More Steps Through Grief

This blog is the fourth in a series of five in-depth blogs looking at the experience of grief and loss.  As a therapist, I’ve supported many people who want to benefit from bereavement counselling, or who are looking for space to find a sense of freedom from the pain of loss.  Many people face issues of loss without necessarily initially considering that grief could be part of their processing – for example, when people are facing retirement and unsure about the future,  when important plans have had to change or even when a house move leaves someone suddenly overcome with difficult feelings.  These experiences are common to many of us, and – as we have seen in previous blogs – loss is a universal given, part of life for each and every one of us. 

In the first blog in the series, we considered some of the forms grief can take, as well as the impact and effects of loss for many people.  In the second blog of the series, we looked closely at the Kübler-Ross model often used to help explain grief and loss.  The third blog explored two mode models of grief: the Tasks of Mourning Model and the Dual Process Model.  This blog will consider two more theoretical models of grief, before we turn our attention in the final blog to considering support for the experience of loss and grief.  As with all of our blogs, please do take care of yourself as you read.  Consider what you may need, and what feelings and thoughts arise for you as you read.  Above all, be compassionate with yourself in response to the content of the blog.  

Continuing Bonds Model:

Like the other theoretical frameworks we’ve considered here and here, the Continuing Bonds Model provides a structure designed to support people to make meaning of their loss and grief.  The Continuing Bonds Model was developed by Dennis Klass, Phyllis Silverman and Steven Nickman.  Their book, Continuing Bonds: New Understandings of Grief, published in 1996, challenges the ideas that the grieving process is about cutting links with that which has been lost.  Instead, they proposed a new way to think about and approach loss – one in which the emphasis is upon the ways in which a deceased person “stays with” the person grieving.  They note that for many people, promoting a continued bond with a deceased loved one provides comfort and support in coping with loss and adjustment.  In this way, it is possible to carry the person with us throughout our lives. 

Is it possible to consider any continuing bond you may have with someone you are grieivng for?

Forms of Continuing Bonds. 

Behaviours and rituals which seem to be instinctive to so many people who experience loss are seen as ways in which a person can continue to feel a bond and connection with the person or even situation they are grieving.  This can take the form of physically holding onto items, such as a piece of clothing or a photo of a loved one.  Private rituals and conversations with your loved one can also be a way that bonds are continued.  Many people report speaking to their deceased loved one, and find this to be helpful and therapeutic.  They may also visit places where they feel close to them.  These are all ways people continue bonds with deceased loved ones.  Whilst these types of behaviours are in fact, common to those who grieve, some people do not tell others about these rituals and forms of comfort as they may feel pressure from others to “move on”.  The Continuing Bonds Model reframes these rituals and behaviours as a helpful part of the grief process. 

People often find their own unique ways to continue to feel a bond with a loved one, even after death.

The “Growing around Grief” Model.

One final model we will consider that offers a framework for thinking about the process of grief and loss, developed by Grief Counsellor, Lois Tonkin, in 1996, is known as the “Growing around Grief” Model.

This model challenges the idea that our grief or sense of loss will shrink and disappear.  Tonkin’s model recognizes that significant losses initially consume most or all areas of our life.  There is little life space left initially for anything other than the feelings of loss.  You may feel the loses you’ve experienced consume you just now.  Grief can feel as it is suffocating or robbing us of any form of life.  It can be hard to feel anything other than our raw pain of loss.    That’s certainly true for many, many people when they first experience grief, and is visually represented to good effect in the haunting, spectre like image, with ghostly, staring eyes in Munch’s painting, Death in the Sickroom

Edvard Munch, Death in the Sickroom (1895).  

An expansion of life:

However, according to this model, in time, it is possible to experience an expansion of life, so that the grieving person gradually grows around their grief.  The bereaved person adjusts to their grief by encompassing it into their lives. They can even grow from their grief.  This process may take some time, or even a very long time, and everyone’s journey through loss is different.  However, according to Tonkin – it is possible to experience a sense in which life has grown around the grief. 

Like tree roots that have found a way to grow round the rocky terrain, some poeple find it is possible for their life to grow round their grief.

It’s not necessary for grief to “go away”:

Some people believe this model is a helpful challenge to the idea that grief is something we should put behind us, that we should “get over” or no longer feel.   In this model, grief does not have to “go away” for a life to develop and grow around the grief.   This can feel comforting and offer hope to anyone who feels any sense of guilt about the idea that, one day, they will be able to “get on” with life.   

Pause and reflect for a moment:

So, take a moment to consider what meaning you make of your own grief, your own loss?  Or, whether indeed, you feel there is any meaning to be made at all amidst the confusion and difficulty of loss.  As we acknowledged in a previous blog, models of grief can feel helpful in making sense of grief and providing a structure.  Equally, they can feel far too abstract, and removed from the raw pain of grief.  There are no right or wrongs here, no best way to approach or navigate grief.  Your grief is unique to you.  Finding ways to give voice and expression to your own feelings of loss, even when these are messy and seemingly without sense or meaning, is one of the ways that counselling can be helpful for anyone experiencing loss, bereavement or grief.  In our final blog of this series, we take a look support for the experience of loss and grief.

Counselling can help you to untangle some of the confusing feelings that are part of grief and loss.

If you have been impacted by any of the themes or topics in this blog, please reach out for support.  One of the ways you can do this is by speaking to a bereavement counsellor via the free webchat service provided by Cruse.  

Making More Meaning of Grief

This blog is the third of a series of five blogs looking at the experience of grief and loss.  Many people seek out counselling for grief, or look to access bereavement counselling after the death of a loved one – including after pregnancy loss.  Others find speaking with a therapist to be helpful after experiencing other forms of loss, such as the feelings and challenges associated with loss of a job, retirement, children leaving home, or the loss of health or even hope.

In the first blog, we considered some of the forms grief can take, as well as the impact and effects of loss for many people.  In the second blog of the series, we looked closely at the Kübler-Ross model or  framework often used to help explain grief and loss.  In this blog, we look a couple of other models of grief that are often used to help provide some structure to making meaning of the grieving process.  We’ll explore the Tasks of Mourning Model proposed by William Worden and also take a look at the Dual Process Model of Grief was developed by Margaret Stroebe and Henk Schut.

Photo by Jonathan Borba on Pexels.com

Tasks of Mourning Model.

Let’s consider the model of grief proposed by William Worden, professor of Psychology at Biola University California.  This model was put forward by Worden in 2008, and suggests that there are four tasks to accomplish during the process of mourning.  Completion of these tasks of mourning can lead to a sense of equilibrium.  Worden is clear there is no set order in which the tasks are to be completed in and that revisiting certain tasks many times may be part of the grief process for some people. 

Task 1 – To accept the reality of the loss.

Accepting that a loss has happened is a task of mourning.  Rituals such as funerals can be helpful in acknowledging the reality of the loss. With other forms of loss this could be to recognize that losing our job, losing our status, losing our income, losing contact with family is a significant loss in our life.  It may even be to recognize a past loss that happened years ago that you have not yet acknowledged. 

Task 2: To process the pain of grief.

This task asks us to find space and ways for the pain associated with loss.  This may involve speaking with others and crying.  Processing pain may also include the expression of other difficult emotions such as anger and guilt. 

Task 3:  To adjust to a world without.

This task requires adaptation as we adjust to the change we experience as a result of our loss.  To live without our loved one.  To live without the sense of identity we once had.  To live without whatever person or cherished thing that we have now lost.  It may mean taking on different roles within our family, conducting a myriad of practical arrangements including financial decisions and also adapting socially. 

Task 4: To find an enduring connection. 

In this task, we consider how to stay emotionally connected with whatever or whoever we have lost without the loss preventing us moving on in our own life.  In this task, memories, thoughts and feelings connected with what or whom we have lost can become significant.  In this task, we remember, rather than forget.  This allows us to connect with other aspects of our life.  

The importance of time to process and self-compassion. 

