Coping Skills

Coping with justified sadness

Note: this post talks about death and mentions brain injuries, a car accident, and bodily functions. Note 2: this post was written and edited over a couple years, so some examples from my life were written at different times. 

My DBT skills book gives suggestions of what to do when an emotion is justified (i.e. it fits the facts of a situation). However, I don’t really like what it suggests for sadness and would like to add on to it.

Sadness is justified when something important is lost or missing. When sadness is more intense, it is often a signal that the thing lost was very important. For example, sadness is justified when a loved one dies, when your life is not what you expected it would be, when you realize a parent has not really been a parent, and in many more situations.

The DBT book (DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan) suggests the following (on p. 243):

  1. Grieve; have a memorial service; visit the cemetery (but don’t build a house at the cemetery).
  2. Retrieve/replace what is lost.
  3. Plan how to rebuild a life worth living without the beloved or expected outcomes in your life.
  4. Accumulate positives.
  5. Build mastery: Do things that make you feel competent and self-confident.
  6. Communicate need for help.
  7. Accept help offered.
  8. Put on rose-colored glasses.

I would like to add on some other things:

1. Radically accept that this is the way it is now.

Change starts with accepting the reality of now so that you can identify what is wrong.

Example 1

For example, my uncle and grandmother passed away in January 2019. I cannot change the fact that they are gone. I am still sad, and my family feels very small all of a sudden.

Example 2

Another sad thing that I’m working on radically accepting is that my dad had a brain injury after our car accident. He is more easily angered now than he was before the accident. He is forgetful and often repeats himself without realizing it. He forgot to pick me up from school (back when I was in high school). He forgets important personal information that I have told him about my life, like what classes I’m taking (despite the fact that I FaceTimed my family every day when I was at college and talked about my classes all the time), what I’m majoring in, and that I have dietary restrictions.

In family therapy, I had long conversations with him and my mom about what information they were allowed to disclose to their friends about my mental health and treatment. My dad broke our agreements several times, telling several almost-strangers that I was in a partial hospital program and that I was depressed. Despite reminders and more discussions after these incidents, he has continued to breach our agreement. He seemed to be genuinely confused and thought that he was following the agreement. Regardless of the reason for all this, I’ve decided I can’t trust him with personal information anymore. This is sad to me because I’d like to have more of a relationship with him, and due to his brain injury and other pre-existing problems, that relationship is missing.

Example 3

On perhaps a smaller scale, another thing I’m radically accepting is that this summer [note: I wrote this part in summer 2019, but some of it applies to summer 2020, too] hasn’t been what I wanted it to be. I didn’t get an internship. I’m living at home when I’d rather be living with my friends near my school. I haven’t seen many friends this summer — they’re all off in different places. Despite working so hard on my ptsd, I’m still depressed. This is the way it is right now.

2. Mourn and grieve by expressing through art

People have told me that it’s okay to grieve, but I haven’t heard many examples of how to actually do this. The DBT book isn’t very specific with this, either, apart from the suggestions of holding a memorial service and visiting the cemetery. I sometimes find myself full of valid, justified sadness and I don’t know what to do with the emotion. 

One thing I’ve found that I can do is to express myself: express what I’m feeling, what has happened, where I’m at. And one way to do that, for me, is through drawing or art. It helps me see things visually/spatially and make sense of them a bit. 

Example 1

I drew this when I was feeling sad in the weeks after my uncle and grandmother died. 

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My drawing of people walking around and being sucked into a black, spiraling hole, with this quote around the edges: “Where you used to be there is a hole in the world, which I find myself constantly walking around in the daytime, and falling into at night.” -Edna St. Vincent Millay

Example 2

Due to digestive issues, I can’t eat many of my favorite foods. I drew the foods I miss most on gravestones. Seeing them like this makes me laugh a bit and also reminds me that I am grieving the loss of my favorite foods. It is a loss. Even though it doesn’t affect me as much as the deaths in my family, it makes me sad. I really do miss these foods. 

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My drawing of chocolate chip cookies, ice cream, pasta with tomato sauce, and brownies on gravestones

Example 3

At the beginning of the pandemic, I was struggling with all the death. The news kept talking about so many people dying. And someone died close to where I live in a violent way that got in the news. Then my mom’s friend’s father died of Covid. To try to process these deaths, I made a little house/box thing. I wanted to do something using my hands. I made steps going up to it. Inside, I made chairs and wrote “House of Mourning.” I cut out people and wrote the appropriate names on them, and I sat them down on the chairs inside the house.

