Staying Informed

The best way to quiet the “ What if’s” is “ What can I do now?” We need to get the latest most valid information on guidelines for  prevention, transmission and spread in order to plan for self and family members. Listed below are some important clarifications.

What We Now Know

Here is some updated Information about transmission, exposure and testing that has changed as experts have dealt with COVID-19 since March 2020.

Transmission

The virus that causes COVID-19 is thought to spread mainly from person-to-person through respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Masks are the most important way to prevent this spread,

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads. ( cdc.gov)

Prevention and Protection

The best way to protect yourself against COVID-19 is by wearing a mask and  maintaining physical distance of at least 3 feet. This virus is spread by droplets and aerosol from an infected person. Because people may have the virus and may not yet be showing symptoms, anyone with or without symptoms is a potential source of infection for others. Anyone of any age can become infected and spread the virus – even if they never become symptomatic. Being vigilant about your own exposure before you spend time with others – is mutual care.

Testing

Testing is crucial and findings must be considered in the light of new information.

According to the FDA, the most common Diagnostic tests are the Molecular Tests like the RT-PCR test or the Antigen Test.

• The Molecular test, like the RT-PCR test, detects the virus’s genetic material. It is taken with a nasal or throat swap, has results in one week or same day depending on location and is considered highly accurate.
• The Antigen test which detects the virus’s genetic material is the Rapid Test involving a nasal or throat swap and with results in one hour. The positive findings are considered accurate but negative findings may need to be confirmed with a Molecular Test.

Test Results

If you have had no exposure to anyone who might be carrying COVID-19, a negative result on a COVID-19 test may well be accurate.

Exposure and Test Results

A negative test result in situations where you have been exposed to anyone who tests positive must be considered in terms of time of exposure, contraction and build-up of virus in your system over the course of several days.  Retesting may result in a positive test result.

Supporting Research

• In a systematic review of seven studies published in May 2020, researchers at Johns Hopkins University considered that the time between exposure and testing positive may be much longer than just a day or two. When taking the P.C.R., after a possible exposure, it makes sense to wait three or four days, ideally self-quarantining while waiting and then getting a test a few days later.
• The researchers maintain that there is not chance that a test will work in the first day or two after exposure when the false negative rate can be from 60 to 100%. The danger of actually thinking you are negative when it is simply too early to tell is dangerous for you and others.

Other Factors – When considering your possibility of exposure and contraction, experts suggest considering:

• Do you have symptoms ( shortness of breath, fever, extreme fatigue)?
• Do you live in a community where the virus is on an upswing?
• Have you been at large gatherings or exposed to someone who tested positive.

If so, than re-testing may be very important to you and the spread of COVID-19.

Reducing Feelings of Helplessness

• The sense of helplessness is what is terrifying to adults and children.
• Provide facts to children and teens about what is going on now and information to reduce their risk of being infected-in words they understand depending on their age.
• Make plans for every day that involve small and big goals that consider safety.
• Creative ways to connect by Zoom or to do some of what you need to do or love to do while being at a distance with masks on may feel like a safe accomplishment.

Emotional Bonds

• A universal factor that mediates our experience of  fear and uncertainty is our connection with familiar networks of support (family, friends that are family and pets) The bond in such groups offers predictable support and validation.
• Hold on to loved ones through creative means if contact or social media contact is not possible. Go through pictures, draw pictures to be given at a later time to children or grandparents. Narrate your healing by writing your story or keeping a gratitude journal. Children can be encouraged to write their story of the situation or make a book of pictures. A family diary can be kept with everyone adding even one sentence of good, bad, funny, unexpected events, thoughts and feelings each day… Five years from now it will be precious.
• Given the parent-child stress connection, we know that a parent’s own stress regulation and sense of constancy is a reliable resource that offsets the impact of the unexpected for a child.
• Parents need rest and turns at being “ Off the Job”  They are the physical and emotional lifeline for their children. Someone once told me that the mother of a large family in the 1950’s stopped everything at 1 PM in the afternoon to lay down on the couch and watch her favorite soap opera – She was re-booting.
• When parents find ways to regulate anxiety and deal with uncertainty – the children benefit.

Working With Body and Mind

One of the most important ways to cope with fear and uncertainty is to pay attention to body rhythms.

• Daily routines like exercise of any type, biking, running, playing ball, walking your dog,  playing outside with children are all invaluable in lowering stress.
• Connection around fun activities a four-way crossword puzzle, watching an evening sitcom (laughter is a great stress reducer), listening to your favorite music, all reduce the hyperarousal associated with the body’s fight/flight stress reactions.
• Children big and small can reset calm through connection with pets, favorite toys, playing musical instruments, listening and even dancing to music or some version of that.

Sleeping is crucial in regulating the anxiety and worry that disrupt body’s rhythms.

• A recent study on the impact of fear on insomnia offered unexpected results. Whereas it was predicted that the greater the fear, the greater the insomnia or lack of REM sleep, the finding showed that it was a subject’s response to safety that was the important factor. Regardless of how much fear a person had (as measured by startle response) the ability to re-establish a sense of safety made the difference in sleep.
• With that in mind, children and adults need bedtime rituals to create safety. There are many options in this culture. Anything that reboots your sense of safety from free mini relaxation sessions http://www.calm.com/to your favorite book, blanket, meditation or prayer can make a difference. The consistent use of it conditions your mind and body for a respite.

Holding on to Hope

Be it through meditation, prayer or the amazing gifts of nature, many lift their spirits and resilience in uncertain times by holding on to hope.

Hope is the belief in options in the future.

It is seeded by catching glimpses of the new flower,  the sound of laughter, the sight of children’s awe, the feel of a pets’ love, the power of human kindness.

It is what makes this journey together possible….

Listen in to Renowned Epidemiologist, Dr. Gary Slutkin discuss “ Coping with Two Epidemics- COVID-19 and Violence on Psych Up Live-

Be Safe -Suzanne

The Meaning of Awe

According to Dascher Keltner, researcher and founder of the Greater Good Project, “Awe is the feeling of being in the presence of something vast that transcends your understanding of the world.”

