Karen Kleiman MSW, LCSW
This Isn't What I Expected
Tips for Coping With Scary Thoughts
Learning how to slow down anxiety.
Posted Dec 11, 2014
Many women experience scary thoughts during the postpartum period. In fact, it has been estimated that as many as 91 percent of all postpartum women experience negative, unwanted, intrusive thoughts about their baby (Abramowitz, 2003). That’s almost all women who have a baby!
Due to the extremely high degree of distress associated with scary thoughts, it’s hard for many women to know how to get some relief.
Start with these eight principles:
- Denying the feelings and thoughts will not make them go away.
- Panicking will make it worse.
- Resistance creates persistence.
- Distraction will help for a while.
- Enhancing awareness might feel counterintuitive, but it is meaningful.
- Acceptance is hard but essential.
- Letting others know can ease the burden.
What Won’t Help
One of the first responses reported by postpartum women with scary thoughts is denial. Maybe if I just pretend it isn’t happening it will go away. Denial serves to emotionally protect people. In some instances, it can be temporarily adaptive, as when someone is forced to deal with the reality of unbearable news. Likewise, this common psychological defense seems to soften the blow of scary thoughts. However, if over time, when someone refuses to or simply cannot accept the certainty of a situation, denial is viewed as maladaptive. Because scary thoughts are so often accompanied by feelings of shame and the belief that one is damaged in some way, they often are wished away with fierce determination. Many women who are having scary thoughts believe it would feel better to pretend they weren’t there. However, this doesn’t work.
Most postpartum women will admit that their initial instinct is to suppress the thought; quite simply, they want to make the bad thought go away by trying not to think about it. The notion that it is unhealthy, and even dangerous, to stifle emotions and bottle them up inside is not a new one. But the message here is important: The instinctive response to control a scary thought by holding it in or concealing it, typically backfires and makes things feel worse. Persistence creates resistance; the more you try to push thoughts out, the bigger they get.
Panic and negative thoughts have a reciprocal relationship; that is, one often leads to the other. Knowing this can promote both awareness and management of the scary thoughts. If a postpartum woman is in treatment for anxiety or depression, she will notice that as her anxiety is successfully managed, her scary thoughts will likewise decrease in degree and or severity. This is because it is not the content of the scary thought that is noteworthy; rather, it is the level of distress it causes. Thus, even though a woman may be preoccupied with the content—Why would I have a picture in my head of my baby tumbling down the stairs?—trained clinicians will focus their intervention away from the specific content and toward treatment of the anxiety.
What Will Help
Although it may sound psychologically unsound, distraction has actually been shown to be an effective intervention and has been associated with the reduction of a distressed mood. At first glance it may seem similar to denial and thus, be counterproductive; however, distraction has been shown to temporarily interrupt the loop of negative thinking. This is not the same thing as avoiding its presence. Rather, it is a way for you to remain in the stressful situation by coping with it.
If you are terrified of your own scary thoughts, can you really distract yourself from this uncomfortable mental state? Yes! When you feel fear taking hold, do something that feels manageable. When you engage in work or activity that feels manageable in the present, you minimize your involvement with anxiety-generating thoughts and images and keep the mind actively focused. Your body is then able to settle down a bit and you will feel more in control.
Here are just a few examples.
It can be pleasing:
- Flipping through a magazine
- Listening to music
- Making a phone call to a friend
It can be absorbing:
- Engaging in work-related projects
- Planting in the garden
- Helping a neighbor
- Making a scrapbook
- Playing computer games
It can be detailed-oriented:
- Doing puzzles or playing games
- Counting the tiles in the ceiling
- Counting backward by threes from 100
It can be physical/bodily:
- Snapping a rubber band on your wrist
- Visualizing and repeating the word STOP
- Splashing cold water on the face
- Gently slapping your cheek
- Talking or reading aloud
It can be energizing:
- Taking a brisk walk in the sunshine
Breathing, Relaxation, and Mindfulness
When the mind is anxious, the rest of the body kicks into high gear. The heart starts pounding, breathing becomes rapid and shallow, muscles tighten, and one can feel dizzy or disoriented. In addition to the emotional strain and impact on negative thought processes, anxiety can deplete energy reserves and cause a host of physical, emotional, and cognitive problems, such as: restlessness, irritability, fatigue, achiness, sleep problems and difficulty concentrating. It follows then, when one is a chronic worrier, her body remains in a fixed state of tension. This is why so many anti-anxiety strategies emphasize relaxation techniques. They reverse these reactions. When in a relaxed state, the heart rate slows down, breathing becomes deeper and slower, muscles loosen, and blood pressure stabilizes. Learning to breathe in a controlled manner and refine your relaxation response takes time and practice, but it can pay off both in the short and long run.