Before we move onto consider one more model of grief, let’s take a pause at this point in the blog.  Take a moment to consider how you are?  How do you feel just now? And what questions or thoughts have arisen for you as you’ve read about the Tasks of Mourning Model.  Aim to notice your thoughts and feelings without judgements or self-reproach.  This is important.  Whilst learning about theories and models of grief can be helpful, they can also throw up feelings and sensations we hadn’t expected or anticipated.  Take a moment to be compassionate, kind and gentle with yourself.  What do you need just now?  Give yourself the time and the space, with kindness, to allow yourself to feel your feelings, and to find comfort in ways that feel right for you.  If that means abandoning the blog for now, so be it.

Photo by eberhard grossgasteiger on Pexels.com

But, if you do feel ready to read on, then, let’s take a look at the final model for making meaning of grief that we are going to cover in this blog – the Dual Process Model of Grief. 

The Dual Process Model of grief. 

Another model for making sense of the loss and grief process is known as the Dual Process Model, developed by Margaret Stroebe and Henk Schut in 1999.  It helps to convey a sense of fluctuation and change that many people who experience grief describe – the sense that you feel distraught one day, and then more hopeful the next, only to find yourself sobbing and consumed with emptiness the next.  The Dual Process Model describes grief as a process of moving between two different ‘orientations’:  loss orientation and restoration orientation.

Grief is seen as a process of shuttling back and forth between these loss and restoration orientations.  In this model, grief is not understood as a linear or a one-way journey through a series of stages.  The Dual Process Model considers that people move in and out of different forms of grief, often over many years, almost as if they are zig-zagging back and forth between moving forwards and looking back. With this model, it is important to recognise that both orientations are important pats of the grieving process.

Grief can feel as if we are zig-zagging between looking forward and looking back. The path through grief rarely feels straight forward.

Loss orientation.

Loss orientation refers to a focus upon painful emotions connected with loss, and a focus on what or who has been lost.  We may yearn for the person or thing we have lost. We may find ourselves remembering and reminiscing. We may imagine what the person would say if they were still here.  We may yearn for things to be as they were “before”.  We are likely to experience a range of emotions including loneliness, sadness, fear, pain and anger.

Restoration orientation

Restoration orientation refers to a focus upon the changes and practical challenges you need to face to continue with life.   It can provide a state where we gain some respite from the loss-oriented work.  That might mean finding distraction that takes our focus away from our grief, or even living in denial of our grief.  Restoration orientation may also include doing new things, and trying out new roles and relationships. 

Your grief experience? 

And so, as we come to the end of this blog, consider what grief feels like for you?  How do you make meaning or sense of your experience of loss?  Does it help to have some sort of theoretical framework to provide a structure that gives meaning? Or does this feel far too abstract, and a world away from your visceral raw pain of grief.  There are no right or wrongs here, no best way to approach or navigate grief.  Your grief is unique to you.  Finding ways to give voice and expression to your own feelings of loss is one of the ways that counselling can be helpful for anyone experiencing loss, bereavement or grief.  In future blogs, we will look at two more theoretical frameworks for making meaning of grief, before considering support for the experience of loss and grief.

If you have been impacted by any of the themes or topics in this blog, please reach out for support.  One of the ways you can do this is by speaking to a bereavement counsellor via the free webchat service provided by Cruse.   You may also like to consider speaking to a counsellor face-to-face. 

Making Meaning of Grief

Grief and loss are common human experiences that touch us all at some point in our lives.  Death is one of the universal givens of life, and no-one is immune from the pain and sorrow of bereavement.  Likewise, we all face a myriad of losses as we journey through life – the loss of health, of a job or of the hopes and dreams we had, for example.

In the first of five blogs, we considered some of the forms grief can take, as well as the impact and effects of loss for many people.  In this second blog, we look at one of the models or frameworks often used to help explain grief and loss.  We will look at other models in subsequent blogs.   These models can be helpful in making meaning of the experience of loss.  That said, they never eradicate or remove the pain of grief.  Grief and loss remain one of the biggest hurdles that, as a human being, we all face.

Death in the Sickroom.

Before we dive into the first of models of grief, let’s take a moment to pause and consider how grief has been expressed through the medium of art.  Perhaps you are familiar with the Norwegian painter, Edvard Munch?  His best-known work, The Scream, is one of the art world’s most iconic and recognisable images.  Edvard’s mother died of tuberculosis when he was 5 years old.  His older sister Sophie also died from the same illness in 1877, when Munch was a teenager.  A number of his paintings touch upon the theme of grief and loss – in particular, his 1893 work, Death in the Sickroom.  This painting was produced 4 years after Munch also experienced the death of his father. It portrays a family overcome by the death of Munch’s sister, Sophie.  In it, we see the raw pain of loss, as each of the characters seem frozen and lost in their own inner world, silenced by grief. One figure, with hollowed eyes looks pale, drawn and almost ghost-like.  Heads bowed, each of the characters refrain from connection and eye contact, and some even seem to need support to stand as they lean against a chair, a wall.  This painting, for those familiar with grief, helps to convey something of the loneliness and agony of loss.  This image is a helpful reminder that grief and loss are debilitating and impact us, no matter our age, economic status or privilege. 

“Death in the Sick Room” by Edvard Munch.
(Credit: Wikipedia)

 The Kübler-Ross Model of grief.

And, so, how to make meaning from grief?  Is there any way that we can find some structure, some explanation that provides a framework to explain the grief experience?  This is what various thinkers have tried to do, in an attempt to being some containment to grief.  Whilst no one model provides clear answers, or a simple “aha” moment – each model does offer something that can help to make some sense of the grief experience.  Let’s look at one of these models – often the model that most people are familiar with – the Kübler-Ross Model. 

The five stages of grief model was developed by Elisabeth Kübler-Ross and became famous after she published her book On Death and Dying in 1969.  Kübler-Ross’ model was a way of explaining the common processes experienced by people with terminal illness facing their own death. But it was soon adapted as a way of thinking about grief and loss in general.  That can include the grief we feel with any form of loss:  loss of status, retirement, loss of income, loss of social contact etc. 

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Is it helpful to think in terms of stages?

Whilst it can be helpful to recognize common phases within the grieving process, it is also important to recognize grief is rarely a predictable journey.  Everyone is unique and everyone’s grief is unique too. There are no set stages of loss that everyone passes through, no neat way to move through grief. That said, there are often common themes, and these are the five stages represented by Kübler-Ross’ model.

  • Denial
  • Anger
  • Bargaining
  • Sadness
  • Acceptance

Denial.

Denial after loss can present itself as a numb feeling.  It may involve a person carrying on as if nothing has happened.  Even though we logically understand a loss has occurred, denial makes it hard to believe this in our hearts.  We might feel as if soon we will discover it was all just a bad-dream of that there has been an error or mistake.  With loss that involves death, it’s also very common to feel the presence of someone who has died, hear their voice or even see them.  These experiences can be a form of denial.

The short-term benefits of denial.

Other people may not understand your denial.  However, denial is a helpful short-term coping mechanism that gives you time to adjust to distressing situations.  If you’re in denial, you’re trying to protect yourself by refusing to accept the truth about the loss that’s happening in your life.

Whilst denial can offer short-term benefits, it is also perfectly normal to not experience denial after a loss.  Remember, everyone’s journey and process through loss is different.

Anger.

Photo by Pixabay on Pexels.com

Anger is a completely natural emotion that humans experience as part of life.  In life, we often get angry when we can’t control what’s happening to us.  Anger can be expressed in ways that are productive and cathartic – such as speaking with a supportive person.  Anger can also be dealt with I ways that are less helpful – such as taking out our anger on others, using violence or turning our anger inwards and attacking ourselves.

Anger after loss.

Anger is common response after a loss, in that loss often involves a situation that we don’t have control over. Whether that is a death, a redundancy or loss of social connection due to the pandemic.  These are all things we have little or no control over, and that can lead to intense feelings of anger.  Loss can seem cruel and unfair and impacts our plans and hopes for a dreamed for future.  We may look to blame or direct our anger towards someone or something – God, the person who has died, the NHS, the Government etc. We may feel intense anger towards ourselves and direct that anger inwards.

Anger isn’t always understood.

Feelings of anger as part of the grieving process are common.  Anger was identified as one of the stages of grief in Kubler-Ross’ model.  Yet, feelings of anger can be misunderstood by others, and can be difficult to talk about.  Perhaps people around us expect us to feel sad, lonely or tearful.  They may be confused or frightened if we express feelings of anger.   