Now they have a place to go, even if it’s only their name on a paper version of them in a paper house. It makes me feel better. It’s a way of acknowledging their deaths. I acknowledge that they have transitioned from living to dead by physically placing them in the house. There are chairs there; it’s a nice place to be. Since I’m not religious right now (and haven’t been for the past couple of years), it’s kind-of a non-religious alternative to the comforting belief that the deceased are happy up in heaven with the other people who have died. It’s a way of making sense of it and processing it. 

I’ve also placed some other things (not people) in my House of Mourning. I just wrote them on pieces of paper and put them in the house. They are: my dad not acting how I want him to as a dad; loss of certainty; and summer 2020 in the place I wanted to live this summer with my friends. When I write them out and put them in the house, I acknowledge that I am mourning them. 

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The paper house of mourning I made with people and things inside

3. Identify smaller qualities or aspects of the big thing that is lost or missing, and then problem-solve to see how you could put them back in your life.

When something important is lost or missing, there is usually some sort of underlying need that is no longer being filled. I know that you can’t replace a person, and it makes me feel a little disgusted to think of trying to do that. That’s not what this is, though. It’s just making sure that you’re still getting the things that you need and finding ways you can still live a life worth living without the important thing in it.

Example 1

For example, I’ve had to stop eating a lot of foods that I really like due to acid reflux. I can’t eat chocolate or dairy, so that eliminates most desserts. It was especially bad in the summer [2019] when I really craved ice cream and everyone around me was eating it. I can’t eat tomatoes, which eliminates a lot of pasta options and tomato soup. There are so many foods I can’t eat, but I don’t feel like listing them all. This may seem like not as big a deal as some other things, but it really does make me sad that I can’t eat my favorite foods anymore, and I’ve decided I’m grieving this, and I’m going to let myself actually be sad instead of invalidating my sadness. (note: bodily functions) I have tried to eat these foods again and have had diarrhea for two days afterwards each time. Thats no fun! 

So, I’ve been trying to think of what, exactly, is missing and how I can replace it. I think what’s really missing are good, sweet foods for a special treat or occasion. It’s taken me some time to come up with good replacements, but I’ve found that sugar cookies are delicious and edible to me. Peanut butter cookies are also good. My mom made me a carrot cake (with sugar icing, not cream icing) for my birthday. I can eat lollipops, smarties, lifesavers, and butterscotch instead of chocolate when I want candy.

Another thing that’s missing is the social connection from eating foods together [pre-pandemic]. I have to say no to offers of many foods, and it makes me sad to not be able to connect with my friends over liking good food. I haven’t come up with a solution to this one yet. I guess we can still enjoy other things together. 

Example 2

With my grandmother and uncle gone, and no grandparents left at all, one of the things I’m missing is some older person who will check in with me every now and then about casual things / general life stuff and be kind-of protective and warm. One of my aunts (the one that didn’t lose her husband (my uncle)) has kind of stepped into this role on her own. She called me last January [2019] after the deaths and left me a very kind voice mail message when I really needed it, and even said I didn’t need to call her back. She visited me at school and made sure we took pictures. She sent me an article she thought I would like. She’s more of a part of my life now than she was before all the deaths. I think that that awful time has brought my remaining family closer.

Another issue is that my family feels very small now. It doesn’t feel like there are enough people in it. One way I can make it bigger is by getting married. This is a long-term goal. I’ve never even dated someone. But it’s nice to know that there is a way that families naturally grow. People die, and families shrink. People get married or are in long-term relationships, and the partner and partner’s family are added to the family. Babies are born or kids/babies are adopted, and families grow. I’m not ready to get married right now, but it’s nice to know that I can someday and bring more people into my family’s network. 

4. Allow for time for sadness AND time for other things

Sometimes sadness and grief can be overwhelming. It can easily consume my whole evening, if not my whole day, or week. Sometimes that is not helpful. I say sometimes because sadness serves an important function, too. Sadness makes people ruminate, which can be helpful because people can process things and realize what they are missing. Sadness can also encourage people to try to get the things they are missing. Studies have shown that sadness can improve memory, judgement, motivation to get the missing things, and social attentiveness (source). Other studies have shown that depression can make people more analytical and allow people to gain insight to their problems (source).