Journaling. Another self-help strategy that has proven to be useful is writing things down or journaling. Journaling can be a good tool for self-examination and expression.
Support Groups. Support groups for women with postpartum anxiety or depression can help by reducing the debilitating isolation of suffering alone. It can be enormously comforting to find others sharing common anxieties who can relate to the concerns you are having.
And finally, since scary thoughts are a symptom of acute anxiety, remember to take care of your S.E.L.F.
Listen to those who tell you to take care of yourself. Things that seem way too obvious to be helpful can make the difference between a good or bad day. Keep the S.E.L.F. acronym in mind to help you remember the important elements of self-care:
SLEEP: Lack of sleep will make anxiety and depression worse. You might need to rearrange things or ask for help, but ensuring that you get a good night’s sleep is essential to the management of anxiety symptoms. It goes without saying that the baby’s sleep is intricately connected to your ability to get a good night's rest. Studies have shown that when infant sleep is problematic, sleep intervention strategies can benefit both baby and mother.
EXERCISE: Moving your body, even when you don’t feel like it can make a significant difference in the way you feel. Exercise can help diffuse the adrenalin produced by anxiety, ease muscle tension and promote better sleep. It also enhances well-being by the release of endorphins, the chemicals in our brains that are associated with feeling good. It has also been shown to make a significant difference for women with postpartum depression and anxiety. Even though it is not easy to do when you are overwhelmed and overloaded, small steps can make a difference. A little bit of exercise is better than none. Much of the research focuses on exercise and the improvement of depression levels during the postpartum period, but given that exercise works to combat anxiety in general, it makes sense that it could be an advantageous distraction from scary thoughts.
LAUGH: It feels good to laugh. Laughter exercises the abdominal muscles and lungs. During a hearty belly laugh, the heart rate increases quickly. A pioneer in the research of laughter, William Fry observed in his own experience that after one minute of hearty laughter, his heart rate was equal to the rate he achieved after 10 minutes on a rowing machine. Several studies have demonstrated a significant and physiologic impact on the body’s immune system. Laughter has been shown to lower levels of adrenaline and cortisol—hormones that are released in times of stress—and to raise levels of endorphins. Fry claimed it took 10 to 15 strenuous minutes on a rowing machine or stationary bike for his heart rate to reach the aerobic equivalent of just one minute of vigorous laughter! If you find that laughter is difficult for you, try a “half-smile,” such that you curve the corners of your mouth upward. Your facial expressions are hard-wired to your brain, so turning to corners of your mouth upward sends signals to the brain to feel good.
OOD: Modifying your diet can help reduce anxiety symptoms:
- Eat more frequent small meals. This can help stabilize blood sugar. Swings in blood sugar can cause symptoms that mimic anxiety, such as lightheadedness.
- Drink lots of water. It has been shown that dehydration can affect your mood.
- Complex carbohydrates (whole grains) can increase serotonin, which is associated with feelings of calmness.
- Restrict simple carbohydrates (sugar).
- Consumption of processed foods and high-fat dairy has been linked with higher levels of depression and anxiety. The recommendation is for an increase in fruit, vegetables, and fish.
- Avoid alcohol.
- Avoid caffeine. Caffeine can exacerbate anxiety and interfere with sleep.
If your symptoms of anxiety cause significant distress and interference in your life, then a professional treatment approach might be a better choice for relief of your symptoms.
Adapted from “Dropping the Baby and Other Scary Thoughts" by K. Kleiman & A. Wenzel (Routledge, 2010).