While we tend to think of “ awe” in terms of vast views of wildlife and nature, Keltner and Haidt’s idea of “ vastness” goes beyond literal size and includes things that are beyond our ordinary level of experience like an impressive person or a great work of art or music.

Just watching the news and seeing the frontline workers going into hospitals  to care for COVID-19 patients filled many with a sense of awe – for their courage and expertise.

Researchers find the feeling of awe can be stimulated by music, the sight of your toddler sleeping on top of the dog, the size of the tomato growing in your summer garden.

 Why We Need to Feel Awe in Difficult Times

 At times when nothing seems to be the way it was and everyone is faced with uncertainty in their day to day life, we need to look for the moments that take us away, that remind us of the magic in life, in nature and in what we have never seen before –  moments that move us from anxiety to awe and wonder.

Historically, psychologists like Maslow underscored the importance of awe as “ peak-experiences” important for health development.

Dascher Keltner maintains that for evolutionary reasons, awe is good for our minds, bodies and social connections.

Christopher Bergland lists the sense of awe as one of the tools of “The Vagus Nerve Survival Guide to Combat Fight or Flight Urges.” Drawing upon emerging neurophysiological research on the experience of “ awe”, he suggests is that unlike worry or even very strong positive emotions, the experience of awe uniquely activates the vagus nerve which sets in motion the parasympathetic nervous system and the heart regulation, deep breathing etc. associated with a calm steady state.

 How Experiencing Awe is Transformational

• Keltner’s findingsreveal that experiencing awe (looking up in a grove of the tallest eucalyptus trees in North America) seemed to make people more inclined to help someone in need.
• In addition, people reported feeling less entitled and self-important than study participants who did not have the awe experience. They realized their place with respect to the vastness of nature and more.
• In other studies, Keltner found that feelings of awe, more than feelings of pride or amusement, led people to cooperate, share resources, and sacrifice for others.

 Getting a Daily Dose of Awe

While few of us will have the opportunity to see the whales in Alaska this summer or Fall, there is no end to other possibilities. From the morning butterflies in your garden, to the cat snuggled up with the old dog, to the sight of your 4 year old carefully feeding his year old sister – research finds a daily dose of awe contributes to our well-being.

You Can Even Expand Your Opportunity to Experience Awe

Practices you can try:

Noticing Nature – and taking note of connected feelings.

The Awe Video – 4 minutes

Taking in the Impact of Awe

Science writer, Matt Hudson describes his three month experience trekking alone as a young man in the wilderness in his book The 7 Laws of Magical Thinking . He reports that it was his experience of awe when faced with the “new dawn” that infused him with the self-acceptance he struggled with at that time. As a science writer of magical thinking– he affirms the magical power of viewing a rainbow after a long storm.

 In face of a pandemic, economic crisis, racial oppression and fear – we need to look for the experience of awe and to share it with

Much as the vastness of nature, art, music, courage and science can inspire awe –

our gift is our ability to embrace it.

If you have children or grandchildren or you are a caregiver join me on Psych Up Live – Listen in to Sue Badeau, child advocate and mother of 22 children discuss,“ Helping Adults Caring for Children Who have faced Trauma.”

The problem is that secrets are costly. They have been demonstrated to burden us and take their toll cognitively, physically, and emotionally. Essentially they preoccupy us, compromise our health and jeopardize relationships across generations. Whereas we often keep secrets to prevent  pain, the loss of love, respect and connection, too often that is just what they cost.

A Secret Exposed

I can still remember where I was sitting on a college campus when my friend shared her secret. We were not quite eighteen and had been planning on taking our road tests during winter break when she said,

“ My father is not my father. My sister is not my sister. I went looking for my birth certificate for the road test… The name for my father was different. Who is he? What does it mean?”

She stared ahead looking across the lawn rattling off more questions. She didn’t stop for answers and I certainly had none to give. She turned to me. All I could say was “Oh My God. It feels like too much.” She started to cry… so did I.

The impact of this secret on my friend was traumatic. She became intensely preoccupied with this assault on her sense of self and family as she had known it. She obsessed about why her mother had kept this secret and whether she should confront her now. She felt tremendous loss of the unknown father and confused about the father who had raised her. She could not imagine what her sister would think as they had never been close and her sister always accused her of being Dad’s favorite.

The Psychological and Physical Burden of Secrets

• Consistent with studies on the burden of secrets, what makes a secret “ big” is the degree of preoccupation it demands.
• In their refinement of earlier studies on the physical burden of secrets, researchers have found that there is a consistent relationship between how preoccupied a person is with a secret and their perceptual judgments about physical burdens.
• More specifically, experiences of physical burdens have been associated in research with a person feeling like they have fewer resources available and with their perceptual judgment of the environment as being more forbidding– a hill is perceived to be at a greater slant, or an object is perceived to be at a greater distance or heavier with the increase in the experience of a physical burden.
• A very recent study finds that recalling preoccupying secrets vs. non-preoccupying secrets increases the judgments of hill slant because by preoccupying one’s resources, a secret seems to become physically burdensome. It requires more effort to keep.

By the end of the week my friend could no longer hold this secret. She went home and left her birth certificate on the kitchen table for her mother to find. She found it. Tears and explanations followed. There was the description of a man who came and left and of the man who stepped up to love my friend and raise her as his first daughter.

 My friend was a beautiful and gentle person. She hugged her mother and the man she loved as her father, but she was shell-shocked. When her sister learned, she and her sister barely spoke about it.

 I have often wondered if my friend’s early marriage and quick divorce from a young man she met soon after she learned her history, was reflective of the burden and loss caused by the family secret. It would take time for her to find a place for what had been hidden from her.

 A Secret Imposed

Secrets not only preoccupy us and physically exhaust us— they become hazardous to our physical health.

