Vaccination Anxiety Tips

As COVID-19 vaccines are becoming more accessible, I am seeing an increase in anxiety among clients in regards to shots, needles, and medical environments.  Some people are nervous about the pain, the thought of something entering their body, or even the post-symptoms they may experience.  Here is a list of coping skills to help decrease your vaccine anxiety:

• Have someone you feel safe with on the phone or facetime with earphones in when you are in the building and getting the vaccine.

• Bring fidget toys - stress ball/rocks/clicking a pen/key chains.

• Listen to music or a podcast in your earphones starting when you leave the car. This is very regulating for any kind of dissociation or rumination.

• Bring a book to read. This is mainly helpful if there is wait time before or after the vaccine.

• Tell the person giving you your vaccine that you are anxious and need "X". "X" is where you insert whether you want them to just be aware that you will be on your phone to distract, or if you need them to walk you through every part in detail, or need them to distract you with conversation. You get to choose what kind of behavior you want from them while administering. They are there to help!

• Bring a water bottle with cold water and ice and drink it often. Coldness regulates our reptile/anxious brain.

• State a safety affirmation over and over i.e. "I am safe" or have the person you are on the phone with state “You are safe.”

• Deep breathing in and out to the count of this shape gif. Having something visual along with physical is most helpful because it includes more senses.

• Mindfulness - name 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, 1 thing you can taste. Make it a game like eye spy if needed.

• Do the ABC’s. Pick a category and name something that starts with each letter of the alphabet. I like to use food or animals as my category.

• Try “butterfly taps.” This is where you cross your arms and rest your hands on your upper chest almost to your shoulders OR on your upper arms. Take turns tapping each hand on your chest over and over.

What is Anxiety?

Anxiety is a physical and mental response to stress and worry. Anxiety can present physically such as feeling hot, heart palpitations, headaches, stomach pain, lethargy, and even difficulty breathing. Anxiety can present mentally as difficulty concentrating or making decisions, racing thoughts, self-criticism, and second guessing yourself often. I usually define anxiety to my clients as our response to situations we cannot control. Control is a central aspect to anxiety, and worry and rumination is usually a way we try to assert some type of control over the anxiety. Anxiety always spikes when we feel we do not have control over something.

Anxiety can mainly present as avoidance or procrastination, and can also present as perfectionism. People with anxiety may put off tasks because those tasks feel overwhelming and to some people it may seem like the person does not take the task seriously, though they do. Perfectionism can look like being on top of tasks, going above and beyond what is asked, and "having it all together." This is silent or what we refer to as high functioning anxiety, because what usually drives perfectionism is anxiety about being judged or seen as "not good enough."

You should check on your friends or family who may make to do lists often, and seem to get it all done, or people who may tend to isolate to avoid stressful situations. This could be a friend who always cancels plans, or someone who is the CEO of a company working 50+ hours a week. You can help by asking them if they are stressed, or verbalizing what you see that is concerning. Remember to always encourage communication, provide lots of empathy, and make sure they know they are cared for and "enough" no matter what they achieve. Avoid saying you "understand", and make sure you do not minimize or diminish the stress they may communicate to you. Avoid saying things like "that project isn't a big deal", or "don't worry about that."

Contact a therapist if you think you may be experiencing anxiety. They can help you figure out if you are dealing with clinical anxiety, and how to treat your anxiety so you don’t feel so controlled by it.

When Anxiety Presents as Anger

Throughout my time working with many individuals who are dealing with anxiety, anger or irritability has been the most common symptom that is worked on in therapy.  Irritability is one of the symptoms of Generalized Anxiety Disorder (GAD) in the Diagnostic and Statistical Manual 5 (the book used to diagnose all mental health disorders).

Most people jump to the uninformed conclusion that if anger is a consistent symptom, the person must have a mood disorder, such as bipolar or depression.  An important concept to understand is that we all have primary and secondary emotions.  What this means is that when we are faced with an event, we have our initial emotional reaction (primary), and then we have deeper emotions that we are not as aware of (secondary).  Primary emotions are usually our gut reactions and are commonly in the anger spectrum, whereas secondary emotions connect to deeper wounds/core beliefs and can also be emotional reactions to the primary emotion i.e. shame, guilt, or not feeling “good enough”.

It can be difficult to differentiate between the two, which makes identifying them confusing, but necessary when dealing with anxiety.  For example, if someone is walking down a hallway and they trip and fall, and someone extends their hand to help them up, the person who fell may lash out stating they do not need help or become very defensive.  The primary emotion here is anger, and the secondary, more engulfing emotion, would be embarrassment, worry of judgment etc.

