels

All-or-nothing thinking keeps us stuck between two restrictive options. This anxious thought pattern refers to when we things as falling into extreme categories without any middle ground. We are either perfect or a complete failure. Things are either good or bad. Life is either easy or impossibly hard. When we focus on these polarized options, we forgot to notice exceptions to these extreme thoughts. We don’t take into account all of the various and complex factors that may have affected achieving full success. We don’t consider how our self-worth is separate from our achievements.

Personalizing

Personalizing is when we take on the responsibility of a situation or take ownership of other people’s behaviours. This happens quite often with parents who take on the responsibility of their child’s behaviours as if they are fully to blame. It does not allow space for the many external factors that could have also influenced what had taken place.

  • E.g. the baby is teething and unable to fall asleep: “I’m a lousy parent. I can’t help my baby get some rest.”
  • E.g. Your partner received negative feedback from his/her boss. “It’s my fault. I kept my spouse awake by asking for help during the feedings.”
  • “It is my fault that my baby is not walking, talking, or meeting a developmental mile stone at this time. I must be doing something wrong.”

Should Statements/Perfectionism

This anxious thought pattern is really tough during the postpartum period. We are all trying our best as new parents, but the pressure to manage these high standards can be incredibly straining. Perfectionist thoughts involve terms like should, shouldn’t, must, must not, ought to, have to, etc. We use these thoughts as if they are iron clad rules. Unfortunately, there is a lot of frustration and resentment when we cannot meet these high expectations.

  • “I should be able to do the dishes, make supper, tidy up and take care of the baby.”
  • “I have to get to the gym. I can’t be walking around with all of this baby weight still.”
  • “I should be calm and soothing all the time, even when my baby is cranky.”

Do these anxious thoughts sound familiar?

Anxious thoughts can happen to any one. However, there is a higher vulnerability for anxiety during the postpartum year. If you are concerned that you may be experiencing postpartum anxiety, the Edinburgh Postnatal Depression Scale is a quick self-assessment that reviews signs of depression and anxiety in parents. Postpartum anxiety is treatable. If you are struggling, please reach out.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Anxiety

What is Exposure Therapy?

Exposure therapy is a wonderful and challenging form of treatment that can improve phobias and anxieties. This treatment modality works off the assumption that, by slowly and continually facing a fearful situation, we become less scared. Gradual exposure involves creating a formal list of tasks that are completed in order to build confidence in facing our fears. Repeating the exposure task helps us become desensitized to a scary object or event. Exposure therapy is based on cognitive-behaviour therapy wherein clients address their anxiety by challenging negative thought patterns and shifting their behaviours. If you have struggled for years with anxiety, exposure work could be the effective approach that helps meet your needs.

Exposure therapy to treat anxiety

Anxiety and Avoidance

When we experiences anxiety, our natural reaction is to avoid whatever it is that is causing fear. For example, if you’re scared of heights, you may avoid climbing ladders or standing out on a balcony. If you’re scared of roller coasters, you may avoid amusement parks. If you live with social anxiety, you may feel distressed at the idea of speaking to strangers or participating in group work.

When our anxiety gets triggered, it tells us there is some form of imminent threat. The safest option is to get away from that threat. Avoidance is an effective strategy, and it can work for many years. However, if your fears are more common place (e.g. public speaking, taking tests, speaking to strangers), it becomes harder to avoid these fears all together. At some point, facing the actual fear becomes a necessity, and our desire and need to address these fears becomes stronger.

How avoidance makes things more complicated:

When we become anxious, we worry that something bad will take place if we actually face our fears. This belief is so strong and uncomfortable that the idea of confronting our fears is overwhelming. Unfortunately, we can spend years avoiding this fearful object or event because of this feared negative consequence. So, we listen to these problematic beliefs without testing whether it is accurate or likely to occur. We trust this belief without assessing whether we have any evidence to back it up.

Because our anxiety naturally feels better when a scary or distressing threat is taken away, we feel like we have managed this situation. However, the next time we are presented with the same threat, our anxiety comes back. As we get into these habits of avoiding, our anxieties become stronger. We stop trusting that we have the skills or ability to face our fears.

exposure therapy to treat anxiety

If you are struggling with a phobia, take a moment to consider: What would happen if you actually faced this fear? If you take public speaking, for example, the problematic beliefs could be:

  1. others will laugh at me
  2. I will make a mistake
  3. I will stutter and have a hard time being articulate.

