How to Cope with Shame

First things first: Guilt and shame are NOT the same emotion.

Guilt is "I did a bad thing." Shame is "I am bad."

Both are natural human emotions.

Guilt is useful (when it's actually called for). It calls you in to notice when your behavior is out of line with your values. Socially, it spurs you to apologize and do better in the future. In this way, guilt can be useful. (Guilt can certainly take over and become not useful, like we often see with depression or anxiety, so we're not talking about that kind of guilt right now).

Shame, on the other hand, is not useful. Shame says "you are bad, and you no longer belong in society." This is not helpful. Shame prohibits empathy and curiosity, and so gets in the way of even wanting to learn how to do better. Shame also gives you no incentive to change, because you are already "outcast".

**You might at this point be feeling shame about feeling shame. "What is wrong with me that I keep feeling this useless emotion?!" Please be nice to yourself. You are human, and shame is part of being human. We fear disconnection more than almost anything, and shame grows out of this fear. That's okay.**

You might notice that shame has a stronger physical/somatic presence than guilt. It might feel physically different than guilt--showing up in different places in your body with different patterns.

The thoughts associated with guilt and shame are also different.

Guilt thoughts tend to sound like:

"I wish I had called my friend earlier when I knew they were struggling."

"I should have studied more for that test."

"Lying like that was not okay, I don't feel good about that."

Shame thoughts tend to sound like:

"I'm a terrible friend for not being supportive. I don't deserve friends."

"I'm so stupid. I'm an idiot for not studying more and failing the test."

"I am a liar, no one can trust me."

You can practice moving from shame to guilt. Separate the BEHAVIOR from YOURSELF. (Contrary to popular? belief, you are more than your behaviors.) This can help you from spiraling from guilt, to shame, to hopelessness, even to feeling suicidal.

Questions to reflect on:

What did you actually do/not do?

Was this in line with your values or not?

Can you talk to yourself about the behavior and avoid making a global evaluation of yourself? (See above examples of guilt vs shame talk.)

What can you do to make amends? (Apologize, plan how to change your behavior in the future, etc).

And, as always, practice self-compassion. Everyone makes mistakes. It's human to fuck up. You're still good enough and loveable, even when you fuck up.

So how do we sit with shame??

Like many other emotions:

1) Identify THAT you are feeling it in the first place. Name the emotion: "this is shame."

2) Notice where and how you are experiencing shame in your body. I often feel it as sweaty pits, red face, heavy heart, and difficulty breathing. It will show up differently for all of us. For many who have experienced trauma, shame comes with a hypoaroused collapsed state and dissociation (below the window of tolerance). Notice this.

3) Write down or name what thoughts are coming with shame. "I'm the worst, everyone hates me, I don't deserve what I have..."etc.

4) Separate those thoughts from the moment that triggered shame:

-Maybe you did something you regret, shift "I am awful for doing that" to "That was out of line with my values, can I apologize or do better in the future?"

-Maybe you were just vulnerable with a friend, and now are questioning your disclosure. How did your friend respond? Were they supportive? Are there signs you will be rejected? More likely than not, they responded well and were supportive. Check those facts, and remind yourself that you are worthy of love and connection.

5) SELF-COMPASSION. Remind yourself that we all experience shame, that it is related to our fear of disconnection and abandonment. Remind yourself that all humans make mistakes, it is human to be imperfect, and that imperfect connection is what we're here for. Go for a walk, take a bath, play with your dog...do something that nourishes your soul and shows yourself care.

Coping with Seasonal Depression

What is seasonal depression?

Depression that happens seasonally, of course. Typically, the onset is in the early fall with symptoms worsening throughout the winter months, alleviating in the spring and summer. Seasonal depression, officially called “seasonal affective disorder” tends to be more common in those with preexisting mental health conditions, as well as more common in people who live father from the equator.

Symptoms of seasonal affective disorder mirror major depression. They include: depressed mood, low energy, difficulty sleeping, changes in appetite, feeling irritable or sluggish, difficulty concentrating, hopelessness, feeling unworthy or excessively guilty and having thoughts of death/suicide.

What causes seasonal depression?