Expressing anger after loss.

If you feel anger after loss, the following considerations may be helpful:

  • It’s common to feel angry and ask why you face this loss?
  • It’s possible you may find yourself taking out your frustration on family and friends.
  • You may feel overwhelmed with a deep sense of resentment.
  • In the case of death, your anger might be directed at the person who’s died for leaving you.
  • You may feel anger towards family members, medical staff, God or even yourself. 
  • Anger can be experienced at any point during the grieving process.
  • If you’re unable to express your feelings in a way which feels safe, feelings of anger may increase.
  • Even the most supportive people around you may not expect anger as a part of grief, and might not know how to deal with it.
  • A grief counsellor or supportive listener may be able to help you to acknowledge and explore your feelings of anger. 

Bargaining to try to reduce the pain of loss.

The pain of loss and grief can leave us feeling desperate.  It is a common experience for people experiencing grief to express that they’d be willing to go to great lengths if it means they no longer had to experience the pain of loss.  If you are facing loss, you may feel willing to do almost anything to alleviate or minimize the pain.  We can make bargains with ourselves to try to avoid the pain we are experiencing.

People can begin to make “promises” as a form of bargaining, that include:

  • “I’ll never argue again with my Mum if she recovers from her terminal illness”.
  • “I will never get angry again if it means the pain will go away”.
  • “I’d do anything just to see my family members”.

Bargaining with a Higher Power.

Bargaining can be directed towards a Higher Power, and many people report questioning their faith or religious beliefs after experiencing a significant bereavement.  Their world view and belief system may adapt and change as a result of the loss.    For example, they may have prayed: 

“God – if you can heal this person, I will never sin ever again. 

Yet, now they are experiencing the ultimate loss of the person they love, they may then question their faith or belief in a Higher Power. 

Such thoughts can help us to deal with the sense that we are human and there is nothing we can do to influence change or a better end result.  This feeling of helplessness can cause us to react by bargaining, which gives us a perceived sense of control over something that feels so out of control.

“What if” questions.

Another aspect of bargaining includes asking “what if” questions that center around our personal faults or regrets.  “What if I’d never said that….”, “What if I’d made different financial choices…”.  Guilt and bargaining often go hand in hand. We may wish we could go back and behave differently.  We might ask “what if” to express the assumption that if we had acted differently, we would not be experiencing this pain now. 

Some of the “what if” questions you may find yourself answering in this bargaining stage include:

  • “What if I hadn’t said that?”
  • “What if we never visited that place on that night?”
  • “What if I’d managed to get her to the hospital sooner?”
  • “What if I’d saved more money before the Pandemic?”
  • “What if I’d never let my family move away from the local area?”
  • “What if I’d worked harder, or put in longer hours at work?”
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The sadness of loss.

Loss involves sadness.  We grieve because we have lost something important and significant to us, and that involves sadness and longing.  Many people also become more acutely aware of their own mortality, which can also prompt sadness. Sadness is an emotion that many people anticipate and expect during the grieving process.  Of course, that doesn’t mean it is easy to experience.   

The Kübler-Ross Model includes depression or sadness as one of the five stages of grief.  Such grief can be both reactive or anticipatory.   We can react to losses we have experienced.  We can also anticipate loss and experience grief as we prepare to face such loss.  This is common when we are anticipating our own death, or the death of someone we love who has a terminal illness, or some degenerative condition such as dementia.   

For some people, a journey through loss can involve both reactive and anticipatory loss.  For example, if you are living with someone with dementia, you will experience a number of reactive losses as you adapt to their many changes and loss of abilities.  You will also be aware of their eventual demise and death as a result of the dementia.  If you are facing the loss of retirement, you may begin to feel a sense of loss months before the actual date of retirement. 

The difference between grief and depression.

Although the Kübler-Ross Model speaks of depression, some people note that the sadness associated with loss is not necessarily the same as clinical depression.  There are many similarities, but also differences between grief and depression.

Grief is an entirely natural response to a loss, while depression is an illness.  People who are grieving find their feelings of sadness and loss come and go, but they’re still able to enjoy things and look forward to the future.  In contrast, people who are depressed constantly feel sad. They find it difficult to enjoy anything or be positive about the future.  Remember that if you do feel depressed, it’s important to seek medical help.  Talking therapies are available on the NHS, via Cruse Bereavement Care, or you can seek support via a private counsellor.    

Losing a sense of purpose. 

The sadness and depression associated with loss can be very intense and come in waves over many months or even years.  Whatever the form of loss, if we have loss something important to us, it is normal and natural to feel sadness.  Life can feel like it no longer holds any meaning or purpose.  In this way, we can lose touch with our own joy and vitality in our loss.  To engage in activities that we enjoy can evoke feelings of guilt.  Our loss is now present and unavoidable. 

The isolation of sadness.

People experience sadness and low mood as a result of loss may seek to retreat from the world.  Socializing can feel very difficult in this stage.  This stage of grief can feel very isolating.

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Acceptance in the Kübler-Ross model.

Acceptance is one of the five “stages” of in the Kübler-Ross model.  When Kübler-Ross first created her model to explain the process that people with terminal illnesses often faced, she noted that some people were able to come to terms with the prospect of their own death and felt a sense of peace about the future.  

Acceptance of other forms of loss.

Nowadays, the Kübler-Ross model is used to help make sense of other forms of loss.  When we think about the grief and loss we face after the death of a loved one, a retirement, or other form of loss, the idea of peaceful acceptance can feel appealing.  It may also seem like an impossible dream.

A gradual process.

For many people, grief comes in waves, and it can feel like nothing will ever be right again. Whilst we may idetify with some of the themes in Kübler-Ross model, it would be unusual if we experienced our grief in a way that neatly follows the five-stages in the order in which Kübler-Ross presented them. Grief can be messy and confusing. However, gradually – over time, many people find that the pain eases to some degree, and it is possible to accept what has happened.  We may never ‘get over’ the loss, but we can learn to live again.    It is possible to feel that you have begun to accept the loss one day, and then feel sadness, anger or some other emotion another day.  Remember, everyone’s journey through loss is unique. 

The mourning process can be helpful in supporting people to begin to move to acceptance.  In time, many people do reach a state of acceptance of their loss.  Some people find creative ways to express their experience of loss, as Edvard Munch did through his painting.  Some people benefit from additional support from a grief counsellor or other professional to help them in the process.  

In subsequent blogs, we will consider other models of grief and also look at support for the experience of loss and grief.

If you have been impacted by any of the themes or topics in this blog, please reach out for support.  One of the ways you can do this is by speaking to a bereavement counsellor via the free webchat service provided by Cruse.  

Understanding Grief

Sadly, the acute pain of loss and grief are an inevitable part of being human.  We cannot escape loss and bereavement and are likely to find ourselves experiencing grief of some sort many times throughout our lives.  This blog, the first in a series of 5, offers a consideration of grief and common reactions to loss.  We also consider why it can be so hard to speak about loss and grief. 

We give the name “grief” to the feelings of loss and emptiness we commonly experience after the death of someone we value or love.  Yet, there are multiple forms of loss. It’s normal and natural to also experience grief when faced with the loss of a job, the death of a pet or even when moving home.   Having a friend or family member with a diagnosis of dementia can be a form of grief, as you anticipate the unknown journey ahead.  Perhaps you’ve known the heart-breaking agony of pregnancy loss?  Or the grief that can result after a life-changing health diagnosis?  For many parents, empty nest syndrome also throws us feelings of loss and grief.  Then there are forms of loss which are less tangible – the transitoriness of youth and the loss of our vitality as we age, the loss of hopes and dreams when plans change and the gradual loss of optimism as we become disillusioned with certain relationships or situations. 

Photo by Mikhail Nilov on Pexels.com

Why is it so hard to speak about grief?

Talking about grief and loss can feel difficult and daunting.  Thoughts, feelings and physical sensations associated with grief can, in themselves, feel very confusing, overwhelming and disorientating.  We might feel like we don’t know which way is up?  Whether we are coming or going?  People grieving often speak of feeling like they are living in a fog, or a daze, or report a numbness where they are just “going through the motions”.  Feeling such confusion can make it difficult to find the words to express your sense of loss, and connect with the pain.  It’s also possible to feel scared and apprehensive about allowing yourself to identify and name your feelings of loss.  For many people who are grieving, there can be a visceral fear that if they allow themselves to speak of the loss they feel, it will be loke opening a floodgate, and that they will be overwhelmed with a Tsunami of loss. 