Based on these beliefs, you may decide to avoid all forms of public speaking. While this makes sense, the unfortunate consequence is that we never actually test the validity of our belief. How likely is that you’ll make a mistake? If you do make a mistake, then what happens? Will you really be laughed at by your peers? Sometimes, we don’t quite know what would be so bad about these fearful consequences, but the sense of dread is so strong, we don’t want to test it out.

Starting Exposure Therapy

Exposure therapy is a gradual and systemic approach to facing our fears. By slowly placing ourselves in situations that make us fearful, we can start to challenge our fears and our problematic beliefs. We learn to assess whether our feared beliefs are valid. By taking a gradual approach, we can start at a pace that feels uncomfortable, but manageable. For example, if you have a fear of spiders, your exposure task may involve looking at pictures of spiders as a starting point. The task is not pleasant; however, it is much more manageable than actually touching a spider or being in the same room as a spider.

Gradual exposure is incredible in helping build our confidence. The more often we practice an exposure task, the easier it becomes because we learn that these problematic beliefs are either a) not happening, or b) not as bad as we initially believed. With an increased level of confidence, we can then move on to a more challenging exposure task.

Step One: Creating an exposure tasks

The first step to starting exposure therapy is to create a list of exposure tasks. A therapist can support you in creating a list where you consider every anxiety-provoking and avoidance-inducing scenarios related to this single issue. This list can be extensive, and it’s recommended that there are at least 15 exposure tasks to help give enough varied scenarios to build your confidence. For example, your fear of public speaking can include exposure tasks such as:

Exposure Tasks
Providing a long presentation (10 min+)
Providing a short presentation (5 min+)
Introducing myself during ice breakers
Speaking in small groups
Speaking to strangers one on one
Having conversations with authority figures (e.g. boss, teachers)
Maintaining eye contact
Sample Exposure Hierarchy

Step Two: Rating Distress Level

The therapist and the client then review the created list of exposure tasks and assess how uncomfortable, distressing or avoidant-prone the task seems. This is a subjective score, and the distress level depends on how the client perceives a situation. These items are then ranked from highest to lowest level of distress to create an exposure hierarchy.

Exposure TasksHow distress is it?
Providing a long presentation (10 min+)100%
Providing a short presentation (5 min+)90%
Introducing myself during ice breakers80%
Speaking in small groups80%
Speaking to strangers one on one75%
Having conversations with authority figures (e.g. boss, teachers)60%
Maintaining eye contact40%
Sample Exposure Hierarchy with Distress Ratings (0= neutral. 100= highest level of distress)

If you are looking for some examples of exposure hierarchies, here are some great examples from Anxiety Canada.

Step Three: Gradual Exposure

This is the hardest step of exposure therapy. Now that we have created a list of exposure tasks, we want to begin the actual behavioural work. The general principal with exposure therapy is to start with tasks that are mildly distressing (in the 30-50% range). This way, we begin with tasks that are challenging, but not so overwhelming that the individual wants to give up or is overwhelmed.

When you start exposure therapy, it’s best to do an exposure task enough times that the distress level goes down. You can stop the task when you are either at a point of habituation (you’re used to it), or to a point of extinction (the distress rating is at a 0% and the task does not bother you). When either of these factors happen, you can move on to the next task on your exposure hierarchy.

Some considerations to note when doing exposure work:

  • Make sure you are actually focusing on the fearful experience. If your exposure task is to look at pictures of spiders, but you have music on in the background distracting you, this is preventing you from truly doing the work. The point is to practice being in that state of distress without any form of avoidance, so that you can recognize your own skill and ability to handle the situation. This is also part of the reason we start with an easier task when we begin exposure work.
  • Who is with you? Are you able to do the task on your own or do you always have someone nearby? In the beginning, it is okay to practice doing an exposure task with another person. However, it’s important to try a task on your own so that you can gain confidence in your ability to manage the situation.
  • Try and switch the length of time you practice exposure work. In the beginning, it’s okay to start for a small period of time, but as the days go on, see if you can lengthen your amount of time doing the work.