The causes of seasonal depression are not fully known. However, there are a few factors that have been identified which likely play a role:

• reduced sunlight in the fall/winter and the time change can upset our internal clock (circadian rhythm). This can impact sleep, which impacts almost everything else, including mood;

• with less sunlight, there may be a drop in serotonin which negatively impacts depression and mood;

• darker weather may trigger overproduction of melatonin, creating sleepiness and fatigue;

• vitamin D deficiency (which can be a cause of depression generally, but worsens when we are exposed to even less sunlight) contributes to depressed mood.

There may also be more behavioral or environmental factors:

• the tendency to be less physically active in fall/winter months;

• spending less time outside in the fall/winter (we know that nature is highly regulating to a nervous system, so less time outside negatively impacts mood);

• upcoming holidays (including family stress, uncertainty, grief, etc.) and also the passing of holidays (feeling we built up to something and now are let down that it’s over, disappointment, less to look forward to after the holidays for some).

 What helps with seasonal depression?

• light therapy (phototherapy): lightboxes mimic outdoor light, which may boost serotonin. Exposure to even artificial sunlight at the same time every morning may help reset and regulate our circadian rhythm, stabilizing sleep and therefore mood;

• medications (antidepressants, specifically SSRIs);

• vitamin D supplements;

  • *Talk to your doctor about any of the above before starting a course of treatment.

• Therapy! While the causes of SAD are partially biological, there is also a cognitive, emotiona and behavioral component. Therapy can help make those behavioral and cognitive changes that might help boost mood;

• body movement and exercise (naturally boosts serotonin levels and boosts mood);

• social connection;

• time outside in nature.

Do you struggle with seasonal depression? Find out more on the podcast!

Election Stress

We need a plan to cope with the election. It's going to be stressful, probably no matter what happens.

Questions for you to reflect on in the days leading up to and on election day:

On the news:

-how does reading/watching the news impact your thoughts, emotions and body?

-which news consumption platforms create the most and least stress? (TV news, newspapers, websites)

-which news outlets create the most and least stress? (CNN, NBC, Fox, NYTimes, local news outlets, etc.)

-how much time is too much time interacting with the news? how do you know when you've hit your limit? (body reaction, intense emotion, etc)

-how might you interact with the news for the next week in a way that keeps you informed but doesn't suck you into a doom spiral? It's going to be stressful as a baseline, so how you can interact in a way that cares for yourself within that stress?

On polls:

-if you read poll data, how does that impact your thoughts, emotions and body?

-what stories do you tell yourself after looking at polls?

-is that helping? hurting? how does looking at this data serve you?

On social media:

-what is your relationship with social media relating to politics?

-leading up to the election, how might you use social media to encourage people to turn out and vote?

-how do you know when you've been on social media too much? When this happens, how can you disengage and what else can you spend time doing?

On election day:

-how do you want to spend election day/night?

-Do you want to watch the vote counts come in live on TV? Or maybe do something else and check in with results periodically?

-We may not know the official results on election night. What time will you go to bed? What will help you get to sleep?

-Who can you be with, virtually or in person, for support the day of and days after?

Types of Trauma Therapy

Before I talk about types of trauma therapy, I’d like to address a question I get often:

what is "healed trauma"?

First, the word "healed" is tricky. It implies a complete end point, a place where the thing is over and we are done with it. These things don't happen. No matter how "healed" we are from anything, we will always be impacted by it. By no means does this mean we cannot heal trauma. It's just important to acknowledge that we cannot completely eradicate the lasting effects of trauma. That being said, we can CHANGE them.

While trauma is "unhealed", survivors may experience flashbacks, nightmares, hypervigilance, difficulty sleeping, difficulty concentrating, negative thoughts about themselves, feeling unsafe (in the world and in their own body), difficulty trusting, among other things. All of these experiences contribute to a feeling that *trauma* is in charge and is running your life. Trauma decides whether and where you go outside your house. Trauma decides whether and when you remember. Trauma decides whether, when and with whom you feel safe.

First and foremost, healing trauma is putting yourself back in the driver's seat. It is releasing trauma as the primary narrative of your life. There's a great quote from Michael Rosenthal:

“trauma creates change you don’t choose, healing is about creating change you do choose.”

I love this. Trauma healing is about empowerment. Regaining control where you didn't have it before, while also realizing that you'll never have full control of everything.

Trauma healing is about re-learning how to feel safe in your body, and in the world. It is about soothing and rewiring your nervous system. Healing is embodying an authentic sense of self, defined by YOU. It is living with purpose, meaning and connection.