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Other people’s reaction to our loss.

There’s also other people’s reactions to deal with.  Perhaps you’ve experienced grief, and attempted to open up to others, but felt shut down by their response?  Perhaps you’ve noticed their desire to “cheer you up” by speaking about something else or seen their discomfort when you’ve begun to share the rawness of your pain. Sadly, people who have been bereaved sometimes report that colleagues, or even friends and family members keep their distance, perhaps unsure of exactly what to say.   It may be that you feel a need to protect others who are grieving, and avoid speaking of your pain out of a concern and a care not to upset them further.  Silencing yourself in this way can make dealing with the pain of loss even more difficult.

Disenfranchised grief.

It’s also possible that you feel unable to give voice to your grief, or feel you can’t tell anyone about what you have experienced.  This is something people sometimes say when they have experienced pregnancy loss, or after the death of a lover where the relationship was not public knowledge.  This form of grief is sometimes called “disenfranchised grief”. Here, the cloak of secrecy and silence can feel heavy and cloying. 

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In this series of 5 blogs, we’ll be exploring loss and grief, including:

  • Common reactions to and symptoms of loss and grief.
  • Different ways of understanding grief.
  • Support for the experience of loss and grief. 

Common reactions to and symptoms of loss and grief.

Let’s take a look at the first of these.  Is it possible to speak of common reactions to loss?  Or to identify symptoms of grief?  These are important questions.  Certainly, there is no one “right” way to grieve, and no standard grief process.  Indeed, everyone’s experience of grief and loss is unique, just as we are unique.  How we feel about and respond to a loss is impacted by many, many factors – including our past experience of loss, and the resources and support we have available, including both inner resources, such as resilience and self-compassion, as well as external resources, such as an understanding employer, supportive friends and access to accurate information.  Therefore, everyone’s experience of loss and grief will be different, and may even feel quite different for a person on different days.   

It’s also important to consider whether there are “symptoms” of grief.  The word symptom has overtones of illness and disease.  Grief is not an illness, although it may feel painful – including physically painful, at times.  Therefore, speaking of symptom of grief can lead to people asking if there is a medication or a solution to “take away” their grief.   Indeed, lots of people will ask for their GP, or another health professional’s input after a bereavement or other loss, and there is some helpful NHS advice available in relation to feelings of loss and grief following a bereavement.   

So, that said, is there any way we can identify some of the things that are common to many people’s experiences of grief?  Doing so provides some sort of a framework that can help to normalise and make sense of grief. 

Some of the reactions and responses that people who have experienced loss report are:

  • Feelings of shock and numbness.
  • Overwhelming sadness, with lots of crying.  Equally, feelings of guilt because there are no tears, despite your sadness. 
  • Tiredness or exhaustion and difficulty sleeping.
  • Seeing, hearing or sensing someone who has died.  
  • Anger – towards the person you’ve lost, towards yourself, or someone or something else.
  • Guilt – for example, guilt about feeling angry, regrets about something you said or did not say, or not being able to prevent the loss. 
  • Physical pain – grief increases inflammation in our body which can impact existing health problems or lead to new aches and pains, as well decreasing our immunity. 

This list is in no way exhaustive, and many people experience changes and fluctuations in their experience of grief.  There’s plenty more information about the effects of grief on the Cruse (the National Bereavement Charity) website.

Adapting to loss and grief.

Many people report, and research shows that, with good support, they are able – in time – to adapt well to bereavement, and regain a sense of balance after some weeks or months of acute grief, although they still feel a sense of loss for a long time after the bereavement.  

However, we also know that some people can experience chronic or complex grief, sometimes known as Persistent Complex Bereavement Disorder (PCBD) where grief is having a significant impact upon their functioning for a lengthy period of time post-bereavement.  Rates of prolonged grief tend to be higher after the death of a child or violent traumatic death.  It is really important to seek professional help if you feel that grief is having a significant impact in your functioning for a lengthy period of time post-bereavement. 

Counselling for grief and loss.

Counselling can help you process feelings of loss.

Speaking with a qualified and experienced therapist can be helpful in managing feelings of grief and loss, whatever the cause.  Many people seek therapy in the first few months after a loss.  Others seek support years and even decades after a loss.  Psychotherapy can be a great support to help with feelings of loss and grief, our relationship to that loss, and chance to feel our feelings in a non-judgemental space. 

So – grief may be a normal and natural part of life.  It’s also painful and raw.  In this blog, we’ve considered some of the forms grief can take, as well as the impact and effects of loss for many people.  In the second blog in this series, we’ll consider some of the many different models and ways of making sense of the grief process.

If you have been impacted by any of the themes or topics in this blog, please reach out for support.  One of the ways you can do this is by speaking to a bereavement counsellor via the free webchat service provided by Cruse.   

Why do I Procrastinate?

Are you someone who puts off till tomorrow what could be done today?  Time is ticking by, yet you find yourself with an ever increasing to-do list.  Even though you know there are tasks to be completed, somehow you are finding it hard to get started.    If so, you are not alone.  Research has shown 84% of Brits procrastinate, with 20% of us procrastinating every single day.  Procrastination can lead to feelings of poor self-worth and self-criticism.  Let’s consider some of the psychological processes at play with procrastination and consider steps you can take to help manage that desire to do it later. 

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What is Procrastination?

Procrastination is the avoidance or putting off doing a task that needs to be accomplished by a certain deadline.  You may be familiar with the teenager plea of:  “I’ll do it in a bit…..” Yet, many of us find ourselves making deals with ourselves, in a bit to avoid talking something in the moment.  Procrastination can involve avoiding getting started or avoiding finishing a particular task. Procrastination is a common human experience, and people often report procrastination in relation to things they’d rather avoid.  Perhaps you recognise some of your own procrastination hot spots? 

Do you:

  • Avoid completing chores:  the hoovering can wait till another day? 
  • Attending medical appointments:  you tell yourself you don’t really need to bother the dentist or the GP, and that you can wait a bit longer till you book the appointment?
  • Completing work or study tasks:  the project doesn’t need to be started just now – you’ll get round to it eventually.
  • Having a difficult conversation with a friend or acquaintance:  it just seems to much for today – you’ll wait till you feel in the mood.  
Procrastination can lead you to doubt your self-worth.

Psychological Impacts of Procrastination

It’s also worth reflecting on the responses you have to any form of procrastination you might exhibit.  Does procrastination help you?  In the short-term?  How about the long term?  Does procrastination enhance your self-belief and confidence?  Is procrastination a form of self-care?  There are no right or wrong answers to these questions but exploring them can help you to find out more about the role of procrastination in your own life, and to make meaning of your experience.  For many people who seek counselling or therapy as a result of procrastination, these are questions you may like to consider and explore with your therapist. 

Isn’t Procrastination just Laziness?

No matter what others around you might say, or even what you might be telling yourself, procrastination is not the same as being lazy.  Procrastination is an active process – you choose to do something else instead of the task that you know you should be doing. In contrast, laziness suggests apathy, inactivity and an unwillingness to act.  Again, self-reflection and consideration of the role of procrastination in your life can help you to discover more about what it is you are gaining from procrastination.

The Benefits of Procrastination? 

It is possible to think of procrastination as a negative trait, in that it prevents us from being productive and can lead to feelings of failure, inadequacy and guilt. It certainly can result in these feelings.  However, procrastination can be a useful short-term strategy if we consider what our desire towards procrastination might be revealing to us.  Procrastination can also be considered a wise response to certain demands that could present risky or negative outcomes or require waiting for new information to arrive.  Consider the school pupil who is scared of failing their assignment.  Somehow, there is a logic in the process of “if I don’t start, I can’t make a mistake”. In this way, procrastination serves a protective function and a useful short-term strategy, acting as a safeguard against fears of failing.

Why do I Procrastinate, and How Can I Procrastinate less?