Many years ago a man was sent to me by his primary care physician. He was suffering from anxiety, insomnia, and gastrointestinal complaints. When I asked him what he thought was creating such stress, he hesitated and then revealed that his wife had been diagnosed with breast cancer. She had made him promise not to tell anyone, including his best friend at work. He had tried, but work was becoming a nightmare as he felt he had to avoid his friend who kept asking what was wrong. This man was torn with guilt about needing to speak about his wife’s illness and the stress he felt keeping her secret.

• Research finds that there is an association between keeping an emotionally charged secret and illness ranging from the common cold to chronic illness.
• There is even evidence that teens who confide in a parent or friend have fewer physical complaints and depression.

Neuroscientists suggest that holding on to a secret creates considerable stress. While one part of the brain (the cingulate cortex) is wired to tell the truth, the choice to keep the secret results in another part of our brain (the prefrontal cortex) simulating all the negative outcomes of sharing the secret. The result is a triggering of the “ fight flight response” and the release of stress hormones that impact health– blood pressure, gastrointestinal functioning, metabolism, immune system etc.

In my work with this man, I validated the crisis his wife was facing and the common wish many people have to hide illness. Much like other types of trauma, we feel self-conscious and sometimes judged for not staying well – as if we had such control.

In tandem with that I invited him to consider the often over-looked trauma of the spouse of a seriously ill person—the pain of seeing your loved one suffering and the feeling of helplessness to make it better.

We discussed how his body was telling him that like many other spouses–it is too much to carry your loved one’s illness alone.  It is not only too stressful to hide—it does not help the partner who is ill. He was clear that he couldn’t hold the secret any longer and took the risk of believing that his wife might understand. She did.

In literature and research, we have seen that even when we try to hide a traumatic secret, it outs itself– in the form of bodily symptoms, or anxiety and distress in later generations.

Lessening The Burden of A Secret

What if we can’t find a person to listen or can’t yet bring ourselves to share the secret we carry?

There is a first step…

• Research has found that personally writing about it, transforming it from the burden we carry to words that tell the story, is very valuable in reducing the stress and health risks of a secret. Sometimes what is written becomes the means of sharing.
• Recent studies have also shown that opportunities to be creative –“ to think outside the box” lifts the feeling of constraint and the sense of physical and psychological burden of secrecy. Much as in healing trauma, the affective use of mind and body in a creative way preoccupies it with something that competes on every level with stress.
• In my work with couples, a step toward sharing what is feared to be a destructive secret has been to write it down and have the partner read it when they are together. It often gives room for expressing the fear of disclosure and the apology for what has been hidden. In some cases, the partner wants the chance to respond in writing to express reactions as a first step toward discussion. It takes many steps or writing, sharing, responding and feeling.
• Sometimes a family benefits from using a therapist to provide a safe place of containment for the secret to be shared. In one case a young college student came out as gay to his dad in my office. Both cried as the Dad revealed that he already knew it and loved his son.
• Relevant to the burden of carrying a secret, therapist Joe Kort author of LGBTQ Clients in Therapy: Clinical Issues and Treatment Strategies, notes that a young person who cannot reveal his/her/their gender suffers the trauma of an assaulted authentic self. 
• Whatever reduces the fear of disclosure makes moving beyond secrets possible.

Life is too short and relationships are too valuable to bear the cost of secrets.

Listen in to Psych UP Life to hear  Dr. Elaine Cooper share her family story in How to Identify and Heal Intergenerational Trauma

According to DSM-V a persistence of such symptoms for over three months is diagnosed as Post-Traumatic Stress Disorder (PTSD). Many who have suffered serious life-threatening illness qualify by reason of the persistence of symptoms driven by ongoing treatment, follow-up, and fear of the recurrence at any time on their life journey.

While their PTSD symptoms are comparable to those who have suffered from life-threatening external events as combat, rape or assault, Dr. Donald Edmondson has proposed a new model of PTSD  for those who have been traumatized by medical illness.

This model, The Enduring Somatic Threat Model (EST) of Posttraumatic Stress Disorder captures in a more distinct way, the emotional fallout from life-threatening medical events. It may well fit the persistence of symptoms and emotional reactions that COVID-19 survivors are reporting.

The differences between PTSD and the Enduring Somatic Threat Model of PTSD:

• PTSD results from a discrete and external event as rape, assault, or combat. The source of threat is external and has an actual beginning and end.
• Enduring Somatic Threat (EST) results from diagnosis and treatment of a life-threatening illness as Cancer or Heart Attack, etc. The source is an internal, somatic threat that is enduring and without a definite end.
• The occurrence and time perspective of Posttraumatic Stress Disorder (PTSD) for an external trauma is the past, although many feel that they relive aspects of it in the present.
• The occurrence and time perspective of Enduring Somatic Threat (EST) is past, present and future. There is the diagnosis of the illness, the past/present medical intervention and the fear of future recurrence. The vigilance is not to the dangerous road in Iraq or the ride with the stranger– it is to an internal sensation or symptom in one’s body.

According to Edmondson, what maintains the PTSD symptoms in The Enduring Somatic Stress Model is the “ underlying fear of mortality” from medical illness.

The Need for the Enduring Somatic Threat Model of PTSD

As he describes, Edmondson’s work is prompted by the tendency to overlook PTSD and the impact of health consequences of PTSD in patients who have suffered from life threatening medical events. He found in his research that in the case of acute coronary syndrome, for example, patients who developed PTSD due to the event were at double the risk for recurrence and mortality in the next three years compared to those who did not develop PTSD.

Crucial to his proposal and ongoing research of the Enduring Somatic Threat Model ( EST), as a more distinct way of capturing the post-traumatic distress suffered by those with medical illness, is the need to recognize that the symptom clusters, of hypervigilance, hyperarousal, avoidance, cognitive and moods shifts, may present somewhat differently in medical patients and have different implications.

Avoidance of stimuli that are associated with the traumatic event is a key feature of posttraumatic stress disorder (PTSD). There is often an ever increasing attempt to avoid anything that might re-trigger the flashbacks, physical terror, self-blame, etc. of the event. Sadly, this keeps the person from ever integrating the horror – of finding a place for it in their story.