And this healing is totally available to you. I know it.

So, how do we heal from trauma?

There are a million ways to heal trauma--and not one of them is the single “correct” way to go about healing. Different things work for different people, and I want to be clear that psychotherapy is only one factor in trauma healing. A short and incomplete list of other things that support trauma healing includes: social justice, supportive relationships, financial stability and a sense of purpose.

When it comes to therapy though, there are a lot of different approaches to treating trauma. Most therapists you meet will have an eclectic approach, meaning they will blend techniques and interventions from various different theoretical approaches. It's great to ask your therapist what approaches they draw from and what that means for your treatment.

Here are *a few* of the trauma treatment modalities you might run into:

Sensorimotor Psychotherapy (created by Pat Ogden): This is a type of therapy that believes that we store trauma in our bodies through procedural/implicit memory. When trauma becomes PTSD, it is (in part) because our active mobilizing defenses like fight/flight get truncated or are incomplete and subsequently get trapped in the body. Sensorimotor Psychotherapy interventions support regulating autonomic nervous system dysregulation, and help move that truncated defensive response through the body in a mindful way. This expands the window of tolerance and increases embodiment, empowerment and a sense of groundedness. A very similar approach is Somatic Experiencing (created by Peter Levine).

EMDR (Eye Movement Desensitization and Reprocessing; created by Francine Shapiro): EMDR also believes that trauma gets trapped in the body, along with deeply held negative beliefs about self and the world. This can lead to phobic avoidance of traumatic memory which is associated with symptoms of distress like intrusive memories, flashbacks, nightmares, avoidance of triggers, and negative thoughts about self. EMDR uses bilateral sensory stimulation (visual by tracking moving fingers or a light bar, or tactile, typically using light buzzers in each hand), memory recall, and grounding resources to reduce distress and desensitize clients to the traumatic memory.

TF-CBT (Trauma-Focused Cognitive Behavioral Therapy): This therapy asks, what negative beliefs or stories are you telling yourself as a result of the trauma? Examples: the world is not safe, this is all my fault, all people are dangerous. TF-CBT focuses on these thoughts and emotions to challenge these beliefs through both thought challenging and behavioral action.

[Personally, I like to use this in conjunction with SP so we can get at both the thoughts and body memories associated with trauma.]

Prolonged Exposure Therapy (PE): This is quite similar to phobia treatment. The idea is that we become phobic of traumatic memory, and that avoidance of the memory creates greater distress and exacerbates other symptoms of PTSD. PE therapists will help you create a list of graduated exposures (starting with least triggering to most triggering) to practice approaching triggers while using skills to regulate emotion. In PE therapy, you will also tell the story of your trauma repeatedly, again, to desensitize to the trauma memory. 

I won’t speak necessarily to the pros and cons of each type of treatment, because it really depends on the client, type of trauma, and clinician’s experience and training. What is most important when working through trauma in therapy is that you find a therapist you feel safe with, who can explain their treatment frame to you, and that their treatment frame resonates for you. If these factors are in place, then likely any of these modalities are likely to be effective for you.

There are also quite a few therapies that don’t necessarily conceptualize trauma specifically in their literature, but are still quite supportive in healing from trauma. These include:

-Yoga therapy

-DBT (Dialectical Behavioral Therapy)

-CBT (Cognitive Behavioral Therapy)

-ACT (Acceptance and Commitment Therapy)

-IFS (Internal Family Systems therapy)

This is by no means a comprehensive list. The treatment frames listed above are ones that I have training in or am familiar with enough to be able to speak on them. There is no one right way to treat trauma, it's about finding what works for you. As I said before, healing is totally available to you. I know it.

Suicide Prevention

It is a complete myth that talking about suicide makes people more likely to die by suicide. In fact, it is the EXACT OPPOSITE. Knowing about suicide risk and protective factors, ways to intervene if someone is suicidal, and how to talk about it actually make it more like that the person will seek and find help. So, we’re here to get you educated! Watch out for each other. If you notice warning signs in someone you know, don't be afraid to talk to them about it.

SUICIDE RISK AND PROTECTIVE FACTORS

Risk factors for suicide include:

-prior suicide attempts or self-harm

-abuse of drugs or alcohol

-mental health diagnosis (ex: depression, bipolar disorder, or PTSD)

-access to means of suicide (medication, firearms, etc.)