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Psychologists have been studying some of the drivers behind our desire to procrastinate.  Research has looked at why we procrastinate more in some situations than in others and what causes or leads to procrastination.  An important piece of research[1], looked at almost 700 studies, and combined the ideas and findings.  This study identified 4 main factors that increase tendency towards procrastination.  As with so many things in life, effecting behavioural change begins with better understanding of the reasons for that behaviour.  Let’s take a look at the 4 factors that can lead to procrastination, with strategies for managing these situations to reduce procrastination: 

  1. Low Self-Efficacy:  Self-efficacy relates to how effective a person believes they are. When we have low-self efficacy, we don’t have much confidence in our ability to complete a task or to complete it well.  As a result, our likelihood of procrastinating increases.  We are then less likely to get a positive result that shows us we can achieve!  It’s a vicious circle, or a self-fulfilling prophecy.   Finding ways to believe in our abilities and success as a result can help us to procrastinate less. 
  • Low Value: When we need to do something that we perceive as boring, too easy or of little importance, then we are more likely to procrastinate.  We can procrastinate less by making sure we have enough challenge in what we do, and really getting to understand “why” certain tasks matter, so they have more value for us.
  • Impulsiveness: When we have lots of distractions, then we’re much more likely to procrastinate. We can procrastinate less by turning off notifications on tech, finding a quiet space and telling others that we need space to work without disturbance. 
  • Delay: If we sense we have a long time to complete a task, we are more likely to procrastinate.  We can procrastinate less by setting ourselves goals and deadlines, rather than relying on other people’s deadlines. 

So, procrastination can be a creative response to a situation or feelings that are difficult to face.  Whilst procrastination can lead to negative long-term results, it may offer some short-term gains.  Increased awareness about the role of procrastination in your life can be fruitful in making meaning of the role and function of your procrastination, opening up increased choice about the steps you take in response. 


[1] Steel P. (2007). The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological bulletin, 133(1), 65–94. 

Work-Related Stress and Anxiety

2021 has seen huge changes in people’s work patterns and habits, with many people adjusting to blended working, returning to face-to-face working and working in very different circumstances that pre-Pandemic.  Whilst change is a part of life – it can also be a trigger for anxiety and a cause of work-related stress.  This blog looks at the ways work can impact our sense of wellbeing, and how work-related stress and anxiety can steal our serenity. We will also consider some practical self-help strategies that can support your psychological health if you feel impacted by work-related stress and anxiety. 

Work is a key part of so many of our lives.  Whether that’s in the form of paid employment, voluntary work or laboring at home to keep on top of chores and the tasks of life.  On average, a third of our adult lives are spent at work if we’re working full-time.  And, part-time employment does not necessarily mean part-time work, as anyone who juggling non-paid work, including caring for children and other family members, alongside paid employment knows.   Even if we are not currently employed, the toll of looking for work can take up significant amounts of focus.   Therefore, if work leaves us feeling stressed and anxious, then a big chunk of our life is impacted.  Feelings of tension, stress and anxiety can spill into other areas of our lives as we take the anxiety with us outside of our workplace.  Work-related stress and anxiety affect our personal relationships, leisure pursuits and rest, spreading and contaminating our non-work life.  The utopian vision of the 19th Century reformer, Robert Owen, who campaigned for “eight hours labor, eight hours recreation, eight hours rest” seems pure fantasy when you find yourself lying awake, anxiously ruminating about work. 

The Satisfaction of a Job Well Done

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Work, in whatever form it takes for us, can provide both income and industry.  Paid employment not only helps pay the bills, but also provides a potential sense of accomplishment and satisfaction.  Research shows that being under occupied can be detrimental to wellbeing, and this helps to explain why retirement or redundancy, or even being not-so busy at work can also feel stressful.  It helps to make sense of the anxiety that can come from self-employment in a changing economy and ever shifting market.  Not only do people fear for their livelihood, but there’s also a worry about what an empty order book might feel like.  No orders = no income + lack of accomplishment.  That’s certainly an anxiety provoking equation.   

So, what do we mean by work related stress and anxiety? Stress is the term we use to describe our reaction to feeling threatened or under pressure.   In the short term, stress focuses the mind and the body to meet demands – to get the report to your boss ahead of the deadline, or to process a sudden influx or orders.  However, when sustained over time, stress is detrimental to physical and mental health.  We tire, mentally and physically when we are under duress for too long.   If we assess that the demands outstrip our ability to cope, feelings of hopelessness and threat emerge.

In a similar way, work-related anxiety is the feeling of dread, fear or apprehension about some aspect of our work.  It may be experienced as physical symptoms of tense muscles and difficulty breathing.  It may be felt as a panicky sensation in our stomachs.  It can also take the form of troubling thoughts and feelings that cause real distress.  Whilst some level of anxiety can alert us to action, – for example, by prompting us to take a look at our situation and environment and make changes as needed – too much work-related anxiety can be paralyzing.  Anxiety causes our body to release adrenaline and cortisol and our hearts beat faster so that blood can quickly reach the parts of our body needed to run or fight the threat.  This can lead to feeling shaky and breathless as a result, and may culminate in a panic-attack. 

So, let’s consider some of the common workplace threats and pressures that can trigger work-related stress and anxiety.  Threats in the workplace can take the form of the passive-aggressive email that leaves us feeling under threat.  It may come in the guise of a colleague who is ever critical and has zero tolerance for imperfection.  Overheard rumors of lay-offs and redundancies can be a significant workplace threat, as can news reports about downturns in the economy.   Needing to adapt quickly – perhaps with inadequate training – to new work patterns and remote and digital ways of working can feel unsettling.  Being asked to work in areas and ways outside of our comfort zones can feel threatening.  For anyone on a zero-hour contact or where pay comes in the form of commissions, there can be anxiety and stress associated with the uncertainty. 

Increasing Awareness and Regulation Strategies

There are steps employees and employers can take to prevent and manage workplace stress and anxiety.  Awareness is a powerful tool here – being able to name and describe different stressors and challenges allows for an objective view of the situation which, in turn, invites an audit of the skills and resources available in response.  Such logical and objective thinking can be difficult when we feel overwhelmed by difficulties at work.   Having some strategies that help with regulation of emotions and sensations is helpful.  These allow your nervous system to calm so that you are able to respond in a considered way. We will cover a range of regulation techniques in later blogs.  Two  of the many useful regulation and calming strategies are Mindfulness and Slow Breathing techniques, and research has demonstrated that both Mindfulness and Slow Breathing Work can reduce experience of work-related anxiety (Zaccaro et al., 2018; Janssen et al., 2018).   

Resources for Mindfulness and Slow Breathing Work

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For busy workers who want to find ways to learn more about Mindfulness, there are some excellent Apps out there that can support Mindfulness practice.  Headspace provides easy to access Mindfulness exercises.  For people interested in finding out more about the theory as well as the practice of Mindfulness, Sam Harris’ Waking Up App may be of interest. 

And Slow Breathing Work can take many forms.  We’ve covered some of these in a previous blog.  Other resources that may be of interest include Tom Granger’s Draw Breath book and the NHS Every Mind Matters video.   

Calming, regulation strategies, then, are helpful in helping with gaining a sense of perspective upon the issues that are impacting work-related stress and anxiety.  Having a clear sense of what the issues are and how they impact you allows for supportive conversations with others.  It may be that speaking with a line-manger can help.  You may find speaking with a friend helps.  And, for many, speaking with a counsellor to explore issues of work-related stress and anxiety is a helpful outlook that can result in increased self-awareness and lasting change. 

References:

Eklund, M. & Argentzell, E. (2016) Perception of occupational balance by people with mental illness: A new methodology in Scandinavian journal of occupational therapy, 23:4, 304-313.

Jasssen, M., Heerkens, Y., Kuijer, W., van der Heijden, B., & Engels, J. (2018). Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review. PloS one, 13(1), e0191332.

Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in human neuroscience, 12, 353

The Psychology of Panic Buying

Panic buying is currently big news, resulting in big queues.  Fears about fuel and food items shortages have resulted in shoppers stockpiling in a phenomenon that’s been labelled “panic buying”.  In this article we consider some of the psychological drivers at play with panic buying, how this relates to other forms of panic and anxiety and how we can remain calm and grounded in the face of panic buying news reports.   Throughout, this blog aims to take a non-judgmental approach to panic and panic-buying in order to make meaning of panic and panic-buying. 