Step Four: Tracking using an Exposure Record

As you do these exposure tasks, it’s important to keep track of your distress level. Does it change over time? If not, it’s important to let your therapist know so that you can problem solve together, such as by creating additional steps to help bridge between a task that is manageable versus an overwhelming task. Keeping track of your distress level is also a great marker that tells you when you are ready to move on your exposure list to a task that is slightly harder. Your end goal is to ultimately face your fear in a variety of environments.

As always, everyone has their own specific and unique needs. If you have any questions about exposure therapy, or are looking for support, please feel free to reach out.

Cheers,

Kasi

Mental Health · Anxiety · Depression

15 mindfulness exercises to try today

There are so many ways to incorporate mindfulness in to your daily life and one post doesn’t suffice. Mindfulness is a moment to moment awareness of what’s happening internally (your emotions and physical sensations) and externally (using your senses to note what you see, hear, smell, taste and touch). While the definition may sound complicated, the actual practice can be quite simple.

It may seem like I’m constantly talking about mindfulness, but there’s a reason I keep encouraging its practice. By trying mindfulness exercises, you can gain various benefits such as:

  • feeling more in control of your emotions
  • improving your attention and concentration
  • reducing stress and anxiety
  • becoming aware of your thoughts and triggers
  • having more capacity to pause and reflect versus acting automatically
  • improving relationships
  • living in the present moment (rather than worrying about the past or future)
Photo by Simon Migaj on Pexels.com

How to be mindful:

When we start our mindfulness exercises, it’s important to keep the following components in mind. These four factors shift our normal daily activities into intentional mindfulness practice.

  • Observe: When we are mindful, we are observing using our five senses to notice what is going on internally and externally.
    • Note: You stop being mindful when you move away from observing with your senses to focusing instead on interpretations (e.g. “That person is looking away from me” versus “that person must think I’m the worst”)
  • Participate: When we are mindful, we throw ourselves into an activity and fully engage with the present task. Rather than shying away, or being an observer, you want to be an active participant.
  • Non-judgement: When we are mindful, we describe only what we observe. This means noticing and moving away from interpretations, evaluations or judgements.
  • One thing at a time: Mindfulness means the end of multitasking! Instead, we want to only focus on ONE activity at a time.
observing with our senses

15 Mindfulness Exercises

So let’s dive in! There are many ways to practice being mindful. The importance is doing these activities by observing with your senses, participating fully, being non-judgemental and doing one thing at a time. Whenever your thoughts stray away from the activity, you want to bring it back. This may involve bringing your attention back many times, and that’s okay! Mindfulness is like a muscle, and the more often you practice, the stronger it becomes. With practice, your attention will improve.

Eating a meal

Notice how the food tastes and smells. Pay attention to the movement involved in taking a bite. Notice the visual presentation and the sounds that you hear from the moment you pick up your food to swallowing.

Going for a walk

This is a great way to be mindfully aware of how your internal environment interacts with the external environment (e.g. can you notice how it feels when your feet hit the floor? What happens in your body when you notice your surroundings? How does your body respond when it hears a bird chirping versus a loud car horn?

20 mindfulness exercises that you can practice today. Kasi Shan Therapy offers counselling online and in Kitchener, ON.

Listening to the news

This is a great way to practice being non-judgemental! Try and sit through the evening news noting when judgemental thoughts arise. When they show up, can you try and bring your attention back to the material shared on the TV instead of evaluating the information?

Dancing

This works especially well if you feel self-conscious about dancing. Can you throw yourself into this activity letting go of all judgemental thoughts and insecurities?

Watching TV

Yes! You can watch TV mindfully. It involves only doing this activity (not also playing on your phone, talking to your family member, or get supper ready). Can you bring all your thoughts back to the show that you are watching whenever you get distracted?

Washing dishes

Can you notice the sense of touch when you are washing dishes? What temperature is the water? What does the suds and sponge feel like? Are you able to focus on just watching dishes instead of thinking of something else?

Describing your home

Can you close your eyes and describe your home? What is actually observable? Where are items located? Can you notice if any judgemental thoughts come up and replace them with observable facts?

