Mental Health

Coping with Emotional Tailspins

Mark came into my office agitated and on the verge of tears.  He reported that he’d had another argument with his boyfriend the night before.  Mark was afraid that a break-up was imminent.  He told me that he’d been unable to concentrate at work since the fight, and spent the day beating himself up because the cause of their disagreement was “trivial” (although he acknowledged that it didn’t seem so at the time).  The argument raised older fears about being alone, and beliefs about being unlovable resurfaced.  The argument, the guilt and self-recrimination, the anxiety, and all the thoughts and feelings he was experiencing sent him into an “emotional tailspin.”  He was desperate to regain some sense of balance and calm, but felt hopeless about doing so.

Many of us have experienced emotional tailspins, moments when we feel flooded with anxiety, guilt, shame, or grief.  These feelings are so acutely averse that our most immediate desire centers on finding some rapid means for stopping the feelings and/or escaping from them.  And while gaining some distance on the feelings is a reasonable first step, impulsive flight does little to resolve whatever issue triggered them, much less the dynamics that sustain the tailspin.  Impulsive flight derails us from the necessary work of understanding and healing the circumstances that created the tailspins in the first place.

Every emotional tailspin has antecedents.  Some event triggers the cascade of powerful emotions that over-ride (flood) our ability to cope, think, reason, or problem-solve.  The event also taps into dysfunctional beliefs we may have about ourselves.  Further, it’s been my experience that triggering events also stimulate memories of past experiences when we actually were helpless.  Those traumatic memories magnify the aversion we feel.  Our feelings quickly become the primary focus of our attention.  Consequently, we try to flee or otherwise change the feelings as quickly as we can in order to eliminate our acute distress.  While fleeing the feelings may diminish the emotional discomfort, flight does little to resolve the issues that created the emotional tailspin.  When our primary focus centers on ameliorating our discomfort, we fail to focus on our relationship to the problem itself.  The problem remains and will trigger yet another episode of aversion.  As a result, the downward spiral accelerates and worsens.  We feel increasingly out-of-control and incompetent, and more aversive feelings ensue.  We might even come to believe that we ARE incompetent and unlovable which further amplifies the aversion we feel.  We are in a full emotional tailspin, feeling both helpless and hopeless. 

There are a number of actions you can take to respond to, manage and prevent emotional tailspins. 

1.     Slow down.  When we feel panic or other strongly aversive feelings, there is often an immediate sense that we must act quickly, now.  Indeed, the impulse to flee aversive feelings is powerfully immediate.  But you do not need to take immediate action to rid yourself of the feeling—a form of emotional reactivity. 

There is a difference between being reactive and responsive:  reactivity is impulsive, free of conscious thought, and driven by discomfort.  Reactivity tends to be narrowly focused on the goal of ridding yourself of discomfort.  On the other hand, responsiveness is thoughtful, attempts to broaden focus and has the goal of deeper healing.  Slowing down allows you to develop enough emotional distance so that you see the whole picture, discern the choices for responding that are available, and choosing a plan of action that can resolve the problem. Slowing down helps you respond more appropriately.  Take one or two deep breaths to physiologically slow and diminish the sensations of panic and despair. 

2.     Stay in the present moment.  Be aware that you may be telling yourself a story about the situation.  A negative story about the situation will fuel the tailspin.  Similarly, try not to get ahead of yourself.  When we start thinking “what if,” we are likely to create more anxiety for ourselves and perpetuate the tailspin.

Focus on what is happening right now.  Grounding exercises and self-talk about what you are seeing, hearing, and sensing can be help you gain footing in the present moment.

3.     Feel feelings without judging them as good or bad, pleasant or unpleasant.  One strategy that helps you manage aversion centers on attending to your body’s sensations—without labeling or judging them.  Direct your attention to the parts of your body where you experience a sensation.  Feel the contours of tension or constriction, and then soften around the sensation.  (Again, deep breathing can be effective for softening around tension.)  Try not to tell yourself a story about the feeling (i.e., “this feeling is awful; I can’t stand feeling this way”) because doing so will likely create more tension.  You are not trying to get rid of the feeling; you are acknowledging the feeling and letting it be.  Feelings arise and fall on their own.  Indeed, the feeling you’re experiencing will diminish by itself on its own time.  If you try to rid yourself of the feeling, the sensation will tighten.  Have faith that the feeling will diminish on its own.

4.     Engage a reality check.  There is an old psychotherapy adage that comes from cognitive theory:  feelings are not facts; feelings are feelings.  Your experience of aversive feelings may be creating a filter through which you are misperceiving what is actually happening.