In the case of medically caused PTSD, which we might consider in terms of an EST model, avoidance not only precludes emotional integration of the trauma from hearing the diagnosis to dealing with the illness, it may add the dangerous reality of avoiding medical and medication recommendations.

Implications for Survivors of COVID-19

Wedged between those who have had a very mild case of COVID-19 and the tragic loss of now over 160,000 deaths in the US from this pandemic, are many who have suffered with serious symptoms from COVID-19, only to be faced weeks or even months after recovery with new symptoms and long-term complications from Covid-19.

Given the unknowns and the varied symptoms from extreme fatigue to lung scarring, blood clots, cardiac, and neurocognitive impacts reported as collateral damage from the virus, it would make sense that survivors would be frightened and traumatized. The emotional aspect of this might well fit into an Enduring Somatic Threat Model of PTSD. It might help conceptualize and make meaning of feelings and responses.

It may legitimize hyperarousal, re-experiencing of feelings from different points during the illness, emotional avoidance as well as cognitive and mood swings. Importantly, it may enable seeking support from both medical and mental health providers as well as support groups with others suffering in similar ways. People heal in community. The journey of COVID -19 is a journey into uncharted territory – go with a group.

New formulations like Edmonson’s Enduring Somatic Model of PTSD provide language to talk about what we are feeling and fearing.

They are scientific advances and emotional gifts.

When you take into account the effort, the planning, the stolen moments, the affection, the creative communications and the anticipation of connection – you have to wonder what having an affair with your spouse could do for a marriage.

The likelihood is that it will do great things.

Having an affair with your spouse is something I have recommended to couples for years. It is an antidote to what Esther Perel describes as “Mating in Captivity,” the neutralizing of connection, the tendency to take each other for granted, the need to prioritize the kids, the jobs, the house, the money…. over the romance.

Does having an affair sound irrational, unlikely, possibly erotic and without guarantees? Yes. That’s the nature of affairs…only this one has a real chance of a happy ending.

What Do You Need to Have an Affair?

Here are the ingredients for having an affair – Do you have anything to lose?

Pursuit

Someone has to start. One icebreaker that works is to tell your spouse at a quiet moment – not across the family dinner table or while she/he is watching football or Game of Thrones,  “ I want to have an affair.” You are likely to catch his/her attention and curiosity before you add, “with you.”

If you know that your partner is very reactive, you may soften this to, “Do you ever want to have an affair?” Regardless of the answer, you are ready to say “I would love to have an affair with you.”

Keep in mind that even in the face of the other’s verbalized or non-verbalized response of “Are you crazy?” – The idea of having an affair, of investing in self and spouse, of pursuing and being pursued is emotionally and physically transformative. Many partners will agree to try it for a week.

Mutual Seduction

Seduction is central to the heightening of desire in any affair.

In a study of what men and women desire in sexual relationships, Elaine Hatfield and her colleagues (1989) found that the top two desires for married men were for partners to initiate sex more and be more seductive. The top two desires for married women were for partners to talk lovingly more often and be more seductive.

Clearly both men and women want their partners to be seductive – but in different ways.

When men and women put their own fears of rejection, performance or imperfection aside, and reach across the gender divide to say the tender things or initiate connection…the seduction unfolds.

Take a moment to think about being seductive:

• Think back to how you invited your partner to know you were sexually interested – Once the kids or asleep, send a text message to meet you somewhere in the house. Find and play  the DVD of the love story you once saw together; put the music from back then into her/his car; leave the notes, be affectionate when you have a moment alone, be affectionate in an unexpected way –in a public place like you used to– even if  the only place you are going together is walking the dog …
• Often the unexpected in a spouse sparks interest and neurochemistry.  Wear the clothes, cologne,  shirt she/he likes, that sends a message of self-affirmation and romantic interest (self-esteem is very attractive).  It’s not Hollywood – it’s a conscious and unconscious message of attraction between two people that can be as unique as the decision to wear lipstick or the color of his shirt.
• No matter what fine reasons to laugh- even at self. Don’t forget how sexy a sense of humor and laughter can be.

Take your time. Let the seduction build. The goal is not instant sex — it is a connection with interest, and mutual desire.

Interference and Waiting

In an affair, interference and waiting fuel anticipation and passion.

If you are married with kids, jobs, chores, pets, bills, seniors, all much more present due to the pandemic, you have all the ingredients for interference and waiting that you need for an affair.

The challenge, the mutual secret and potential excitement is working around them: Little ones who end up in your bed; older ones who keep you waiting, worried or arguing, jobs at home or at risk that steal time… not to mention everyone and everything else.

Practicing the Night Moves

One of the reasons that affairs take off and strangers are so idealized and captivating is that they are rarely considered in the actual or metaphorical “light of day”.

Romantic and sexual connection happen when we suspend reality, draw upon imagination, and go emotionally and physically to another place with our partner, someone we love … in any way that works.

If you have both been secretly pursuing each other, waiting and working on finding the time to get it together, feeling the other’s desire, there is a good chance that when you finally find the time and place — you will find each other.

Perhaps it won’t be a surprise that in a survey of dozens of academic research articles, Leitenberg and Henning found that of the top ten themes of sexual fantasies for men and women, number one was having sex with your current partner and number two was having sex with a stranger or imaginary lover.

The Look of Love

Regardless of the venue, people can usually tell when something is going on between two people. The two look at each other more, physically look better, find reasons to stand closer, touch each other innocently, smile more, seem more confident, laugh together, tease more, even argue more. Clearly they are connected. Probably they are in love.

That’s a really good message to send to the world inside and outside your home. It is a really good feeling to have with your spouse.

Have the affair together… Give them something to talk about!

 Listen in to author and therapist Keith Wilson discuss “Constructive Conflict – Make Your Arguments Matter.” Thanks, Suzanne

Anger in the aftermath of a traumatic event, be it the loss of a child, the destruction of one’s home, a life-threatening diagnosis, a pandemic out of control, the experience of racial oppression or the sequel to combat stress is a common and complex response. It can be experienced as a physiological state, an emotion, a way of thinking, a behavioral response or a combination of these.