But, it’s generally not good for me to be sad, grieving, or depressed all day. There are generally still things I need to do, like eating, cleaning, talking to people, going to appointments, or going to school. 

Example 1: 20 minutes of sadness a day

A therapist I used to have suggested I do “20 minutes of sadness a day.” I was supposed to set a time, like 4 pm, when I planned on being sad. And then when that time came, I tried to not push away the sadness and let myself be sad. I tried to “ride the wave.” Sometimes I cried. It was useful to take the time to acknowledge the sadness. It’s similar to having a “worry time” where you dedicate time to worrying so that you don’t have to worry during the rest of the day. It is more contained. 

The hardest part about this for me was stopping being sad and moving on when the time was up and my alarm went off. I was supposed to use opposite action (because sadness is valid and justified but not effective in this moment), but I normally had a hard time getting out of bed and would just keep lying there for an hour. I think it would have been better if I had tried having 20 minutes of sadness while sitting up, instead of lying down, and for less time, so that I didn’t get overwhelmed by the sadness. 

The general idea behind 20 minutes of sadness can be altered a lot. It could be any amount of time, even a few seconds to just acknowledge the sadness that is there. I prefer just doing “STUN waves,” noticing my sadness come and go, acknowledging it, and validating it. It could also be in any form. People could write in a journal, talk or write to a missing person, pray, make art, meditate, do any of the ideas above, etc.

It’s important for me to allow for time for sadness and then also acknowledge that other things may need to be done. I can temporarily move on from the sadness, knowing that I will come back to it later and am not ignoring or forgetting about it. 

In contrast to feeling the sadness, I try to identify positive things. Oftentimes, things are not all bad. Sometimes I am overwhelmed by sadness and forget everything else. Trying to make an effort to notice good things, like sunsets or flowers, can be helpful. I also try to add enjoyable things into my days using DBT’s “Accumulating Positives” skill. I make plans to do things like hang out with friends, watch a good movie, and take some time to do art. These things can also help with opposite action when I am trying to come away from the sadness and back into the rest of my life. It helps to have plans to hang out with friends, do other fun things, or just to notice the positives after having my sad time.

Sometimes happy things make me sad. Maybe someone I miss isn’t here to enjoy this with me, or I used to be able to do x fun thing but now I can’t because of illness. If they make me sad, that’s okay, too. I acknowledge that and let my joyful memories turn blue with sadness. 

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Sadness turning joyful, yellow memories blue. (screenshot from Isaac Carlson’s video “Why Does Sadness Turn Memories Blue? | Pixar Theory: Discovering Inside Out,” originally from Pixar’s movie Inside Out.)

Example 2: Grieving periods

Some religions have set grieving periods. In Judaism, during the first week after a funeral, the shiva, people mourning are allowed to withdraw from life, and their needs are met by the community (people bring them food, etc.). In the next phase of mourning, sheloshim, people gradually return back to “normal life.” I have a couple friends that are Jewish and have followed this process of mourning after a death, and it seems to have been a good way for them to take time to process their grief. I think that taking some time off work/school, or even just giving yourself a break to allow yourself to grieve (any loss, not just death) can be helpful, too. Gradually returning to activities is an important part of it, too. It is “moving forward,” not “moving on.” 


So, these are my strategies for how to cope with justified sadness. 1) Radically accept that this is the way it is now. 2) Mourn and grieve, maybe by expressing things through art. 3) Identify smaller qualities or aspects of the big thing that is lost or missing, and then problem-solve to see how you could put them back in your life. 4) Set aside time to feel sad, and time to focus on other things. They seem to be helping me.

How do you deal with sadness?

Affirmations

Affirmation #18 — I have gotten through this before, and I will get through it again

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I have gotten through this before, and I will get through this again.


Some of the things I struggle with come up again and again. (note: mentions of self harm and suicidal urges) I think that I did something wrong, I feel intense shame, and I want to hurt myself. I haven’t been sleeping or eating enough, haven’t seen my friends in a while, feel like I never get a break from the grind, and nothing is pleasurable anymore. I get my period, and the pain is so bad that I want to die. A trauma reminder comes up, and I feel so scared and overwhelmed.