Mindfulness exercises to practice today. Kasi Shan Therapy offers counselling services online and in-person (Kitchener, ON)

Engaging in a conversation

Can you participate in a conversation with someone mindfully? This means truly taking the time and effort to hear what the other person is saying (as opposed to planning your retort). Are you able to focus on the conversation and not multitask?

Mindful breathing

Paying attention to your breath is boring, which is what makes it a great mindfulness exercise! It’s easy to have your attention wander if all you’re doing is focusing on your inhale and exhale. This means ample opportunity to gently bring your mind back whenever it shifts away from the breath.

Observing your thoughts

Set a timer for two minutes and notice the various thoughts that come to mind. We want to teach your brain to not become hooked to these thoughts. This means acknowledging a thought when it pops up, but not going down the train of thought to elaborate. This one takes practice and can be frustrating, and it’s part of the reason I recommend sticking with a two-minute timer to begin.

15 mindfulness exercises to practice today. Kasi Shan Therapy offers counselling services online and in person (Kitchener, ON)
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Using a meditation app

There are many online apps that can guide you through meditation such as: Insight Timer, Calm, Pacifica or Head Space.

Completing a body scan exercise

Take the time to start noticing the various shifts that happen internally. This video is a great starter to help you start mindfully observing your body.

Courtesy of The Mindfulness Teacher

Driving

It’s so easy to get critical of others’ driving when you’re on the road. Can you observe what is happening around you without these critical thoughts? If critical thoughts happen, can you rephrase so that you focus on observation rather than evaluations?

Finding music that puts you in a specific mood (sad, angry, happy)

Listen to each song, and observe the shifts it has in your body when various emotions come up.

Cleaning your home

Try and create a plan of cleaning your home one step at a time. Once a task is done, move on the next. Pay attention to judgemental thoughts if they arise, and bring your attention back to the task at hand. Notice how it feels when you are sweeping. What do your muscles feel like when you are dusting? Instead of focusing on the end result, can you slow the process down to being in the present moment?

As always, if you have any questions or comments, please feel free to reach out.

Kasi

Anxiety · Mental Health

COVID-19: Working with the fear of not knowing

One of the biggest struggles with COVID-19 is the uncertainty with this virus. How do we treat it? Will we become infected? How long will we need to maintain physical distance?
Given that there is so much that is unknown right now, it is understandable that many of us are struggling with anxiety. The following are some suggestions that may help support your emotions.

1) Find areas in your life where you have control.

Do you have a routine that you follow? How are you managing to get adequate sleep, exercise, and diet? How are you practicing physical distancing? While there is a lot of uncertainty right now, notice and foster the many areas in your life where you have control.

2) Physical distancing is not the same as social distancing.

For many extroverts, it is extremely difficult to not have access to other people. Practicing physical distancing does not mean emotional isolation. Stay in touch via electronics. Yes, for once in our lives, it is acceptable to encourage screen time!

Are you feel overwhelmed by the uncertainty of the coronavirus? You are not alone. Read these strategies to calm down your emotions during this pandemic.
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3) Limit your time reading the news

Stay informed, but do not stay glued to CNN, CTV, BBC, or wherever you get your news stories. Set a limited amount of time to tune in during the day so that you are aware of what is going on. Too much time reading about COVID-19 can leave us overwhelmed.

4) Validate your anxieties

Of course, you are overwhelmed right now. We have not faced COVID-19 before, and we don’t know what to expect. Your anxiety is a natural human emotion that is letting you know it’s worried about something bad happening in in the future. Validation does not cure anxiety. However, notice what happens to your emotions when you recognize the normalcy of feeling scared versus pushing it away or trying to argue with it.

5) Notice how you take care of yourself

Your anxiety will feel calmer once it trust that you will take care of yourself today, as well as in the future. This might involve creating a plan for your finances, your work, your health, your education, and so forth. What are you doing right now to ensure you are staying safe and well? Remind yourself often of these steps to help reinforce to your anxiety that you are doing your very best.

Are you feel overwhelmed by the uncertainty of the coronavirus? You are not alone. Read these strategies to calm down your emotions during this pandemic.
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6) Create a plan if you were to get sick

This does not mean ruminate for hours, but set aside 10 minutes to plan for this possibility. If you were to start showing symptoms, what would be your first step? Knowing even a few of the steps you will need to take can balance out the fear of uncertainty.