• You are not alone if you feel angry about what has happened and continues to happen.
• Essentially you are suffering. The problem is that when anger persists–it can obscure everything else.
• The ability to make meaning of it and redirect it, keeps it from holding you back and taking more from you.

Understanding some of the feelings and dynamics that underscore anger after trauma may be an important step in your journey forward.

Anger as Residual of Fight/Flight Response

It is to our advantage that our biological arousal system goes into survivor mode in face of danger causing an increase in heart rate, rapid shallow breathing, cold sweats, tingling muscular tension and often-antagonistic behavior.

The problem is that when the danger has passed, our body often remains in a state of hyperarousal, leaving us reacting with anger to what would ordinarily be mildly distressing stimuli.

• We blow up at anyone asking if things are starting to get easier.
• We storm with impatience waiting on a line or if something break.
• We find ourselves fighting over everything with our partner.
• We drive faster and yell more than usual.

Because this is a physically driven anger, we need to work from the body out to bring it down. Working to reduce our anger is not irreverent to our loss or our sense of horror. Resetting our body rhythms by moving, sleeping and eating well empowers us. It is difficult to think when enraged but if it can be harnessed it can fuel resilience. If your body is restored – going forward is enabled.

Someone who lost a loved one in a Nursing Home to COVID-19 began to walk as much as she could. She would cry, at times talk to her dog -but she just kept walking to calm down.

Anger as Protection From Helplessness

• One of the assaults of trauma is the assault to our sense of control—our ability to be in charge of our lives, to protect ourselves, to keep our children safe, to find a way to repair a home, to save a buddy.
• If we are wrapped in rage, we won’t have to feel shame or blame. We won’t have to accept the reality that a traumatic event is of one that is beyond our control to stop.

Joining with others who have suffered in a similar way often lightens the anger.  Whether on Zoom, on a list-serv or on the phone, hearing others struggling with devastating trauma often lifts the self-blame and directs us to what is possible. It does not take away the excruciating loss, but it gives us the perspective to see a path.

The parents of one of the children killed in the Newtown CT School Shooting, established a Facebook page called W.W.D.D.—What Would Daniel Do. It is a page that essentially reverses the sense of helplessness in face of random violence because–it is intended to inspire random acts of kindness.

Supporting and marching for a cause like Black Lives Matter with others who share your feelings moves you from helplessness to connection and action.

Anger as a Mask for Depression

• Depression is very common in the aftermath of traumatic events because all trauma involves loss—be it loss of safety, loss of home, loss of loved ones or loss of country. Depression is the most common disorder suffered in conjunction with PTSD.
• Whereas common symptoms for depression are sadness, sleeping difficulties, concentration problems and a lack of interest in former pleasures, depression in some, particularly men, is often masked by anger, irritability, risky behavior, somatic complaints and domestic problems.
• Often the pain is so well masked that the men, the people who love them are unaware of how much they are suffering.
• Being aware of this connection can be lifesaving.

Anger as an Antidote to Loss

One heartbreaking solution to avoid grieving the loss of a loved one is to stay angry.

Common to veterans who convince themselves that to stay angry is to stay loyal, and to parents whose anger is fueled by the injustice of a child’s stolen life, it is both understandable and emotionally exhausting.

Often it is intended to keep others away as the pain is too great to bear or to share.

Often the world misunderstands that time doesn’t just heal; rather, people slowly heal in their own time.

• While people move through excruciating loss in their own time and in their own way, some begin to use religion, the warmth of a partner or friend, the help of a counselor or the power of a cause to redirect their anger.
• Some find that healing in a community with others who have suffered (Compassionate Friends for bereaved parents, AFSP for suicide support groups, TAPS for military families) allows for validation of anger and lightening its toll.
• Many take up a cause to deal with their own suffering or the suffering of those who have been traumatized in a similar way-be they doctors facing circumstances that make their oath to heal at times almost impossible or Moms of Black Children fighting for reform in the justice system. ( Moral Injury of Healthcare;Mothers for Justice United).

Traumatic loss of any kind is a crisis of self that leaves us trying to hold on by any means.

Often we grasp at anger to shield ourselves from the pain, to lessen our terror, to hide our tears, or to feel less helpless. When we are ready, we may be able to move on with less anger and perhaps more purpose.

We do that even as we carry grief.

We don’t forget.

We still have tears…but life and goals seem possible.

Be sure to listen to the Psych UP Live Podcast with Dr. Keith Corl discussing- “ Beyond Burnout: The Moral Injury of Doctors”

Most of us are familiar with the ongoing danger of negative stereotyping. Over centuries, across nations and in communities, tribes and families, negative stereotyping casts people as unacceptable, disposable, evil and culpable by reason of race, economic standing, nationality, religion, age, gender, etc. The result is dangerous and deadly.

Overlooked but just as dangerous is positive stereotyping. Positive stereotyping presumes that by reason of looks, race,  professional expertise, financial success or standing in society, someone is good, sacred, respectable, trustworthy and above the law. The result is also dangerous and deadly.

You might remember the  reports of close to 265 female gymnasts repeatedly molested by Dr. Lawrence G. Nassar the “respected” team doctor. In his case, as in the case of other predators in scandals that have shocked and horrified us, the predator plays on the positive stereotyping. He hides behind the posture of the good doctor, favorite coach, beloved priest, famous producer or respected politician, etc. Sadly, his pathological denial of doing anything wrong dovetails with our need to confirm our positive stereotypes.

 Abuse is Hard to Believe

Why does nothing happen to prevent abuse, harm, violations, and lies that hurt so many.

The reasons are confounding and certainly include those surrounding the abuser who deny, cover-up and become complicit in atrocity for personal protection or gain.

In addition, many others unwittingly add to the nightmare by pushing back with the question, “How Could this be?” The question is understandable. The reality that we have a difficult time believing the truth because of preconceived positive bias is worth considering.

