That Discomfort You’re Feeling Is Grief

   

 Scott Berinato

March 23, 2020 

Some of the HBR edit staff met virtually the other day — a screen full of faces in a scene becoming more common everywhere. We talked about the content we’re commissioning in this harrowing time of a pandemic and how we can help people. But we also talked about how we were feeling. One colleague mentioned that what she felt was grief. Heads nodded in all the panes.
If we can name it, perhaps we can manage it. We turned to David Kessler for ideas on how to do that. Kessler is the world’s foremost expert on grief. He co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazards team. His volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross’s disaster services team. He is the founder of www.grief.com, which has over 5 million visits yearly from 167 countries.
Kessler shared his thoughts on why it’s important to acknowledge the grief you may be feeling, how to manage it, and how he believes we will find meaning in it. The conversation is lightly edited for clarity.

HBR: People are feeling any number of things right now. Is it right to call some of what they’re feeling grief? 
 
Kessler: Yes, and we’re feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air.

You said we’re feeling more than one kind of grief?

Yes, we’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.

What can individuals do to manage all this grief?

Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren’t linear and may not happen in this order. It’s not a map but it provides some scaffolding for this unknown world. There’s denial, which we say a lot of early on: This virus won’t affect us. There’s anger: You’re making me stay home and taking away my activities. There’s bargaining: Okay, if I social distance for two weeks everything will be better, right? There’s sadness: I don’t know when this will end. And finally there’s acceptance. This is happening; I have to figure out how to proceed.

Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can wash my hands. I can keep a safe distance. I can learn how to work virtually. 
 
When we’re feeling grief there’s that physical pain. And the racing mind. Are there techniques to deal with that to make it less intense?

Let’s go back to anticipatory grief. Unhealthy anticipatory grief is really anxiety, and that’s the feeling you’re talking about. Our mind begins to show us images. My parents getting sick. We see the worst scenarios. That’s our minds being protective. Our goal is not to ignore those images or to try to make them go away — your mind won’t let you do that and it can be painful to try and force it. The goal is to find balance in the things you’re thinking. If you feel the worst image taking shape, make yourself think of the best image. We all get a little sick and the world continues. Not everyone I love dies. Maybe no one does because we’re all taking the right steps. Neither scenario should be ignored but neither should dominate either.

Anticipatory grief is the mind going to the future and imagining the worst. To calm yourself, you want to come into the present. This will be familiar advice to anyone who has meditated or practiced mindfulness but people are always surprised at how prosaic this can be. You can name five things in the room. There’s a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It’s that simple. Breathe. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay. You have food. You are not sick. Use your senses and think about what they feel. The desk is hard. The blanket is soft. I can feel the breath coming into my nose. This really will work to dampen some of that pain.

You can also think about how to let go of what you can’t control. What your neighbor is doing is out of your control. What is in your control is staying six feet away from them and washing your hands. Focus on that.

Finally, it’s a good time to stock up on compassion. Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That’s not like this person; that’s how they’re dealing with this. I’m seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.

One particularly troubling aspect of this pandemic is the open-endedness of it. 
 
This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I’ve been trained for situations like this. I’ve also studied the 1918 flu pandemic. The precautions we’re taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.

And, I believe we will find meaning in it. I’ve been honored that Elisabeth Kübler-Ross’s family has given me permission to add a sixth stage to grief: Meaning. I had talked to Elisabeth quite a bit about what came after acceptance. I did not want to stop at acceptance when I experienced some personal grief. I wanted meaning in those darkest hours. And I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They’re appreciating walks. I believe we will continue to find meaning now and when this is over.

What do you say to someone who’s read all this and is still feeling overwhelmed with grief?

Keep trying. There is something powerful about naming this as grief. It helps us feel what’s inside of us. So many have told me in the past week, “I’m telling my coworkers I’m having a hard time,”

or “I cried last night.” When you name it, you feel it and it moves through you. Emotions need motion. It’s important we acknowledge what we go through. One unfortunate byproduct of the self-help movement is we’re the first generation to have feelings about our feelings. We tell ourselves things like, I feel sad, but I shouldn’t feel that; other people have it worse. We can — we should — stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn’t help because your body is producing the feeling. If we allow the feelings to happen, they’ll happen in an orderly way, and it empowers us. Then we’re not victims.

In an orderly way?

Yes. Sometimes we try not to feel what we’re feeling because we have this image of a “gang of feelings.” If I feel sad and let that in, it’ll never go away. The gang of bad feelings will overrun me. The truth is a feeling that moves through us. We feel it and it goes and then we go to the next feeling. There’s no gang out to get us. It’s absurd to think we shouldn’t feel grief right now. Let yourself feel the grief and keep going.

Scott Berinato is a senior editor at Harvard Business Review and the author of Good Charts Workbook: Tips Tools, and Exercises for Making Better Data Visualizations and Good Charts: The HBR Guide to Making Smarter, More Persuasive Data Visualizations.

Making Peace with Uncertainty: Living in the Midst of a Pandemic

By OCD Center of Los Angeles On April 6, 2020 · In Anxiety, Mindfulness, Obsessive-Compulsive Disorder (OCD)
How can we use what we know about uncertainty and anxiety to support those who find themselves understandably anxious about COVID-19 and all of the fallout surrounding it?



