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Rescue remedy

Calmly accepting emotional distress rather than telling yourself to harden up and get over it can help you cope with life’s ups and downs, MiNDFOOD reports.

Rescue remedy

On holiday in Oxford, I was making sedate progress down the Isis river in a punt. My brother, a lawyer, was propelling the boat forward with a pole while I kept an eye on the scenery. A relaxing scene and yet we had the most intense conversation. “I wouldn’t have the patience to be a psychologist; I’d want to tell them to get over it,” my brother said in his matter-of-fact way. When I asked him how exactly people could get over it (‘it’ being everything from problem drinking and gambling to anxiety, depression and stress), he replied, “Discipline and willpower.” This line of reasoning annoyed me but it also made 
me think: is the solution to life’s slings 
and arrows to harden up and move on?

In our culture, people see themselves as weak if they experience emotional issues they cannot fix on their own and many believe people with emotional problems have some sort of deficiency.

If you’ve grown up in a culture where emotion has not been validated and simple solutions like ‘get over it’ have been the norm, it is hard to know your own feelings. Similarly, if you’ve grown up in a family where emotion is dismissed or criticised, it is difficult to know what to do with unpleasant, intense feelings when they arise because they are somewhat taboo.

Cultural factors can play a part too. 
I am amazed by the number of clients who tell me that their closest friends – and even their partners – are unaware that the client is fighting a daily battle against depression or anxiety. This, more than anything else, tells me that as a society we struggle to acknowledge emotions we deem unacceptable in ourselves and in others.

So if we do in fact have a harden-up culture in our society, what problems might that lead to?

By not accepting that negative emotions are part and parcel of the human experience and assuming that strength is equal to hiding negative emotion and moving on, we begin to blame other people and call them weak, pathetic, stupid and other such pejorative terms. We also assign labels such as “they have had a breakdown”, which essentially means “this person is fundamentally different to me”. This behaviour causes us to ignore commonalities among us. I, and many other health professionals, would argue that our experiences lie on a continuum and most of us have had the experiences 
of feeling sad, anxious or like we want 
to eat everything in sight to distract us from our feelings.

Health agencies have been trying to lessen this harden-up culture for years, providing information on statistics that show many of us have been, or will be, affected by emotional distress (be it depression, anxiety, substance disorders or eating disorders), and that there is no shame in seeking and getting support.

In the New Zealand Mental Health Survey published in 2006, the estimate for lifetime risk of having any mental health diagnosis by age 75 was 46.6 per cent. So almost half of us will experience a diagnosable condition and this does not include those of us experiencing distress who are ‘sub-threshold’ – that is to say, still unhappy but not meeting criteria for an illness. New Zealand research indicates that this category could add a further 25 per cent of us to the total.

When we are in pain we naturally look for quick relief. I’ve observed in myself and others that we’re often on the lookout for quick fixes such as taking a pill for our headache rather than looking at what caused us to have a headache in the first place. While a headache pill occasionally can be helpful, if this is occurring on a regular basis, it might be worthwhile to take a look at the bigger picture.

Unfortunately, some people use the relatively new science of positive psychology as a rationale for trying to eliminate negative emotion. I often see people who espouse such beliefs as: “I must be the best I can be” or “negative emotion is irrational” and believe that there is no place in their lives for negative emotion.

People looking for happiness might assume that it can be a constant state, while trying to eliminate low moods and anxiety from their life altogether. While I am all for optimistic beliefs, we must be cautious that they are not at the expense of recognising and accepting that everyone, however successful, will have times of emotional distress. I am not suggesting that we go to the other extreme of allowing emotion to control us. Rather, it’s important to acknowledge that cultural beliefs can be internalised, leading people to believe there is something wrong with them if they can’t maintain a constant state of happiness.

Many of my clients come to therapy because their usual method of problem solving (including the strategy of ‘get over it’) doesn’t work anymore. It makes sense that if we believe we shouldn’t have the thoughts or feelings that we are experiencing, we would attempt to suppress or ignore these feelings. In fact, this strategy sometimes works with other areas of life, for example, we can ignore people we don’t like and they get the message and leave us alone.

THOUGHT SUPPRESSION AND EMOTIONAL AVOIDANCE

The academic literature on thought suppression (trying not to think certain thoughts), tells us that when thoughts are suppressed they are paradoxically more likely to intrude in our thinking. Similarly, trying not to feel an emotion (emotional avoidance) makes it more likely that the emotion will lie dormant in the short term, but catch us out in the long term. Try it now: try not to think of a zebra for the next 30 seconds. What happens?