When you are experiencing an emotional tailspin, you may not perceive the whole picture.  Anxiety tends to narrow attention, and we tend to selectively focus on those aspects of the situation that are most upsetting.  There may be aspects of the situation you are not seeing and that might help you regain our footing. 

A reality check is an attempt to broaden the scope of attention.  It requires you to separate feelings from facts. 

Ask yourself:  what is actually happening right now?  Am I adding anything to what is actually happening?  What is the story I am telling myself about the situation?  How am I understanding this situation? 

5.     Seek an objective perspective; reach out for help.  When you are caught up in an emotional crisis and are acutely anxious, you are likely to be perceiving the situation through the lens of your anxiety. Seeking help from someone who can see the situation from a different perspective can help you reorient yourself and help you begin to regain balance. 

 

You’ll notice that these steps precede direct problem-solving.  Indeed, it’s my experience that it is often counter-productive to attempt to address and solve the immediate problem when one is caught up in an emotional tailspin.  This is not to say that problem-solving cannot occur.  It can, and should occur—but premature problem-solving robs you of the opportunity for the deeper, more essential, work of understanding and transformation.  Such work is vital if one is to avert recurrences of tailspins. 

However, I would suggest that one is engaging in problem-solving by using these strategies. Slowing down, being present to what is happening, feeling feelings, reality checking, and reaching for perspective: taken together, they are the first steps toward meaningful healing.

You are not helpless, and hope is always available.  These actions are empowering and can be first steps to personal transformation.

 

 

 

So You’re New to Therapy: What to Say and What to Expect

You’ve made the call and scheduled an appointment.  Now what?  

First appointments with psychotherapists can be anxiety-ridden.  You’ve made a step toward talking with someone—a stranger—about your life and your problems.  It’s uncomfortable to go to the therapist’s office and meet your therapist because chances are that you feel very vulnerable talking about yourself.  Many questions naturally arise:  Will I be helped?  Is this therapist competent to help me?  Can I trust the therapist?  Will the therapist judge me?  How much will I have to say?  Will I have to reveal my deepest, darkest secret?  What happens if I can’t think of anything more to say?  What if I don’t feel connected with the therapist?  What if I decide I don’t like the therapist? 

These, and many more, questions usually occur, accompanied by a lot of anxiety.  The anxiety is usually most acutely as you actually enter the office and meet your new therapist face to face for the first time.  The good news:  your therapist is likely aware of questions like these (and may even have similar questions and anxieties about you, the new patient).

Although the therapist will spend time getting a rough sense of what brings you to treatment, first sessions are really about beginning to build a safe space and a therapeutic relationship so that work can be done.  Yes, questions will be asked:  some basics about who you are, how you identify the issues bothering you, a brief history of the problem and how you’ve been coping, how the issues are impacting your current life, etc.  And the therapist (if he is good) will also make sure he accurately understands your perspectives and the basic outline of the issues.  It’s highly unlikely that any solutions will be offered during the first session, although the therapist may offer some ideas for directions to explore in later sessions.

 In addition to getting to know you, the therapist will also talk about how therapy works and how she typically works with patients.  The therapist may talk about how therapy is structured (i.e., agenda setting, use of time, etc.).  Some time is given to administrative details:  fees, policies about cancellations, unscheduled sessions, telephone calls, etc.  But the therapist will spent the vast majority of time listening carefully, attending to you, and trying to understand you, the problem and its contexts.

 During the fist session, I always leave time for patients to ask questions about therapy, about my approach to treatment.  I strongly encourage patients to share their concerns and any ambivalence about entering treatment.  Significantly, I ask patients to not only share concerns at the first session, but throughout treatment.  Indeed, I frequently ask patients how they feel about the help they are getting:  am I helping?  Where did I misunderstand something that was said?  Have I said too much or too little during a session?  Feedback to the therapist is, in my experience, essential to a solid working relationship. 

 You may not feel a good connection with the therapist after the first session.  This is common.  While sometimes it takes a few sessions to feel understood and connected with the therapist, sometimes that connection just isn’t there.  I’d encourage you to share your experience with the therapist—even at the first session, if you can.  Indeed, your therapist needs to know that something just isn’t sitting well with you.  The therapist may explore this with you in an effort to understand what might be blocking the connection.  However, if the connection is not there after a few sessions, it’s important to explore other options.  You are not married to your therapist; you may do better with someone else.

 So, come to that first session of therapy with your problems, questions, and concerns.  Ask questions.  Come to the session with all your feelings—your fears, your ambivalence.  Be honest with the therapist about how you are feeling.  Say as much can, as much as you safely feel able.  All these thoughts and feelings are the fertile soil out of which new growth will emerge. 

You are beginning a new chapter in your life.