What is Panic?

The word panic originated from the Greek panikos, which includes the name of the god Pan: noted for causing terror.  Greek myths frequently blame Pan for causing woodland noises that strike terror and anxiety into the heart of other woodland beings.  This origin of the word panic helps us to better understand something of what panic feels like:  panic can be defined as a sudden uncontrollable fear or anxiety that can result in unthinking or reactive behaviour.  And, it is that sense of fear and anxiety and then a reactive behaviour of stocking up and stockpiling that is being termed “panic buying”.  If we were to distil panic buying into an equation, it would look something like this:

Reports of shortages + fear of future scarcity = reactive behaviour of stockpiling.

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Panic is not a new phenomenon.  Many people come to therapy to seek support after experiencing symptoms of anxiety and, with more severe forms of anxiety, panic attacks.  A panic attack can be extremely distressing and frightening and includes symptoms of:

Panic Attacks 

  • A racing heartbeat
  • sweating
  • nausea
  • feeling faint, dizzy or lightheaded.
  • feeling that you’re losing control.
  • sweating, trembling or shaking.
  • shortness of breath or breathing very quickly.
  • a tingling in your fingers or lips.
  • chest pain
  • hot flushes
  • chills
  • dry mouth
  • a need to go to the toilet
  • ringing in your ears
  • a feeling of dread
  • a churning stomach
Panic Attacks can be extremely distressing and debilitating

What do Panic Attacks and Panic Buying Have in Common?

Whilst panic buying at the forecourts and in supermarkets may not mirror the typical symptoms of a full-blown panic attack, similar psychological processes are behind panic buying and a panic attack.  Both are essentially a mental, emotional, physical and behavioural response to fear.  Both are about perceived loss of control and anticipatory fears about what might happen.  Panic attacks can be triggered by particular situations and scenarios and the beliefs and expectations a person has about that situation.  Panic buying is, ultimately, fuelled by an anticipatory fear of scarcity:  that we will be left without food, without fuel and struggling to get by.  Such fear prompts a responsive action to stockpile or hoard. This is something we feel we do have control over, and helps – in the short term- to reduce feelings of anxiety and panic associated with fears of scarcity.  However, in the long term, panic buying behaviour can disrupt the supply chain and lead to issues with supplies in stores.  Even when we are told rationally to simply shop as we usually would, there is some inner drive that can override this advice, leading us to stockpile.

Panic Buying and the Role of Perceived Scarcity

Research shows that the perception of scarcity is strongly linked with the panic buying behaviour.  We fear running out, not having enough, going without.  That is a real and understandable fear.  As an infant, we cried when we were hungry.  Even at that young age, we were driven by a survival instinct that equates food with survival.   News reports and overheard conversations about empty shelves, therefore, fuels our perceptions of scarcity and is likely to increase panic buying.   Our brain moves into the territory of survival.  The feeling of insecurity that arises when we fear we will not have enough food or fuel activates the desire to respond and react by stockpiling.   Buying fuel and food sooths our personal anxiety around scarcity in the short term.  We can consider stockpiling and panic buying as a form of safety seeking behaviour. 

The Limbic Brain and Panic

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With any form of panic or extreme anxiety, our limbic brain – that is, our emotional and reactive brain that is responsible for keeping us safe from danger, begins to work overtime.  The pre-frontal cortex part of our brain that makes rational decisions and weighs evidence before responding is less likely to be functioning and collaborating with the limbic system.  Dan Siegal, clinical professor of psychiatry, calls this “flipping your lid”.  Therefore, if we find ourselves stockpiling as a reactive behaviour, rather than a calmly thought out and reasoned response to a challenging situation, it is likely that we are acting out of panic and without the full use of our pre-frontal cortex.  Just as with a panic attack, grounding exercises and self-regulation support can help us to calm any sense of panic and allow our limbic brain and our pre-frontal cortex to work together and make rational decisions rather than reactive and impulsive actions. 

Grounding Ourselves to Help Manage Panic

Feeling calm and grounded allows us to be more capable of making calm, rational decisions that respond (rather than react) to challenge

Grounding exercises and self-regulation support are an important tool for managing anxiety and panic – and these will be considered more in a future blog.  However, anything that helps to calm our nervous system can be considered a form of self-regulation and grounding.  For some people, this takes the form of meditation.  For others, calm and mindful breathing.  For others, sensory awareness.  The key here to all of these techniques or exercises is that they allow some sense of control or feeling of mastery over our own responses and our reactions.   They can be very helpful for managing emerging feelings and sensations indicating a panic attack.  They are also useful tools to consider when we feel disturbed, anxious or ill-at-ease about panic buying reports. 

Herd Instinct and Co-Regulation:  The Impact of Others Upon Our Sense of Panic. 

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One final consideration that is relevant to the psychology of panic buying is that humans are social beings.  We cannot help but be influenced by the reactions and behaviours of others.   This has been labelled the “herd instinct”.  We often find that we look to others as a means of comparison and to gauge our own responses.  As social creatures, our brains and emotional states are impacted by that of others in a phenomenon called “co-regulation”.  My state of emotional and psychological regulation can be impacted by that of another.  In this way, panic can be contagious.  Seeing news reports and also speaking with others who are feeling panicky as a result of perceived scarcity can result in us also feeling a sense of anxiety and panic. 

So – panic buying, like other forms of panic and anxiety is essentially a fear-based response that emerges from a perception of danger or risk.  Panic buying, like other forms of panic and anxiety, can be a reaction resuting from our limbic systems response to perceived danger.  News reports and being with others who are experiencing panic can also fuel our own feelings of panic.  Grounding and self-regulation that helps us to allow our limbic system and our pre-frontal cortex to work in an integrated and unified way is one way to help respond to panic.  Grounding exercises – explored more in a future blog – are ways in which we can regain some sense of control in a world that sometimes feels out of control.

This blog has aimed to unpack something of the psychology of panic-buying in a non-judgemental way.  It has aimed to make meaning of panic and anxiety and the feelings of being out of control.  For many people, therapy offers a space to explore in a non-judgemental context, what panic, anxiety and feeling out of control is like for them – with the ultimate goal of making meaning of their experiences.  If you feel you’d like to find out more how therapy can help with panic and anxiety, please do get in touch for a free initial phone consultation. 

Therapy can help you to make meaning of your own experiences of panic, fear and anxiety.

References:

Arafat, S., Kar, S. K., Marthoenis, M., Sharma, P., Hoque Apu, E., & Kabir, R. (2020). Psychological underpinning of panic buying during pandemic (COVID-19). Psychiatry research, 289, 113061. https://doi.org/10.1016/j.psychres.2020.113061

Wilkens J. The San Diego Union-Tribune; 2020. Why We Hoard: Fear at Root of Panic-Buying, Psychologists Say.https://www.sandiegouniontribune.com/news/health/story/2020-03-22/hoard-fear-panic-buying-psychology

Preventing Burnout

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This is the final of three blogs unpacking the impact of burnout.  Many clients speak about the way that stress and sustained pressure take their toll and result in depletion, exhaustion and overload that can be labelled as “burnout”.  In previous blogs, we’ve explored what burnout is and some of the typical symptoms of burnout.  We’ve also looked at practical steps that can be taken to help recover from burnout.  But, mindful of the old adage, “prevention is better than cure”, here we take a look at strategies that help to prevent and safeguard against burnout.   

Burnout:  Keeping your Vehicle on the Road. 

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Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.  Think of it like a vehicle that’s driven too fast for too far without stopping to re-fuel.  Once you’ve got to that point, it is a slow and difficult trek to the nearest petrol station to purchase a canister and fuel, and then a hike back to put the few litres, (gallon in old money!) into the tank.  Either that, or an expensive callout to a roadside assistance provider.  With this analogy, its fairly easy to see what preventative action to guard against burnout involves might look like.  Regular “filling the tank”, stopping to replenish and refuel before we become exhausted and overwhelmed.  Keeping a close eye on the measuring gauges and dashboard indicators that tell us about the status of our vehicle.

So, preventative action to guard against burnout includes self-awareness: noticing and recognising our own indicators and early warning signs that we are facing stress and pressure and that our coping reserves are dwindling.  It involves responsive action to then find ways to stop, rest and replenish.  At its heart, preventative action to guard against burnout is being serious about a robust self-care routine.   