7) Enjoy your space

A patient recently told me “your home is not your prison”, and I really resonated with this statement. You’ve worked so hard to create a beautiful home, and now you’re finally allowed to spend time in it. You may have considered slowing down with the busyness of life. Now, many tasks and errands have been removed from your daily responsibilities. Don’t get me wrong- this is no one’s idea of a vacation. However, there is a sense of release when given permission to spend time at home and enjoy activities at a slower pace.

Are you feel overwhelmed by the uncertainty of the coronavirus? You are not alone. Read these strategies to calm down your emotions during this pandemic.
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As always, please feel free to reach out or share this post.

Cheers,
Kasi

Trauma · Anxiety · Mental Health

Understanding our Window of Tolerance

A few weeks ago, I wrote Why is everything harder after trauma? In continuing the conversation about trauma’s shift to our nervous system, I came across this great little video that explains the window of tolerance in a very accessible way. For my fellow learners, I hope this piques your interest! For fellow parents, I hope this opens the door to speaking to your teens and children about common signs following trauma.

As a refresher, the window of tolerance is a term that describes our ideal state. It shows the most effective state of arousal where we can thrive and handle daily stressors. When we experience too much trauma or distress, our window of tolerance narrows, and we become more emotionally vulnerable (i.e. more quick to shut down, become angry, etc.)


Knowing more about window of tolerance is only the first step. Let’s bring this to your own experiences. Try this quick assessment to see how you normally respond when you are out of your optimal zone. Check off the symptoms that you typically experience and rate the intensity of these behaviours from 1 (mild), 2 (moderate), or 3 (severe).

Window of tolerance and hyperaroused. Kasi Shan Therapy support individuals needing support with perinatal mental health and trauma.

Here are few simple exercises that you can practice to get you back within your window of tolerance:

  • Mindfulness practice: i.e. Pay attention to your external environment by noting 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.
  • Focusing on getting grounded by pushing your feet firmly into the ground
  • Deep breathing
  • Progressive muscle relaxation exercises
  • Exercise
  • Using items that soothe or activate your physical senses (i.e. eating comfort foods, being wrapped in a warm blanket, soothing music, touching an ice cube)

We do not have to be in these states of distress forever. For further information and support, please reach out.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Anxiety

Calming the anxieties of our inner perfectionist

I have talked about the “perfectionist” part of me in previous posts. When this part of me gets going, it wants to set high standards and throw all concepts of work/life balance out the window. You may have a similar perfectionist inside of you. This perfectionist may say harsh comments like: Why are you not good enough? Why aren’t you trying harder? How are you making so many mistakes? Are you really taking a break right now? How are you screwing this up? You notice your anxiety continuing to increase with each and every question. It never feels easy to hear these criticisms, and the struggle to calm this part of you can feel like the biggest hurdle.

Calming the anxieties of our inner perfectionist. Kasi Shan Therapy offers counselling support online and in Kitchener, ON

There are a lot of components that go into creating this perfectionist. We all carry wounds and burdens from our past. The ways in which we were raised, our childhood experiences, our moments of distress, and many other factors collaborate to form this perfectionist. Ironically, this perfectionist is acting in ways that it feels are the most effective in getting results. It hopes that by yelling, criticizing, or nagging, you will improve. Despite these well-intentions, the perfectionist’s words are hard to hear, especially when they fly at you frequently and incessantly. There are many ways we can support this part. We can use counselling strategies like EMDR and IFS to learn what happened to create this part of our personalities. We can then provide it the space and tools it needs in order to feel less anxious. We can focus on exposure work to help this part of you learn that making mistakes is not the be-all and end-all that it fears. We can gently challenge some of its beliefs to change thought patterns. We can work on mindfulness to recognize when this part gets triggered, and support it much sooner.

Calming the anxieties of our inner perfectionist. Kasi Shan Therapy offers counselling support online and in Kitchener, ON

I want you to have support right now if your perfectionist parts are feeling anxious. Dr. Christopher Germer is an incredible practitioner who helped develop mindful self-compassion. I encourage you to take a few minutes for yourself and practice this exercise, and I hope that it resonates with you.