-social isolation

You might not always see or know about someone's risk factors. What you might watch for instead, are warning signs like:

-talking about feeling like a burden

-feeling hopeless or worthless

-talking about giving up, feeling trapped, or that pain is unbearable

-reckless behavior and/or increase in drug/alcohol use

-withdrawal or isolation

-depressed mood, or mood swings

-sleeping too little or too much

-giving away belongings

Protective factors include:

-access to and engagement in mental health treatment

-coping skills

-connection to social supports (ie: friends, family, community)

-focus on the future, hope for the future, a feeling of meaning in life

WHAT TO DO WHEN SOMEONE IS SUICIDAL

Know that if you see one or two of these risk factors or warning signs, it doesn't necessarily mean the person is suicidal. It means they might be at an increased risk. When you see one or more of these factors, check in with the person! You can ask “how are you doing?” as a general opener. Depending on their answer, you can ask

“are you having suicidal thoughts?”. THIS IS AN OKAY QUESTION TO ASK. It won’t make them think “oh man, I hadn’t thought of that, what a good idea!” They will either say “no”, or, “yes”.

If they say no, still give support! If those warning signs are present, the person still needs care and compassion.

If they say yes, ask whether or not they have a plan. If they do, ask whether they have the means for that plan (i.e.: if their plan is to overdose, do they have the medication on hand? how much? what medication?) and if the answer is yes here, either support the person in calling a crisis hotline, getting to the hospital, calling 911, or asking if you can hold onto their means for a little while (only if you are comfortable with this last option, of course). These are all great ways to get someone immediately safe when they are at imminent risk of suicide.

If you’re not sure what to do when someone says they are suicidal, you can also call the crisis hotline. They can talk to the person, or walk you through how to be supportive and keep the person safe in their specific situation.

National Suicide Prevention Lifeline: 1-800-273-TALK

Individually, person by person, is one way to prevent suicide. We are all responsible for checking on each other and doing what we can to ensure safety. However, we can also do things on a community level to prevent suicide.

PREVENTING SUICIDE ON A LARGER SCALE

1. Fight mental health stigma to increase the likelihood that people seek help. This means talking about mental illness and suicide, using compassionate language, and learning about mental health. The more we normalize mental health concerns, the more people will get the support they need.

   • AGAIN: When it comes to talking about suicide and self-harm, it is a myth that talking about it makes it worse. It is actually the opposite: talking about it makes it okay to talk about, which can save lives.

2.  Decrease access to means for suicide attempts. Individually, this can mean taking/locking up possible means like sharps, medications and firearms. This also must happen on a societal level....Let's talk about gun control. More than half of suicide deaths occur by firearms, and nearly two-thirds of firearm deaths are suicides (not homicides). We know that restricting access to means of suicide reduces risk, and guns are the most lethal means--reasonable gun control laws will help reduce suicide rates.

   • Types of laws that help: permit-to-purchase (or PTP), waiting periods, child access prevention and extreme risk protection orders (ERPOs). Read more here: https://americanhealth.jhu.edu/article/how-do-gun-laws-affect-suicide-rates

3. Increase social support. Reduce isolation and promote belonging for *everyone* and suicide rates will go down. When we are well connected and feel loved, suicide risk is greatly decreased. Individually, this means care for and check on your people. Ask how they are doing and don't be afraid to ask them directly about suicidal thoughts if you're worried. Help them get to therapy. Be good and kind. This also needs to happen on a cultural level. We need to be an ally to communities where suicide rates are proportionately higher: indigenous people and LGBTQ+ youth. We also need to maintain connection for older adults as they age--this period of life is the riskiest for many.

4. Share resources so help-seekers know where to go for support. Psychology Today, Open Path, NAMI are all great places to start searching for a therapist or support group.

5. Advocate for mental health services. Vote for public service agents and support measures that increase access to mental health care.

If you're worried about someone, talk to them! If you can, support them in finding the help they need. Great places to start to get help are a Psychology Today search in your zip code, Open Path for low cost counseling, and the National Suicide Prevention Lifeline (24/7) 1-800-273-TALK or the Crisis Text Line text “home” to 741741 for 24/7 crisis support.