When Rachel Denhollander, one of the gymnasts assaulted by Dr. Nassar, became an attorney and filed the first police complaint against him in 2016 with documentation of her abuse in 2004 by a nurse practitioner and medical journals disputing Dr. Nassar’s abusive techniques, she reports losing her church, her friends and her privacy to a culture not willing to listen.

Why Won’t People Listen?

According to social psychologist, Leon Festinger, we strive for internal psychological consistency in our beliefs. When we are holding two beliefs that are in conflict, we experience “cognitive dissonance” which creates psychological stress.

“ How can a known and respected person be malevolent – a liar, an abuser?”

• To reduce the dissonance we often block facts that threaten our beliefs and double down on what we hold to be true.
• Psychologists consider “this doubling down in the face of conflicting evidence” as part of a set of behaviors known as “motivated reasoning.” Motivated reasoning is how we remain convinced of what we want to believe. Motivated reasoning drives us to ignore, avoid, reject or argue against information that confronts our beliefs.
• At this time the political and personal need of many to negate the serious spread of a lethal pandemic is a dangerous invitation to ignore what health experts are saying about steps toward prevention and saving lives.

Given the abuse perpetrated by famous directors, beloved coaches, trusted priests and elected politicians, etc., it may be time to tolerate the cognitive dissonance and loosen our positive and negative stereotypes. Stereotypes are a threat to truth. They don’t allow us to see people without bias.  As such, they leave too many adults and children in harms way.

When people wonder why victims are so upset 15 or 20 years after abuse, it is because with validation comes the terrifying realization that the stereotypical “ good guy” was really “ the bad guy” who violated body, mind and spirit. The visceral awareness of the dangerous place they were in and the malice of the person they believed  – is terrifying. Coming forward to bear witness, to join with others, to prevent it from happening to others – is not easy but healing.

The voices of victims, including those dying from COVID-19, are expressions that counter our stereotypes. They invite us to dare to listen for the truth.

We are trying to listen. We are starting to act. Listening and acting invite changes. We can’t stop now.

Here are some Podcasts from my Show Psych up Live – Hope you find them helpful -Suzanne

Listen in to Dr. Sheri Bauman discuss “Digital Aggression: Understanding Your Online Exposure”

The fact is, regardless of what the world thinks, only the couple can decide if their marriage can survive.

In my work with couples standing in the emotional debris of an affair, I have found that if both partners want to recommit to an exclusive relationship and have the courage to trust and reignite their love – they can rebuild a marriage.

Difficult Beginnings are Understandable

Rebuilding sounds good but at the beginning – it is not easy. Often, no one is sure of anything but the wish to make the pain “go away.” Emotionally, the feelings of devastation, anger, betrayal, guilt and blame, don’t just go away.

• There is sometimes an urge to bury them and re-connect as if nothing has happened.
• There is the pull of the immediate world to do or not to do something. (It is interesting how many people who vote against taking him/her back – will fight for their own marriage when put in the same situation).

In face of this, the couple needs to give themselves permission and time to deal with the situation in their own way and heal together.

Here are some important steps towards this goal:

The Apology

An apology is a verbal, sometimes written, expression of guilt that conveys remorse or sorrow for having injured or wronged the other. In the aftermath of an affair an apology is a way of bearing witness to the pain of betrayal one partner has caused the other.

An apology is neither a “get out of jail free card” nor a “ license to kill.” It is not the preface to blame, excuses or retaliation. A true apology after an affair sends the message that no matter what the reason – violating the bond is never the answer.

An apology is important because it repairs a sense of safety between the partners – it promises change.

Forgiveness

For a couple to move on there has to be recognition of the apology and a willingness to forgive. In many ways this is a mutual process that implies a belief in the other’s willingness and capacity to change – sometimes it is a leap of faith worth taking.

Forgiveness is not incompatible with cycles of emotion and upset. Much like any other trauma, one or the other partner may react from the triggers that remind them of the affair.

The betrayed partner may be thrown back into feelings of anger, hurt or rejection. If the betraying partner recognizes this as understandable to the healing process, it is very productive to validate their partner’s pain and upset. This is much more effective in reducing the feelings and creating a sense of reassurance than become angry with the return of the feelings – “I thought we were past this?”

The worst that happens is for the tables to turn and the marriage to become an endless scene of “crime and punishment” toward the betraying partner. Rarely will that support the re-building of a marriage bond. Instead, it locks the partners into the roles of perpetrator and victim.

Re-setting the Trust Point
In the aftermath of an affair the greatest symptom is mistrust. Because verbal exchange has been compromised by lying – the truth now has to be expressed. Often the betrayed partner needs to know the story of the affair. They need to make sense of reality and their perception of what has happened, who their partner is, who this “other person was,” and who they are now to each other.

Although the request for information may come at different times, the clarification is important. HOWEVER, clarification is different than endless ruminating, obsessing or interrogating the partner. I have told partners who continue to interrogate their partner that – they are now the one “keeping the affair going.”

Mutual Reconsideration

One of the most effective steps in recovery is the non-blameful examination of what the state of the relationship was before the affair. This does not equate to condoning betrayal. It is an honest self-reflection by each partner and a mutual exchange of what each was giving and getting in the relationship, what issues each was dealing with and what each wants and needs now.

• “I need to be with someone who wants to be with me more than a few evenings a week.”
• “I need to recognize that I stopped feeling good about myself and avoided connection with you.”
• “I need someone who wants to try new things and keep on living.”
• “I realize that I pushed you out of my life with my work.”

Help Along the Way

• While it is the couple that really makes the recovery possible, help along the way is often very valuable. Given that verbal intimacy has been compromised, it is not easy for partners to just start talking without an overload of anger and blame.
• Often the partner who has had the affair is feeling so guilty and embarrassed he/she has no words, the betrayed partner often has so much rage and pain, he/she can’t stop expressing it.
• A professional counselor by reason of being the “neutral” third serves as a safety point that expands the field enough to contain and consider feelings, examine causes and support resiliency.