In times like these, I find it helpful to remind myself that even though it seems overwhelming, awful, and like it will never end, it has ended before. I have gotten through these things before and come out on the other side. In fact, I have coped well in healthy, effective ways! I am capable of managing this.

I have dealt with strong emotions before, and I will deal with these ones, too. I have gotten through the before, and I will get through it again.

Life, Therapy

What trauma feels like (for me, for now)

(This is about trauma and talks about death, with mentions of self harm and suicidality.)

I’ve had lots of upsetting things happen recently — my mom lost all the hearing in one of her ears suddenly, my uncle was dying and then died, my grandmother was in the hospital and then died — those are the main ones, but my great uncle also died, my aunt’s neighbor died, my family has been very chaotic… taken all together, within a month, it’s traumatic.

I’m used to PTSD and the anxiety, nightmares, intrusive thoughts, and flashbacks as a result of that. But with PTSD, it’s post-trauma. I can use opposite action to face fears because I know (at least, rationally) that I am safe now. I can ground myself in the moment with phrases like “this reminds me of something scary, and, in this moment, I am safe.” I can point out the ways that this situation is different from the traumatic one.

Now it’s different. I’m not living in PTSD anymore; I’m living in trauma. It is happening now.

Trauma is something that overwhelms your ability to cope, something that threatens your life or that of someone you love. These events have definitely overwhelmed me: I feel like everything is “too much” very often; I’ve developed new self harm behaviors; I fantasize about dying to escape it all; accomplishing little things, or even getting out of bed and getting meals, are hard. And the lives of people I know and love were threatened and taken.

I know that my subconscious agrees that I’m overwhelmed because my PTSD (from a car accident) has disappeared. I’ve heard that having flashbacks means that your body and brain are ready to process through the trauma that you couldn’t process at the time. Well, clearly my body isn’t well enough to process old trauma anymore. I’ve had one night of traumatic nightmares and intrusive thoughts relating to the accident in the past few weeks. Just one! I suppose I should thank my body for this, for not giving me even more distress that I’m not capable of handling.

On the other hand, I have had nightmares, intrusive thoughts, and lots of strong anxiety, sadness, and other emotions about the current issues.

And when I have startle reactions, like when the phone rings, or someone knocks on my door, or I hear indistinct raised voices, or my mom texts me, those reactions are actually the response that is needed in that situation. It’s not a post-trauma startle reaction. It’s not out of place. It’s serving an essential purpose. It’s getting me awake from my slumber so that I can drive my mom to the hospital. It’s preparing myself for the news that my grandmother died.

This trauma is happening now. It’s awful. Here are some other things I’m experiencing that help show what this trauma feels like.

  • Constantly high anxiety
  • Checking the facts and finding that the intense emotion is justified: people are in danger.
  • Screaming when startled
  • Splitting headache
  • Not knowing what will happen
  • Feeling like my world is collapsing around me
  • Trying to maintain any sense of constancy in my life
  • Things so chaotic that I don’t know when I’ll next eat
  • Expecting my life to be turned upside down and inside out multiple times in the near future
  • Having to always be ready to drop everything for my family at a moment’s notice
  • Waking up to my mom calling me saying she’s in the emergency room
  • And not being fazed by it because it’s become so commonplace — constant danger is the norm
  • Dissociating so much that I can’t read more than a couple of sentences
  • Dissociating the moment I consciously try to stop avoiding emotions
  • Dissociating in order to survive — because if I don’t, my emotions are unbearable, and I get very suicidal, or can’t eat, or can’t get out of bed — so, dissociating is keeping me alive
  • Needing to use my crisis survival skills toolkit many times every day
  • Almost always wanting to die
  • Crying when I didn’t call my mom because I think that if I don’t call her, someone will die — and then having my grandmother die the next day and confirming my worry
  • Not knowing where I am
  • Not being able to participate in a normal, casual conversation because everything reminds me of the awful things going on, and I don’t want to talk about them
  • All of my thoughts leading back to the trauma
  • Saying “HELP” inside my head or writing it on paper or my skin frequently
  • Wanting very badly to be able to escape and not being able to

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my life is full of holes