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.

Trauma

Considering trauma therapy? How to tell if EMDR is right for you

If you have been searching for trauma therapy, chances are that you have come across the term “EMDR”. While there are many types of therapy that can address trauma, EMDR has become well known in the counselling world as being an excellent and fast option for processing difficult life events. But how do you know if EMDR is right for you? I hope this post will provide you more clarity and answers.

What is EMDR?

What is EMDR and how do I know if EMDR is right for me?

EMDR stands for Eye Movement Desensitization and Reprocessing. Many clients come to counselling expecting a traditional talk therapy session. They may expect to share lots of details about their lives, and have the therapist ask stereotypical questions like, “How does that make you feel?” EMDR is not at all like this.

EMDR involves the use of bilateral stimulation (BLS) to process traumatic events. BLS is a fancy way of saying that a therapist will be adding some visual, auditory or tactile prompts during therapy. For example, you may be asked to follow a ball moving across the screen or listen to audio prompts. A shift starts to occur when you combine these sensory inputs while also thinking of a traumatic event. The understanding from EMDR creator, Francine Shapiro, is that this combination activates an adaptive neural network in your brain. What we see is that EMDR clients feel calmer when they think about these disturbing situations. To learn more about what an EMDR session is like, I’d encourage you to read this earlier post or watch the following video:

Why use EMDR?

EMDR has been proven to work quickly in processing disturbing events. This is especially the case for those who have survived a single traumatic event (as opposed to complex trauma where a person has survived years of distressing circumstances). This therapy can be used irrespective of when the trauma occurred, be it yesterday or 50 years ago. EMDR has been effective in meeting the needs of diverse clientele regardless of age, race, gender and other identifiers. Beyond past events, this therapy can also help clients work through fears of a similar trauma happening again in the future.

How to tell when EMDR is working:

For clients who have had success with EMDR, they will notice several indicators to healing:

How do I know when EMDR is working?
  • Clients can speak and think about these traumatic events more calmly
  • Clients notice a change in their thinking pattern. Negative beliefs are transformed into more compassionate and positive perspectives. For example, a client who initially believed “I should have done more” may shift into thinking,”I did the best I could.”
  • Clients notice improvements of PTSD symptoms (e.g. intrusive thoughts, flashbacks, nightmares, anxieties, hypersensitivity).
  • Clients’ physical pains starts to ease. They can speak about the trauma without feeling tense, clenching their muscles, or experiencing other signs of constriction.

What prevents EMDR from working?

While all of this sounds great, there are some factors that can affect whether EMDR is right for you. As with any therapy, there is no guarantee that one approach will be the miracle cure. While EMDR has a high success rate, the following points should be considered:

1. Readiness:

Before starting EMDR, clients have to be open to addressing a painful part of their lives. While this may sound obvious, I want to emphasize how incredibly hard it is to sit with memories and thoughts that you have worked to avoid. Avoidance is a natural way to manage anxiety. If we find something frightening, we protect ourselves by staying away. As with any form of therapy, readiness involves taking the chance to stop avoiding in order to address these fears. This is much easier said than done.

2. Learning to work within our window of tolerance:

For EMDR to be the right approach for you, your therapist has to ensure that you are prepared. The goal of this therapy is to process disturbing events without overwhelming you. This means being able to think about these events without feeling emotionally hijacked. The point of EMDR is not to relive the trauma, but to recognize you are in a place of safety while thinking of a difficult past experience.

IS EMDR right for me? Trauma counselling online and in Kitchener, ON

If you go beyond your window of tolerance, the work will not feel safe. Your therapist will be monitoring how quickly or slowly to take trauma processing based on your emotional state. There may be pauses in treatment to help calm your system (e.g. deep breathing, relaxation exercises, calming visualizations, distress tolerance skills, etc). You may spend several sessions focusing on these calming skills before beginning BLS. This does not necessarily mean that EMDR cannot be used; however, there may be a delay in starting trauma processing.

3. Complexity:

Complex trauma and complex mental health (e.g. personality disorders, addiction) can take time to heal. Even with a fast approach like EMDR, clients may spend many months or years working through painful memories. You may have to spend a significant amount of time addressing these other mental health needs before starting to work through traumatic events. This does not mean that EMDR therapy is not helping; however, clients must be patient to work through these additional needs.

4. Current life stressors:

Is EMDR right for me? Learn about this form of trauma therapy

Are there current life stressors that are getting in the way? It is hard to focus on a past trauma if you are thinking about current financial struggles, work demands, or a recent arguments with your partner. When life feels unsafe or stressful, you may have a hard time focusing on the past. It is understandable that current needs keep distracting you. In these types of situations, you may need to pause EMDR, and address what changes need to occur today to help life feel more stable.

5. Fear of recovery:

This is a difficult point to make because the majority of people want to get better and the title insinuates that a person is avoiding healing. That is not my intent. There are a lot of changes that will happen in your life because of recovery. This may include embracing new routines after years of living a certain way. It may involve returning to work where there are old triggers and difficulties waiting. Perhaps recovery involves acknowledging that your parents were not kind or well-intentioned people. There is an understandable fear of what recovery might mean for a survivor, and those fears need to be supported and addressed prior to opening old wounds.

Is EMDR still right for me?

Trauma is a fact of life. It does not, however, have to be a life sentence. Not only can trauma be healed but with appropriate guidance and support, it can be transformative.

Peter Levine

While the concerns mentioned above may influence your therapy journey, EMDR can still be the right approach for you. It is best to speak with your therapist about these influences in order to problem solve. The solution may be to do EMDR in a slower manner to prevent overwhelm. Alternatively, your therapist may use a combination of other therapy styles (e.g. Internal Family Systems therapy, DBT) to address other mental health needs alongside trauma healing.

Traumatic events happen to every individual, and we cannot prevent it from taking place, unfortunately. While some recover on their own, many of us experience lasting symptoms from traumatic events. If you continue to be plagued by a traumatic event, reach out for support. EMDR may be the therapy you are looking for.

All the best,

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.

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.