As a society, we are trained to view anger as a more socially acceptable emotion as opposed to showing sadness, anxiety, or embarrassment because the latter is viewed as “weak”.  This is why we tend to react more easily with anger, and it does not seem as frightening to do so as compared to showing outwardly that we are worried.  With GAD, we may feel like no one can help us or that we are incapable of helping ourselves.  This can create helplessness and hopelessness, which can also fuel feeling angry towards others, the world, or ourselves.  Anger can also feel like a more “manageable” feeling to some, so getting angry seems like the better option (unconsciously) than being emotionally vulnerable by showing anxiety.

A way to try to cope with anger is to ask yourself “Why am I really getting angry?  What situation does this remind me of from my past? Is it actually because I dropped the carton of eggs on the ground, or is it because this event feels like just another thing you did wrong, or like you cannot ever do anything right?  Or that people will judge you for being incompetent?”  There are almost always more difficult emotions lurking underneath anger.

This is why it is important to seek therapy if you are having difficulty with managing your anger.  Usually, there are deeper emotions buried beneath the anger that need to be identified and processed so that anger is no longer hindering your relationship with others or yourself.  This is where communication skills and coping skills become helpful after identifying the underlying emotions and concerns.

Top 4 Things to Normalize for Your Child

A large part of my work as a therapist is to help normalize any and all emotions for both my adult and child clients.  This got me thinking about what other things are essential for adults to be normalizing for children so that they grow up with emotional intelligence.  Emotional intelligence includes self-awareness, self-regulation, motivation, empathy and social skills.  Research indicates that emotional intelligence is more important than intellectual intelligence because it allows us to build a fulfilling life.  Who doesn’t want that for their children?

1.     Emotions

Whether a child is behaving in a way that we are pleased with or not, we should be normalizing their emotions.  We want to help them label what they are feeling, and link that they are behaving in X way because of Y feeling so they start to learn that their emotions can affect their behavior and thoughts.  When a child is dysregulated, this is not the time to try to change behavior (unless they are harming themselves or others).  As adults, we have “bad days” where we may raise our voice because we are mad or cry because we are sad.  We need to make sure children learn that it is okay to have those feelings, just like it is okay to feel happy.  When parents consciously or unconsciously teach their children that showing or talking about their feelings is “bad”, they are setting them up for mental health concerns.

2.     Failing

No one has succeeded at everything that they do, so we need to make sure that children know that failing is okay and a part of life.  As adults, if we were to grade ourselves for our performance at work everyday for a month, would we always give ourselves an ‘A’?  Probably not, and that is okay, because sometimes we have days where we are burnt out or unable to focus.  We should not be holding our children to an unrealistic standard of productivity.  This also goes for grades.  If a child is not doing well in school, there is a reason, and it is imperative to uncover what that reason is.  Accusing and belittling your child will only foster low self-esteem and anxiety or perfectionism.  For example, if a child is dealing with symptoms of ADHD and they did not turn their work in on time, they are just as angry with themselves and sad about it as the parent may be.  They do not need another person criticizing them.  Instead, teach them that that happens sometimes, and work on strategies to help them with this skill in the future.

3.     Sex and Physical Boundaries

This is a controversial topic, as some parents have religious or personal views that deter them from talking about sex with their children.  It is important to know that there is research that outlines that children who are taught about sex are more likely to wait longer to have sex.  I say this only to help parents understand that talking about sex does not take a child’s innocence, but actually helps them build a better sense of self and assertiveness.  Another component to this is making sure that when you are teaching your children about sex, you label body parts with their standard terms (i.e. penis, vagina, clitoris etc.).  When you are doing this, make sure you are aware of your tone and non-verbals.  When children see that you are comfortable talking about these things, this safeguards them even more if they eventually have to disclose any kind of abuse to you or someone else.  A rule of thumb is, if you don’t teach them, the Internet and porn will, which creates unrealistic standards about sex and boundaries.

4.     LGBTQI+

This is another topic that is difficult for some families due to their religious views.  Unfortunately, there is a harsh reality to this; if you do not normalize different sexual preferences/orientations and your child identifies as LGBTQI+, then you are setting them up for low self-esteem, and anxiety.  Imagine if you had to hide something from the family that you loved.  In therapy, becoming comfortable with your genuine self is an underlying goal.  The path to feeling comfortable with ourselves becomes much harder if our family is not accepting of who we are.  This can inhibit the individual from being open to others, or encourage them to hide who they really are.  Please be aware of how powerful a parent’s acceptance can be on their child’s life.

Rehearsing for Disaster: Helpful or Hurtful?