At the end of your counselling experience, I hold many hopes for your inner-perfectionists. I hope this perfectionist learns that it’s okay to screw up and to have regrets. Making mistakes is part of being human. I hope this part knows that there is a future beyond this moment and this mistake. I hope this part of you recognizes that this is a moment of suffering; there is a beginning, and there will be an end (even though, sometimes it feels like it lasts forever). I hope it realizes that this moment can be just that: one moment in a lifetime of many moments. I hope that it is able to look around and see that there is more to you than being perfect. I hope it notices the humor, the personality, the kindness, the patience, the efforts, and all the other factors that make you a well-rounded person. I hope it recognizes that these other factors do not go away because you have made a mistake. I hope this perfectionist inside learns to accept that you are not perfect, nor do you have to be perfect, or prove to others that you are perfect.

As always, if you have any questions or comments, please feel free to reach out.

Kasi

Anxiety

Simple daily mindfulness exercises

What would your life be like if you had control over your attention or thoughts? How could you shift your behaviours if you became aware of when your emotions started to take a downward shift? What would happen if you could become more present with your environment or the people around you?

Mindfulness is the skill of moment to moment awareness of what is happening (both internally in your system, and externally in your environment). It involves noticing what is taking place without judging or trying to change things. While this skill takes practice, it does not have to involve complicated or lengthy exercises. Here are some simple ideas of how you can practice being mindful daily:

1) Drinking your morning coffee (or insert beverage of choice).

Take a few minutes to bring your attention to the experience of drinking. What does your coffee taste like, smell like, look like? Can you slow the process down so you can notice all the steps in between pouring a cup of coffee to taking your first sip? How does your body move around your kitchen? What noises do you hear as you take out a mug? I encourage you to practice this exercise for 5 minutes. Of course, your mind will wander (don’t worry! It’s meant to wander!) Being mindful involves noticing when your attention wanders, and bringing it back to our set anchor (in this case, the experience of drinking coffee).

2) Listen to music.

Close your eyes to reduce distractions from outside and bring your attention to the song. Notice the shifts in your body as you listen to music. Are there moments when you feel activated? (Can you notice a spark of irritation? An urge to dance? Do you feel it is easier to breathe?) Are there moments when music calms your body, or perhaps leave you feeling unsettled? Take a listen to these two very different pieces of music. Mindfully observe the changes that happen in your body (and of course, try not to change the experience, or judge it!)

3) Describe a person you dislike nonjudgmentally.

How often are you critical? Do you tend to make quick conclusions about people? Has this behaviour gotten you in trouble? Being nonjudgmental involves describing what we observe with our five senses (therefore, sticking with objective facts) versus evaluating or interpreting people or things. Being nonjudgmental moves us away from relying on harsh, emotional language. Choose a celebrity, a teacher, a family member, a TV personality, or anyone that you have found annoying and describe them using nonjudgmental language (To learn more about the skill of non-judgement visit DBT Self-Help). Why am I mentioning mindfulness today? Well, let’s be honest, we’re all a little anxious right now because of this pandemic. Mindfulness is one of many strategies that can support our emotions at this time.

As always, please feel free to share or reach out if you have any questions!

Cheers,
Kasi

Anxiety · Mental Health

5 Tips to handle stress

Many times in life we come across a problem that we cannot fix right away. During these times, therapists encourage a fancy term called “distress tolerance”. But what exactly does this term mean? Distress tolerance is all about handling a stressful moment without making matters worse.

Let’s say you’re expecting to have a difficult conversation with your spouse that evening. It makes sense that you feel at edge most of the day. You may end up drinking, avoiding your family members, being snippy with your colleagues, cancelling work, or any other strategy to cope with the edginess. These behaviours all make sense given that you’re stressed about the upcoming conversation. However, all of these behaviours tend to create further complications. Not only do you have to deal with the difficult conversation with your partner, but you also have to sober up, apologize for the avoidant behaviours, make amends to your relationships with colleagues, and grovel to your boss. All in all, we’ve taken a crappy situation, and made it significantly harder.