New Partners to Each Other

Essential to the process of rebuilding a marriage is becoming new partners and new confidantes to each other, by leaving the affair behind. For most couples, building new memories with new experiences together, as well as trying out new interests or challenges invites sharing from a different perspective and invigorates interest and intimacy.

Dealing with the Loss-Appreciating the Gains

As with any trauma, healing together in the aftermath of an affair involves mourning loss.

• For many it means coming to grips with the illusion that everything was perfect.
• It means accepting what is human and less than perfect in self and partner.
• It ultimately means the freedom to love self and partner with an appreciation of a new marriage built together.

One word frees us all from the weight and pain of life: That word is love.
(Sophocles)

Listen in to Psych Up Live  to hear Keith Wilson discuss The Road to Reconciliation: Pitfalls and Possibilities

The Positives

The upside is appreciation for someone by your side to get through an unimaginable life event. Someone for support if one or the other gets sick, someone to hold down the fort if one is an essential worker, someone to juggle the children’s ever growing needs, someone willing to swap rooms and beds to make a good night’s sleep possible, someone to discuss the financial worries, the meal preparation, the chores and the sense of emotional and physical stress endemic to COVID-19.

The Negatives

Notwithstanding these affirmed positives, there is no guarantee of constant peace and happiness when coping in captivity. Understanding the possible reasons for clashes and disconnects fosters the ability to step back and re-evaluate what is going on together.

Human Stress Reactions

Being human under difficult and dangerous circumstances brings with it our human Survival Responses of Fight, Flight and Freeze which may be reflected in different ways by each of the partners at different times. One partner may be quick to anger, the other may escape to Netflix, hours of texting or just seem unable to respond even though the kids are looking for him. One may be able to tolerate the news, the other may find it too much to hear or bear. Being able to consider that you and your partner are reacting to a dangerous reality of illness, economic loss and ambiguous loss of life as you both knew it puts your reactions into perspective. It may give both of you license to reference it at difficult times.

“ I had to walk out – I got overwhelmed by the news.”

“ I know I left you with the kids, but the work situation really depresses me.”

Just the effort to make meaning of a disconnect due to stress is a reconnect with a partner. It sets up the possibility for both to consider what to try at those times or how to let it pass and move on.

Disruption of Dependence/Independence

For most couples the balance of dependence and independence that improved and stabilized their relationship was disrupted. For many whose jobs were put on hold or even put on-line, there has been a loss of the balance that traveling to work, involvement with work issues, interaction with work friends, clients, vendors, etc. provided. The outside world fosters self-esteem, intellectual simulation, and multiple aspects of self that supplement and enhance couple relationships.

For essential workers in this pandemic, the necessity of working and putting themselves in harm’s way to respond to the unfathomable impact of COVID-19, has taken a toll on their relationships in terms of fear and worry. While most have been proud of what their loved one was doing to save lives, their feelings were underscored by concern for their partner’s health and the possibility of contagion.  It has been more like a spouse going to war than another day at the office.

In many cases both partners enrich their own lives and that of their spouse by outside friendships and activities. It works for one that a partner loves running with his friends while the other loves spending time in the garden. It works for both that their children’s friends have parents that enjoy big gatherings of parents and children. It is valuable to meet your partner’s working friends and see your partner through the eyes of others. That opportunity to expand the view and appreciation of a partner in differing contexts has been lost at this time.

How Do Couples Cope?

An important key is regulating the Human Stress Reactions that we experience when facing something like a Pandemic.

Deep Breathing

Experts have shown that nothing reduces the Fight/Flight Response and restores calm as quickly as deep breathing. To do this requires breathing deeply and exhaling slowly, ideally so that the exhalation lasts twice as long as the inhalation.  In children the same is accomplished by blowing bubbles ( not a bad a idea to suggest that your kids join you) .If it helps connect the breathing to a step outside the house, associate it with a song, or a place to be alone– let it become your instant down switch.

 A Mindful Self-Compassion Pause

Dr. Kristin Neff who researched Self-Compassion underscores that in life self-compassion is far more important than self-esteem. Self-Compassion is a powerful self-regulating tool because it stops negative ruminating and self-criticism. It has  even been shown to reduce PTSD because it does not encourage avoidance of thoughts of or feelings about what has happened; it invites you to is treat yourself with the compassion you would give someone else in your circumstances.

Mindful Self-Compassion which comes from the joint work of  Drs. Chris Germer and Kristin Neff involves starting with a deep breath to reset reactivity. You then take a moment to ask yourself “What am I feeling?”  In response to possible feelings of “ fear, inadequacy, or self-loathing,” you consider “Most people would feel this way in my situation.”  ( this connects you with others) “I am doing the best I can at this time.” ( this affirms self) Following this with a thought of gratitude is empowering. It builds resilience.

 How Do Couples Enhance Their Bond?

 The Power of Touch

 The Survival Responses all reflect dysregulation in the face of the danger we are feeling.  One thing that couples living together have that no one has taken away – is the power of touch. It is almost an immediate way to reduce the stress reactions of Fight/Flight/Numbing. Touch taps into the parasympathetic nervous system which works to calm us.

The touch of a hand when there is nothing to say, the squeeze of a shoulder after a verbal clash does more to calm partners that they often consider.  During physical affection, our bodies release oxytocin, a hormone produced in the brain, called the “cuddle chemical,” Oxytocin helps manage stress and anxiety, which impede good health. Researchers found that when people received hugs they were better able to respond to conflict and stress later.

Given the restrictions for contact due to COVID-19, couples have the advantage of hugging and kissing each other as well as their children and their pets. It is worth saying that when your children see you hugging – their stress is reduced. Their lifelines are safe.

Couple Time

The COVID-19 Pandemic has hi-jacked time – school time, work time, travel time, gym etc. and changed it to quarantined time, sheltered time, incubation time, ICU time etc.  With the exception of the time given up by couples for whom one or both are frontline medical or essential workers who need to recapture their time together, COVID-19 has not eliminated couple time.  The stress you feel and the unending things or lack of things you need to do- may seem to have eliminated it.