In light of the recent school shooting in Florida, and the gun safety scares around the country, I thought it would be important to talk about how these events affect our children.  Lately, the families that I work with have asked me whether they should prep their child for traumatic events like this or not.  When this was initially brought up to me, I was unsure because I was barraged with thinking out the pros and cons.  Adults, adolescents, and children all have to endure fire drills and natural disaster drills.  Some adult clients have even told me about active shooter drills they have had at work where there are sound effects to replicate a gun being fired.  My first reaction when a client told me of this was “Did they tell you that there were going to be sound effects beforehand?”  This alarmed me, as situations like this can be traumatic, whether they are real threats or rehearsed ones.  As our culture promotes, we feel most comfortable when we are prepared.  The biggest drawback to rehearsing for disaster is that it can make us very anxious.  Also, if we are put in simulated traumatic situations, it can be triggering for some people, whether or not they have had similar traumatic experiences in the past or not.

So back to my original questions: “Should parents be rehearsing these disasters with their children?”  If you know your child has a propensity to be anxious, worried, or scared, then No, you should not be rehearsing these scenarios with your children.  If children have seen or heard of gun-related disasters on the news or at school, the parents should definitely talk to their child about this.  The parents should reflect and normalize if the child is scared or confused.  The parents should also point out the silver linings, only after hearing them out and normalizing their feeling.  The parents run the risk of minimizing how the child feels if they jump straight to talking about the positive side.  Just like Mr. Rogers always said, “Look for the people who are helping.”  Tell this to your children.  Talk about the first responders, teachers, police, students, and community members who are helping make the situation safe.  This reinforces for the child that despite something scary happening, there are always people who want to help.  If the parents are unsure if the child has heard of any disasters, they can inquire by stating, “Is there anything you want to talk about or have questions about?”  Always keep the door open by saying, “If you ever want to talk about anything, I am always here.”  In the healthiest parent-child relationships, the parents will model being open about their feelings, and inquire about their child’s feelings often.  This can be asking your child about something that made them proud, worried, confused etc. throughout the week.  This makes it seem like usual business when the parent might inquire about something they may have heard that was “scary” or “worried” them.

Some rules of thumb to follow:

1.)  Children under the age of 12 should not be watching the news or movies/TV shows that are not PG rated alone.  Before the age of 12, the parts of the brain that processes abstract ideas and understands when things are real and fake have not been developed yet.

2.)  Talk to your children about what they may have heard and correct any information that may be wrong IN A DEVELOPMENTALLY APPROPRIATE WAY.  Parents should avoid using labels for people who may have committed these disasters and should not perpetuate the anxiety by giving information about guns, politics, world problems etc.

3.)  If the child feels scared, express to them if it scares you as well.  We want to normalize feelings, instead of pretending that “everything is fine”.

4.)  Talk to your child about how the family unit can help those in need.  I hear so many times from clients that they want to be able to control these situations.  The reality is that we can’t.  But we can control how we react, and the impact that we can have by spreading support.  Maybe this means volunteering at MANNA Food (a local food drive who donates food to individuals in need), or visiting adults in nursing homes.  Make the supporting effort something that is meaningful for your family.

How Unconscious Emotions Affect Daily Life

Freud’s concept of having conscious and unconscious emotions is innate in all of us and counseling can help identify these emotions.  Consciousness is defined as thoughts, feelings, and memories that we are aware of in any given moment.  Most memories are not always in the forefront of our consciousness, but they can be easily retrieved.  Unconsciousness is defined as thoughts, feelings, memories, and urges that are not readily available to us, but they affect the way that we behave and sometimes perceive situations.  A lot of the time, the thoughts and feelings in our unconscious are uncomfortable or unpleasant.  We either suppress those feelings, or our mind represses them for us because they feel unbearable or damaging.

The easiest way to describe our conscious and unconscious is to picture an iceberg.  The top of the iceberg, which is seen above the water, is only 1/3 of the total mass and this is what we are currently conscious of.  The portion of the iceberg that is under water, which is much larger, are the things that are hiding and festering within us.  Sometimes we react in ways that shock us.  Maybe we snapped at our child, or pulled away from an intimate embrace but we are not sure why.  This is our unconscious at work.  When we have experienced events that make us anxious, scared, hurt, mistrustful etc. it can lead to us showing these feelings without even knowing why.  Sometimes our unconscious can also manifest in dreams.  When there are unresolved feelings (i.e. constantly feeling minimized or unheard from your partner, past abuse etc.) they need to be identified and processed in therapy so that they can have a smaller impact on your daily life.  If you find yourself having bothersome behaviors, thoughts, or feelings contact Emily Griffin at Clarity Through Counseling today to set up an appointment.

