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?

Protecting Your Mental Health During Trauma

We are in the middle of a worldwide trauma.

COVID-19 is scary. It's a trauma we're all going through. (Not to mention all the other global traumas that are happening right now…)

I certainly don't want to amplify this fear...but I do want to acknowledge that reality is scary right now. It is downright traumatizing. Whether you name it as trauma for yourself or not. We are all impacted.

I see more "existential anxiety" showing up in my office. I'm spending more sessions talking about politics, climate change, & generalized FEAR. More of us are feeling unsafe & afraid.*

[*Much of this is not new to BIPOC, LGBTQ+ folx, & those in marginalized communities. That fear has been present for a long time, & it should have been named & changed a long-ass time ago. What I'm noticing, I think, is that those with privilege, myself included, are finally waking up to fear as well.]

Effects you may notice:
-overconsumption or avoidance of the news
-feeling unsafe in public
-trouble sleeping
-fear/dread about the future
-hopelessness
-suicidal thoughts
-rage
-distrust of other people
-helplessness

You are not alone.

Trauma leaves us feeling hopeless, powerless & overwhelmed.

Actions that might help:
-seeking safety & connection with those you love
-move your body, drink water, & try to get good sleep
-setting boundaries with the news
-having important conversations about the issues we're facing as a species
-BUILD COMMUNITY AND CONNECTION
-voting, donating, protesting, advocating, using your voice--whatever you can to do ACT about the issues you care about.

These actions help build hope and help you feel that you have some power (by focusing on what you can do to impact the future), as well as help regulate your nervous system. Not only are these ways that we can keep trauma from having massive lasting effects, they are also ways we can make the world a better, less scary place.

I don't have all (or really any) answers. I'm afraid, too, and trying to figure out how to navigate this. What I'm focusing on is staying connected to other people however I can; listening to fear &regulating my nervous system.

I am here with you. I don't know. How are you dealing with things?

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.