If blaming, quick fixes and avoidance of emotion do not work for you in the long term, what will? Strategies for coping with life can generally be divided into two areas: active and passive/avoidant. In active coping, a person tries to change the situation that is causing them stress or attempts to change the way they think about it to ameliorate their distress.

In passive coping, a person might engage in behaviours (such as getting drunk or over-eating) that distract them from their situation, but that do not solve the problem. Unsurprisingly, it is thought that active-coping strategies are better than passive in terms of long-term psychological health. Whether a person uses active or passive coping depends on a number of factors including their personality, family history and culture, and the type of stressful event they face. Most of us will engage in a mixture of both types.

Within the active-coping category, there is a further distinction to be made. People can either use problem-focused coping or emotion-focused coping. In problem-focused coping a person might list the problems they have, the options for solving those problems, and then weigh up the options to come to a solution. This method of coping is ideal for practical problems that have a solution. However, it starts having limitations when the problem is not immediately solvable, for example if a close friend has just died, you’ve been made redundant or you are newly confined to a wheelchair. In these situations emotion-focused coping comes in to play. Emotion-focused coping is about regulating your emotional response to a stressful event through a variety of methods.

So how can you boost your emotion-focused coping? You can start by noticing the emotion, acknowledging it without judgment, using distraction when necessary, being mindful of your internal state, and not acting on the emotion (rather than attacking when angry and sending an email that you’ll later regret, notice the anger and do something else). You could also practice radical acceptance. The goal with emotion-focused coping is acknowledging that emotion is present and acting effectively.

Rather than trying to ignore (“get over it”), deny or use quick fixes (“just give me that pill”) to deal with negative emotion, problem- and emotion-focused coping can be used. Listen with acceptance to the message of the emotion (emotion-focused coping) and if you need help with your issues, get it (problem-focused coping). This can only happen if we accept that getting support for emotional problems isn’t weak.

Findings from psychological research are useful in pointing to ways of handling emotion without avoiding or denying it.

And findings from neuroscience reserach show us that there are more links from the limbic system where emotion is based, to the cortex where higher-order thinking is based than the other way around. This suggests that when we experience high unpleasant emotion (for example, a sense of being overwhelmed) we can’t think rationally, so trying to reason or talk the problem out is likely to be ineffective.

One of the things I would suggest to clients is to do whatever effective behaviour works for them to lower their heightened physiology. This might include taking a break and walking around the block, listening to their favourite music or relaxation tape, using diaphragmatic (deep) breathing, or splashing their face with cold water for a few seconds. Only when they feel calmer would we suggest trying to re-look at the problem. Obviously, this assumes that people can notice that they are experiencing high emotion and know when this has decreased.

Many people worry that if they allow themselves to feel the emotion they are trying to keep hidden they will feel somehow overwhelmed by emotion and even change their personality. While an understandable worry, this is an example of ‘all or nothing’ thinking, where people assume that that they will turn into the opposite of what they currently are, something I have not observed in years of clinical practice. But it is important to distinguish between allowing the experience of emotion in order to understand it and do something about it, and being beaten by emotion and staying depressed and in bed for months.

PUTTING IT INTO PRACTICE

The following example may help to further explain how it’s possible to use problem- and emotion-focused coping.

On the same holiday with my brother, I was sharing my ideas for business expansion with him. Each idea I had was met with “that won’t work”. It was hard not to feel personally affronted by his comments, and I said to myself, “Don’t be silly, that’s just his opinion.” In other words, “harden up”. Now I had two issues: the emotion caused by his comment (hurt and anger) and the emotion coming from trying to suppress this. What were some 
of my options at that moment?

1. Defend my position and go with the temptation to attack back – “What would you know?” This was likely to lead 
to attack on his part and defence on mine.

2. Do nothing (‘harden up’ by ignoring or denying what he said) and continue with the conversation or change the topic. This would likely provide short-term relief from unpleasantness but long-term resentment on my part as I didn’t let him know how I found his comments hurtful.

3. Try to understand his position. In order to do that I’d need to ask more questions to find out where he was coming from, and make sure my response was coming from curiosity rather than anger. I could ask questions, such as “What makes you think it won’t work?” By focusing on getting information, I could potentially learn something new that may be helpful.

After some intense discussion, my brother and I came to understand each other’s perspective. Although harden up and move on may work for some people in some situations, it is usually a simplification of what needs to be done. The recognition that emotions are there for a purpose (to communicate to ourselves and others) may also enhance our relationships with ourselves and others.

Many of us have a voice inside us with opinions like those of my brother. This voice tells us that the right response to emotional problems is self-discipline, willpower and hardening up. We may decide to listen to that voice, but we 
don’t have to be ruled by it.

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