5 tips to deal with stress: Reach out to Kasi Shan Therapy for counselling support online & in-person in Kitchener, ON
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Don’t get me wrong, I have also chosen some not-so effective strategies on my worst days. We all make mistakes. The point is not to judge ourselves for these mistakes. Instead, we want to see if there are better ways to help us cope. This is where distress tolerance skills come into play. Using well-known strategies like distractions (i.e. video games, reading, watching TV, exercise) and self-care (i.e. comfort foods, long bath, getting a massage) are perfect at these times. They help you tolerate the waiting period until the end of the day when you can finally address the real issue with your spouse.

People often get frustrated with coping strategies because “they don’t make us feel good”. Fair enough. Distress tolerance isn’t meant to make you feel better (although, if they do put you in a better mood, enjoy it 🙂 ). These coping skills are all about tolerating the pain, not actually fixing the pain. In the above example, your primary concern is getting through a hard conversation with your spouse. Unless this is addressed and resolved, why expect that watching TV, taking a walk, or any other distraction will make you feel better? So how do we practice “distress tolerance skills” effectively? Here are a few key points:

1) Find distractions that actually get you distracted

5 tips to deal with stress: Reach out to Kasi Shan Therapy for counselling support online & in-person in Kitchener, ON
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If you are going to be bored out of your mind reading a textbook, this is not an effective coping strategy! Your mind will naturally return back to whatever is stressing you out. If you’re stuck thinking of effective distractions, I recommend an activity that is active or new so that you have to concentrate on the task at hand. Think about the first time you drove a car on your own. If you were angry that day, consider how difficult it would have been to maintain the intensity of your anger AND concentrate on following all the steps to drive. Your mind doesn’t have the mental capacity to do both at the same time effectively. Instead, you have to mindfully focus on driving so that you don’t crash.

2) Have a bunch of coping strategies to use in a moment of crisis.

Some days we’ll only need to dance along with music in the car to ease our anxieties. Other days, we may have to eat a chocolate bar, go for a bike ride, snuggle up with our pets AND practice some breathing exercises. Neither options are wrong. It just depends on our needs in that moment.

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3) Use the acronym ACCEPTS

This is a great term from dialectical behaviour therapy that is useful for distress tolerance.

A= Activities (Participate in activities that you enjoy, or help you stay effectively distracted)

C= Contribute (Helping others out makes us feel better about ourselves, and it takes us away from our own stress)

5 tips to deal with stress: Reach out to Kasi Shan Therapy for counselling support online & in-person in Kitchener, ON

C= Compare (Think about a time when you struggled more than this present moment. This helps you recognize that you were able to overcome hardships, and puts this current issue into perspective).

E= Emotions (What will create a different emotion than the one you’re feeling? Watching sitcoms makes me laugh. Going for a run makes me feel confident. Giving my son hugs makes me happy. What works for you?)

5 tips to deal with stress: Reach out to Kasi Shan Therapy for counselling support online & in-person in Kitchener, ON

P= Push away thoughts (Definitely not one I recommend long-term. It’s okay to tell yourself that you cannot think about a certain stressor right now. For example, if you’re supposed to be concentrating on your exam, it’s probably not the ideal time to be thinking about a fight you had with your partner the day before. Pushing away thoughts is a helpful method so long as you come back to the thought at a more convenient time).

T= replace Thoughts (Focus on something else. Plan your family vacation. Think about the book you’re reading. How do you think it will end? Basically, focus on anything else except the present issue).

S= Sensations (Find safe physical sensations to use as distractions. i.e. a soothing cup of tea, a cold ice cube, a hot compress).

5 tips to deal with stress: Reach out to Kasi Shan Therapy for counselling support online & in-person in Kitchener, ON
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4) It’s okay to take a mini-vacation from the stressor if it takes a long time to get things sorted.

5 tips to deal with stress: Reach out to Kasi Shan Therapy for counselling support online & in-person in Kitchener, ON

Whether this is a physical escape or a short mental break (i.e. guided meditation, pushing away thoughts). The stressor is still there when you return from the break, but the rest gives you some time to feel calmer and more at peace

5) Problem solve whenever possible!

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At the end of the day, nothing will help you feel fully at peace until the stressor is resolved (or you willingly radically accept that the issue will not be fixed). This means hunkering down and brainstorming various solutions. As always, everyone’s situation is unique. If you have any questions or concerns, please feel free to reach out.