Take Back 10 minutes of Couple Time a day. In my work for years with couples after trauma, I have learned that the respected and guarded time for the cup of coffee together early in the morning, the routine of walking the dog together, the late night snack, become rituals that means “ we” matter. What will you talk about? Ideally something unrelated to day to day chores, money, politics or what you both think is wrong with the relationship.

Why? Because you are in a highly stressed situation. First reset the face to face bond of a 10 minute connection.Find out what might be right before you take on what is wrong. In captivity let’s lean into connection vs. contention.

Consider planning for each 10 minute rendezvous with the suggestions by one and then the other i.e. – Tomorrow we each guess the other’s favorite movie, share a childhood memory, remember what each other were wearing on the first date, the location of the first kiss, the song that makes you think of the days you met and more – it’s about a daily dose of intimate time to maintain your bond at a time when nothing is certain but the time you have together now.

Listen in to Dr. Chris Germer Discuss Mindful Self-Compassion on Psych Up Live 

Together we are sharing a space between what we once defined as our lives and the unknowns in the lives we are trying to approach.

This space actually has a name – It is called “ The Liminal Space.”

The word liminal comes from the Latin word limen, meaning threshold – any point or place of entering or beginning.

Author and theologian Richard Rohr describes this space as:

“Where we are betwixt and between the familiar and the completely unknown. There alone is our world left behind while we are not yet sure of the new existence.”

To most of us, this space feels perilous because it generates considerable anxiety. It confronts us with the unknown:

What if I don’t get another job?

Will I get COVID?

Will they ever find a vaccine?

Will my children have the freedom to go back to school?

Will I  find a new relationship?

Will this country survive its medical and political plagues?

.“The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown.” (H.P. Lovecraft)

The Liminal Space is a threshold to the unknown and frightening though it might be, it is also the passage to unknown growth and potential.

The better we can tolerate and negotiate the anxiety associated with the liminal space – the better we can change it from a place of peril to a place of potential. Avoiding the anxiety traps and recognizing some positive strategies make this passage easier.

Anxiety Traps

 Inability to Disengage From the Past

• Research suggests that the inability to stop negative ruminating about “what was” or “ what should have been” keeps us unhappy and limits our view of future options. It actually triggers stress reactions of fight, flight and numbing which compromise our judgment as well as our immune system.
• Of course we need to grieve in our own way for what we have suffered, lost or expected; but we are capable of multiple feelings. Even with tears, looking forward with a moment of hope enables us to see even traces of  possibilities in the future.

“You can’t see where you are going, if you are only looking backwards”

 Staying frightened at the Threshold

• Some try to reduce their anxiety about the unknown by assuming the worst.  They assume the worst about the future and the worst about their capacity to venture into the unknown.
• Given we don’t have a crystal ball on prediction and we know that living with a sense of impending disaster is depleting, the position of predicting the worst undermines resilience.  It compromises potential response to whatever we face- which might be better than we thought.

“ Possibility is the oxygen upon which hope thrives.” ( Paul Rogat Loeb, 2004,p.19)

 Caught in Waiting

It makes sense that most people are exhausted with waiting.  The term “ social distance fatigue” is valid whether you are a new college coed waiting to find out if there will really be classes at the school you dreamed of attending, a little one waiting for playdates, or adults who just want to go back to the office or go out for dinner with friends.

What might have felt at first like “the pause that refreshes” is increasing feeling like the traffic jam that doesn’t move while the radio blasts mixed reports as to what, why and when you will start moving again.

When we factor in the surge of COVID-19  in states that have “ started opening up”  we add the  anxiety of worrying whether you should actually continue if traffic starts to move.

“Going into the unknown is how you expand what is known.” (Julien Smith)

 Strategies for Moving Forward

Take Back Time and Space by Filling it with Achievable Goals

• Reconsider how you are spending your day. Do you have time in the liminal space to take the course, take the walk, re-define your relationship, try a new project, work on your relationship, join in a cause you believe, renew your sense of spirituality, reclaim memories of your childhood with your children, cook your Dad’s recipes, help others in need even online.
• Any goal that we achieve fuels momentum and lowers anxiety.
• Small steps and achievable goals fill the unknown space with life experiences, places, people and a stronger you.

“Sometimes you find yourself in the middle of nowhere, and sometimes in the middle of nowhere you find yourself.” Anonymous

Use Stress Regulators as You Go

• Buffer your steps with ongoing stress reduction. Often when highly anxious, our Fight/Flight response for survival obscures our focus on what we love to do and what we do that lowers stress.
• Accessing our stress regulators like exercise, cooking, praying, gardening, golfing, making music, listening to music, playing cards, reading mysteries etc. on a regular basis gives us something we know, something we can predict and something that buffers stress physically and psychologically.

 Use Realistic Optimism vs Blind Optimism

• As opposed to blind optimism, realistic optimism is active not passive. The person using realistic optimism does not miss the negatives but disengages from problems that appear unsolvable and attends to problems they can solve.

• According to science writer, Matt Hutson, optimism allows us to see openings for success in ambiguous situations and redefine obstacles as opportunities.

• Making note of the resilience of those you love conveys hope and optimism in how they will manage the unknown.

Go with Curiosity

• Curiosity changes the fear of the unknown path to one of possible potential.
• Curiosity allows embracing the unexpected – the life change, option, network, or challenge with a different body and mind than an anxious one.

We are in the Liminal Space Together

You  are not venturing alone. We are all in the liminal space together.  As such we can lean on each other, learn from each other and make peace with each other.  Connecting with others along the way is a source of resilience and a reason to keep hope alive.

 “…Just as despair can come to one another only from other human beings, hope, too, can be given to one only by other human beings.”  ( Elie Wiesel ) 

Listen in to a podcast on Psych Up Live – as Anita K Discusses her new book, Behaving Bravely: How to Mindshift Life’s Challenges