Finding balance is an important aspect of self-care routines

Self-Care Routines

It’s tempting to think of self-care as luxurious trips to day spas or holidays on exotic beaches.  Of course, these things can be part of a self-care routine, and it’s great to have a bit of pampering and take a holiday every now and then.  But, in terms of burnout prevention, self-care is very much about the regular things that help to replenish and restore.  That can be staring the day with a healthy breakfast, a weekly phone call to a friend, attending to medical appointments and taking time each day to enjoy a lunch break away from your desk.  It could even include weekend hikes and getting out into nature.

A self-care (very cold!) hike

Another way to think of self-care is to consider the various domains of your life, and to consider what actions and strategies you can implement to ensure you are taking care of yourself in each domain.  For example, you may consider some of the following domains to be important areas of your life where you can consider appropriate self-care:

  • Physical self-care
  • Psychological self-care
  • Emotional self-care
  • Spiritual self-care
  • Study related self-care
  • Work related self-care. 

Let’s think about some practical self-care examples for some of these domains.  A work-related self-care activity could be to ensure that you do leave work on time.  Or that you book in with your line-manager to discuss any concerns you have before they escalate. 

Physical self-care can be to drink enough water each day and remember to stretch and move if you feel tension in your body.  It can also include taking medication as prescribed, eating well and attending to sleep hygiene to help get a restful night’s sleep. 

Psychological self-care can include considering and implementing appropriate boundaries:  saying no to an extra commitment when you feel you don’t have capacity.  Considering self-talk can also be a key aspect of psychological self-care.  If you find yourself berating and berating yourself up for perceived failure or not achieving what you feel you “ought” or “should”, it might be time to attend to kind and compassionate self-talk:  telling yourself that you did the best you could with the resources you had. 

Each of these domains are worthy of our awareness and attention.  Each domain contributes to our overall sense of wellbeing.  When we are lacking in appropriate self-care in any domain, its likely we begin to feel a bit “lopsided” and out of sorts.  When we allow that situation to continue, it begins to take its toll and we risk burnout. 

Resistance to Self-Care

Perhaps you are reading this and feeling some resistance, or irritation?  If so, good spot! That irritation may have something useful to tell you.  I know that for many clients I have worked with, talk of self-care and self-nurture can feel cloying and uncomfortable.  I am interested and curious about the unique meaning of this for my client. Yet, I also notice that there are some common themes in resistance to self-care.

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For some, self-care feels indulgent and almost frivolous.  Perhaps you’ve never had important and significant people in your life model self-care, and it feels alien to you?  You may have grown up with the encouragement to be strong, tough and to keep going.  To ignore any warning signs that you weren’t managing and instead “try harder”?  Perhaps self-care feels too much like self-pity and you’d rather focus on the things you can do now?  For some people, they become aware that much of their self-image and self-identity is tied up in doing, or even giving to others.  To stop and “be”, or to attend to self may therefore feel selfish, or a waste of time.  Stopping the busy-ness of life might just open up the chance for self-reflection and that can feel daunting.  In which case, staying busy can seem preferable.

So, if you are aware of any resistance, its worth noting and being curious about that, and what meaning it holds for you.  Therapy can help with this self-discovery process.  Once you are aware of any resistance, you have choice.  The choice to remain resistant, or to consider other responses to self-care. 

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Challenging Self-Care Resistance. 

Let’s look at one possible response for someone who is committed to experimenting with challenging resistance to self-care:

Consider someone that you care about:  this could be a friend or a family member.  Now think about what you’d love to do for them on their birthday, to show them you care?  If money weren’t a barrier – what gift would you buy them?  What words would you write in a card?  Where would you like to take them to celebrate?  What would you want to say to them face-to-face to show that they matter to you?  And, how might you respond if you also knew that they were finding this particular birthday really tough as things had been hard for them lately? 

When we care about someone, we like to find ways to show our love, care and kindness.  This is especially the case they are in a time of need or crisis.  It’s unlikely that in this scenario, you’d tell your loved one to just put-up and shut-up, or chastise them for finding things tough in the first place. 

It’s strange, therefore, that it can be so hard at times to be a friend to self, to care for yourself.    Beliefs and established ways of being and doing can get in the way of being a friend to ourself. 

Being a friend to ourselves means offering compassion and kindness as if we were our own best friend.  It means avoiding self-criticism and self-attack.  It means choosing to show ourselves kindness and love and making sure we build in self-care activities into our daily schedule.  Self-care means an appreciation of one’s own worth or value.  Those very times are when we might feel like we don’t deserve care and compassion.  Our inner critic can be quick to say we are being extravagant or indulgent.  However, when that voice surfaces, it’s the exact time when self-care is needed. 

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Self-Care:  Attend to Your Own Mask First

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COVID means it may be hard to remember the specifics of the last time you flew on an aeroplane.  However, any flight always includes the safety briefing, when the flight attendant instructs you to “put your oxygen mask on first,” before helping others in the event of an emergency.   It seems almost counter intuitive to look after yourself before helping children or other people.  But if you run out of oxygen yourself, you can’t help anyone else with their oxygen mask.  The same principle applies to so many situations in life.  If we only ever care for others, and pay no attention to our self-care, we will burn out and be of no use to anyone. 

Burnout Audit

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If you aren’t sure if you are at high risk of burnout, then its good to take time to take stock of how things are for you at the moment.  What stresses and strains might you be under – and what helps you cope?  We can think of this as an audit.  One that is likely to result in some change to your routines around self-care, as you may identify some areas where you’d benefit from taking action.  Such an audit can be as simple as having a think through the sorts of self-care and also the stresses and pressures you face in the various domains of life at present.  You may also be interested in more formal diagnostic and audit tools around burnout.  There are various evidence-based measures, including the Maslach Burnout Inventory

To return to our vehicle analogy, a regular self-care / burnout audit allows you to have a bit of an MOT, or a Service.  A great way to spot and then respond to any minor issues before they escalate.  For many people, a self-care audit every couple of months seems a helpful tool in preventing burnout.  This can then lead to the development of a self-care plan that includes action points in each of the life domains that are significant to you.

So, prevention is better than cure when it comes to burnout.  There is only one unique you, so it makes good sense that you do take looking after you seriously – which also includes having fun! 

If you do feel that any of the issues raised in this blog have left you curious or unsettled, please do get in touch. I’d be happy to discuss how counselling can support you with any self-care or burnout concerns you may have. 

Recovering from Burnout

Counselling for stress and burnout
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This is the second in a series of three blogs exploring burnout.  In the previous blog, we considered what burnout is, the signs and symptoms of burnout and who is at risk.  Here, we cover practical self-help strategies you can employ to help manage burnout if you feel you are beginning to suffer from or are firmly in the grip of burnout. 

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Burnout:  No fuel left in the tank

Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.   If you’ve begun to spot some of the physical, emotional, mental and behavioural symptoms of burnout, then it’s time to take action.  Self-care and self-help for recovering from burnout are essentially about taking steps to reduce stress and to find ways to re-resource.    Burnout is a diagnosable health condition resulting from continuous and long-term stress exposure (ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision).  And, as with any health condition, a return to good health can take time and comes after rest and active treatment. 

Reduce Your Exposure to Stress to Tackle Burnout

Stress and pressure can lead to burnout
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At the point of burnout, we’ve borne the brunt of stress and pressure for too long.  The depletion of burnout comes after exposure to stress and suffering, causing us to remain in a state of flight or fight – on high alert, for too long, without sufficient respite.  Therefore, once you recognise that you are experiencing burnout, it is essential that you reduce your exposure to stress.  Your brain and body need chance to regulate and recover. 

A significant aspect of self-care and self-help for burnout is taking a long hard look at what you can do to reduce stress and pressure in your life.   Do you need to take a break for a few weeks?  It may be prudent to book in annual leave as a matter of urgency to give yourself a total break.  For some people, burnout means that they are not well enough to work and require a break from the pressure and stress of work.  In which case, speak to your GP.  Remember, burnout is an accepted health condition.