Grief and Loss: A Chain Reaction

Since we are now in the midst of the holiday season, it seems important to acknowledge that this can be a tough time for some people.  Grief can come in many forms and can affect people differently.  Some forms of loss may include:

·       Death of a friend or loved one

·       Serious illness of a friend or loved one

·       Illness/loss of health

·       Relationship breakup

·       Loss or change of job

·       Parents’ divorce

·       Moving

·       Death of a pet

·       Graduating from school

·       Loss of physical ability

·       Loss of financial security

·       Loss of safety

·       Retirement

·       Neonatal loss

With every primary loss comes secondary losses as well.  These secondary losses come as a result of the primary loss, though they can be just as difficult and intense.  For example, when someone’s parents’ divorce, the loss of the family unit is the primary loss, but the secondary losses may include: loss of trust in either or both parents, loss of a place to call “home”, loss of future events such as bringing their own child to grandparents’ house, loss of holidays as a family unit, and loss of trust that marriages can be successful.  These are just a few secondary losses that someone can experience, and sometimes the secondary losses can occur later than the initial event.  For example, if someone parents’ divorce, they may not experience that secondary loss until the holidays come around, or until they start a family of their own and notice the absence of the grandparents as a unit.

Here are some helpful tips to manage grief:

1.     Engaging in traditions that make you feel fulfilled.

2.     Allowing yourself to mourn the loss and/or secondary losses instead of pretending they are not there.  It is usually helpful to put a time limit on this so that it does not consume your entire day.

3.     Connect with people within your support network.  If a support system is not yet established, this can be done through support groups, meetups, or local classes that interest you.

4.     Come up with a “safety pan” to refer to when you start to feel overwhelmed with the loss.  This can include activities that you enjoy, and a list of people to contact.

Therapy can be helpful at any stage of grief, and can assist in providing a place to explore both primary and secondary losses.

5 Ways to Help A Loved One In Crisis

When you notice that a loved one is in crisis it can be hard to decide what to do to help.  A crisis can be when someone is experiencing extreme sadness, anger, anxiety, or wanting to hurt themselves or others.  Getting involved with these heavy emotions may feel overwhelming or even frightening.  Try following these 5 tips to help your loved one when they are in crisis.

1.     Avoid “Fixing”

Everyone has experienced a parent or friend that tries to give suggestions and advice on how to “fix” feeling sad, angry, guilty etc.  The word “fix” can be synonymous with stopping the person from feeling emotional pain.  The need to “fix” things comes from a healthy place of wanting to be supportive but it is not effective.  When you try to “fix”, it can make the individual in crisis feel judged or inferior.  Examples of when someone is trying to “fix” the problem are: “Look at all the progress you have made”, or “Don’t be sad, you have so many friends and a great job”.

2.     Listen Without Judgment

The most important thing to communicate to your loved one is acceptance.  This can be done through actively listening and reflecting what your loved one is sad or angry about.  This shows that you are genuinely listening and want to help.  If your loved one communicates feeling lonely to the point where they are thinking about hurting themselves you could say “you want support from someone but you don’t feel like there is anyone that cares.”  As humans, our main unconscious motivation in life is to be heard and understood for who we are, especially in our darkest moments.

3.     “Sitting in the Soup”

This is a phrase that most of my clients hear me say.  “Sitting in the Soup” refers to being in the moment with your emotions instead of trying to distract yourself.  This can also be used when your loved one is in crisis.  Sometimes sitting and being silent with someone when they are feeling at their lowest shows that you care about them and accept them even when they have strong emotions.

4.     Avoid Name Calling

If your loved one is in crisis, you may become anxious, sad, or frustrated due to the pressure of keeping them safe.  You must be in control of your emotions because this models for your loved one that this situation can be remedied.  I cannot tell you how many times I have had clients tell me that their spouse, sibling, parent, or friend has called them “crazy”, “psycho”, or “insane”.  Unfortunately these words are used so causally that we as a society forget how hurtful they can be.  Your loved one does not want to feel the way that they feel, and if they could stop their crisis, they would.

5.     Safety First

If the above tips do not work, and you fear your loved one is in danger of hurting themselves or someone else, call 911 for help and request a crisis intervention team trained officer.  In Montgomery County, MD, not all officers are CIT trained.  This training teaches officers about different mental illnesses, and how to de-escalate a situation where someone wants to hurt themselves or someone else.  Getting the police involved can be a traumatic experience for your loved one, so having someone who understands mental health can make the situation go smoother.