Consider, too, the various commitments that add to your daily or weekly load.  What can you pause or take a break from in order to reduce your exposure to stress?  Perhaps it would help to hire a cleaner for a couple of months to reduce any household pressures.  Or, at least accept that – for this season at least – some jobs will just need to remain undone.  Step back from volunteering for a while.  Learn the art of saying “no”.  The last thing you need right now is more commitment.   However you manage it, it is essential you have a respite and reprieve from stress and pressure for a while. 

Filling the Tank After Burnout. 

As well as reducing your exposure to stress, it’s also important to find ways to replenish after experiencing burnout.  If we take the analogy of a fuel tank, reducing our exposure to stress helps to cover the “hole” in the tank that’s been leaking fuel.  But there is a need to now refuel and restock your energy levels. 

How to refuel?  Take a long hard think about what it is that gives you energy and gives you life.  What makes you feel alive, feel engaged, feel like “you”?  Dancing?  Meditation?  A yoga class?  Time alone to read, relax and create?  Socialising with precious friends?  Walking in nature?  Watching your favourite film or show?  You’ll know yourself what helps you to feel energised and enlivened. It’s different for each of us, and only you really know what feels a perfect fit for you and your own needs.   It is important that you schedule plenty of opportunities to do the things that help, that bring you joy.  These things are a powerful antidote to burnout.  Make space in your diary and prioritise these activities to fill the tank and refuel after burnout. 

Give Yourself Time

Take time to recover from burnout
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Consider that burnout often takes months to take a hold.  Burnout occurs after the prolonged exposure to stress and pressure.  Therefore, you need to allow time for recovery from burnout.  Give yourself time and aim to adopt an attitude of self-compassion and patience with yourself as you slowly recover from burnout. 

Take time to make changes to your daily, weekly and monthly routines so that you are in a position to recover from burnout.  Give yourself time each day for some relaxation, and rest and chance to replenish.  Re-evaluate the expectations you place upon yourself about what you can cram into each day, each week, each month.  Build in time to rest and time to recover.  These are lifestyle changes that will help you to recover from burnout but will also help you to safeguard against future burnout. 

Seek Professional Help

Counselling for stress and burnout in Preston
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Many people seek therapy and professional counselling or psychotherapy as space to explore how they feel about the experience of burnout.  Burnout can trigger a range of feelings and responses.  For example, some people feel ashamed that they have reached a point of burnout.  They are suddenly faced with their own vulnerability and fragility and may feel shocked and shaken at this recognition.  The experience of burnout may also challenge self-beliefs and personal constructs. For example, if we hold a “be strong” mindset, the experience of burnout may lead us to question our own identity.  Perhaps we are someone who has gained our sense of self-worth from doing, and from helping others.  Burnout can challenge that and leave us questioning whether we are worthy or okay as a person.  Therapy is a place to explore and examine our own beliefs and feelings about ourselves, as well as offering opportunity to consider alternatives that can help towards recovery from burnout. 

Burnout….. so what?

We’ve explored some of the important aspects of recovering from burnout.  Recognising burnout is a first step towards recovery, that takes time and deliberate and active action to helps us towards a healthier future. 

The final blog post in this series will explore how to take actions to protect yourself from burnout in the future. 

Let me know what works for you in terms of recognising and managing burnout in your own unique circumstances.  And do get in touch if you’d like to discuss how counselling can help you in your recovery from burnout. 

Free to be Counselling offers professional counselling in Preston for anxiety, depression and self-esteem.
Counselling in Preston for anxiety, depression and self-esteem

What is Burnout?

Stress and sustained pressure can take its toll upon people.  Whilst it might be possible to cope with stress and pressure in the short term, over the long term, we’re at serious risk of burnout.  In this first blog in a series of posts, we’ll look at what burnout is, who it affects and what the signs and symptoms of burnout involve.  Future blogs will cover how to take preventative action to avoid burnout and how to recover from burnout. 

Burnout:  No fuel left in the tank

Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.  A vehicle’s fuel tank is a good analogy here.  If you drive for too long, too fast without stopping to re-fuel, eventually your vehicle grinds to a halt.  You need to take time to find a source of fuel, and then re-fuel the tank before you can carry in.   For many people, the various stresses and strains of life mean that they’re driving too fast, for too long.  That’s not sustainable in the long-term and places a person at risk of burnout. 

And, its worth mentioning, that burnout can also involve the slow and almost imperceptible depletion of energy and resources to cope with the pressures upon us.  We can think of burnout as also being about a hole in the fuel tank.  Without remedial action to stem the flow, there’s a gradual leaking of fuel from the tank which, eventually, results in the vehicle grinding to a halt. 

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What is burnout?

Burnout was first identified and described in 1974 by clinical psychologist Herbert Freudenberger, in his study of nurses.  He noticed that pressures of work led to nurses becoming depleted.  Affected medical staff began to show signs of disengagement, feelings of helplessness and emotional exhaustion.  Now, burnout is widely recognised as a health condition that impacts significant numbers of people every year.  The ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision) includes burnout as a diagnosable health condition resulting from continuous and long-term stress exposure.  And the World Health Organization recognises burnout as an ‘occupational phenomenon’. 

Signs of burnout encompass emotional, physical, mental and behavioural symptoms.  Let’s look at some of the different signs and symptoms associated with burnout:

Emotional symptoms of burnout:
  • Depressed mood
  • Irritability
  • Sense of hopelessness
  • Disillusionment
  • Detachment
  • Resentment
Physical symptoms of burnout
  • Tired
  • Rundown
  • Sleep problems
  • Muscle tension
  • Headaches
  • Stomach complaints
Mental symptoms of burnout:
  • Finding it hard to concentrate / make decisions
  • Persistent thoughts about patients / clients
  • Intrusive imagery of work-related issues 
Behavioural symptoms of burnout:
  • May exhibit robotic actions,
  • Impaired practice with questionable ethical actions and increased errors
  • Jumpy / restless
  • Greater use of alcohol / other drugs. 
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Our brains on burnout

The human brain is equipped to respond to short bursts of periods of stress. The adrenaline that is released under pressure helps us to perform.  That’s useful when we need take prompt action in response to a stressor.  Our brain begins to release the stress hormone, cortisol, equipping us to stay alert in the face of challenge.

However, when pressure and stress are prolonged, our brain is flooded with cortisol and we remain for far too long in a flight or fight states, on high alert without sufficient respite.   In time, the brain begins to struggle to produce cortisol leading to adrenal fatigue.  Over time, the drip-drip effect of prolonged pressure and demands mean our brain is less efficient at regulating our stress response and we find we are less equipped to manage stress.  We label this experience burnout.    

Who’s at risk of burnout? 

The short answer is, anyone and everyone. A recent Gallup survey revealed 76% of employees occasionally experience symptoms of burnout, and 28% say they are burned out “very often” or “always” at work.  Life in the 2021 is stressful and there’s a great deal of pressure on most people. 

However, research also points to people withing caring professions as being at particular risk of burnout.  Recent estimates suggest that up to 40% of UK Doctors may be experiencing burnout.   A European study in shows that 42% of UK nurses report burnout compared with a European average of 28%.  We know that people engaged in the care professions, and where work involves a significant degree of interpersonal contact and exposure to other people’s suffering, are at greater risk of burnout.  That means people engaged in “high touch” (as opposed to high tech!) employment are at greatest risk of burnout.   Social workers, teachers, medical professionals, carers (paid and unpaid), police, firefighters, aid workers, counsellors, members of the clergy…. the list goes on.  Anyone in these roles is at risk of burnout.  Charles Figley, a key researcher in this area speaks about the “cost of caring”:  the empathy and compassion that make people in caring roles so good at their job is what can lead to burnout in the long-term. 

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Burnout….. so what?

We’ve explored what burnout is, the signs and symptoms of burnout and who is at risk of burnout.  So, how can you use this information to help you?  Well, many people do seek therapy to explore their relationship with burnout and to have space to find freedom from the negative impacts of burnout.  Some enlightened workplaces offer access to EAP and other wellbeing support, which can help employees at risk of burnout to access counselling. 

In my next blog, we’ll look at some practical self-help strategies you can employ to help manage burnout. A final blog post in this series will explore how to take actions to protect yourself from burnout. 

Let me know what works for you in terms of recognising and managing burnout in your own unique circumstances.