I cannot count how many times over the last few weeks I have either said or heard the phrase “These are unprecedented times” – and they are. Granted I’ve only spent 34 years on this globe, but in that time my government has never before instructed me to limit time outside of my home or weighed in at all with regard to my proximity to strangers. I’ve never purposefully distanced myself from my parents over concerns for their safety. I’ve never seen so many empty shelves in stores, and if you’d told me on New Year’s Day I’d be wearing a mask on a routine shopping trip, I would have been perplexed to say the least. We each have our own lists of news and firsts, ranging from the strange to the devastating. This novel coronavirus brings with it a great many novel experiences.



What seems to be at the forefront during this strange moment are predictions. Some of these predictions are necessary – how many people will be infected and will we have hospital space to care for them all? How can we prevent the spread of this disease? How many jobs have been, and will continue to be, impacted? How can we support those who are without income?

We have some ideas and some answers, all of which are important as we attempt to save lives, maintain our medical system and support those who’ve lost income. All this said, the common thread that binds us all in this uncharted territory is uncertainty. We can’t know the answers. As each day unfolds it is increasingly clear just how uncertain the world is.

This is deeply uncomfortable to many if not most humans. We thrive on patterns that allow us to predict the next step. This ability is key to our survival – we are the biological descendants of predictors, planners and worriers. Given that our brains are machines that crave the ability to predict, we tend to scramble to find stability when things start to feel shaky.

This is especially true of the subset of people who fall into the “worrier” category. In the United States, 18% of adults meet criteria for an anxiety disorder. I’m a psychotherapist who specializes in

the treatment of OCD and anxiety disorders, so I have the privilege of meeting and getting to know lots of people who struggle with these conditions. What unites these disorders is that they all involve an extreme discomfort with uncertainty. People with anxiety disorders are overcome by uncertainty about a great many things, such as:

• If they’ll meet an upcoming deadline or pass their next exam
• If someone will judge them positively
• If they have cancer
• If they’ll have a panic attack
• If they’re secretly a murderer
• If they’ll go to hell
• If there are germs on that doorknob
  

These worries tend to be founded on little to no evidence and are largely irrational. However, whether the worry is warranted or not is irrelevant. Worry isn’t productive. Whether your concern is about getting cancer or getting COVID-19, endless rumination won’t change the outcome. Limited planning can be helpful in both cases. It makes sense to take preventative measures – whether it’s quitting smoking as a way to stave off cancer or practicing social distancing as a way to stave off COVID-19. Likewise, planning financially if you’ve lost work is wise. If you have legitimate markers of either cancer or COVID-19, it makes sense to consult a doctor. But repeatedly reviewing the facts and imagining the disasters that may or may not befall you doesn’t actually help – it just makes you miserable.

We all have thoughts of a frightening nature – they’re non-negotiable. Whether they’re about COVID-19 or the possibility of getting cancer, they’re going to descend upon your unsuspecting brain, inviting you to worry. Those thoughts are out of our control. Worry, however, is a behavior – an invisible behavior but a behavior no less. We have some control as to whether we continue the conversation with ourselves or not.

There are other behaviors that people undertake in response to scary thoughts that are just as unhelpful as the act of worry. In the case of a person with Illness Anxiety Disorder who’s afraid of getting cancer, they might research the symptoms over and over again. They might hyper-focus on bodily sensations and check to see if they’re feelings something that might indicate cancer. They might ask others if they should be concerned. They might get tested more than is warranted or they might avoid the doctor altogether. With COVID-19, these unhelpful behaviors might include incessantly checking the news to see if there have been any updates, asking anyone you can what they think will happen, avoiding news altogether, or avoiding grocery stores entirely when the CDC guidelines are not suggesting this for your demographic.

The choice to respond, whether through excessive worry, checking, avoidance or reassurance seeking, is a choice to perpetuate anxiety. If you keep trying to resolve your anxiety with unhelpful actions, you’ll likely:

• Lose swaths of time engaged in actions that don’t serve you or the pursuit of what’s most important to you.
• Become frustrated because these behaviors don’t lead to answers.
• Want to continue performing these actions repeatedly. This is because if your actions provide relief even once, the behavior is reinforced and more likely to recur.
• Believe your thoughts are more important than they are. When you respond to your thoughts, you teach your brain that they require attention and action.
• Feel even more uncertain. When you spend more time focused on uncertainty, you will likely generate more doubt both by keeping that uncertainty at the forefront, and by recognizing additional uncertainties that you hadn’t considered before.
  

Given that these actions have so many negative repercussions, in treatment, we teach people with

anxiety disorders to stop engaging in these unhelpful behaviors. This is where anxiety treatment can support people with or without anxiety disorders in relating to uncertainty. We cannot get rid of anxiety, but we can relate to it in a healthier, more productive manner – without endlessly worrying, avoiding, checking or seeking reassurance.

So how can we use what we know about dealing with uncertainty and anxiety to support those who find themselves understandably anxious about COVID-19 and the fallout surrounding it? It’s not easy. Even when a person knows rationally that they don’t need to get weekly scans to make sure that they don’t have cancer, the person with Illness Anxiety Disorder still feels a sense of urgency to get another test run. Likewise, most people can clearly see that watching the news constantly won’t make them develop a cure or a vaccine for COVID-19 any quicker. That doesn’t mean that it’s easy to turn off the television or put the article aside. It’s easy to get consumed by trying to eradicate doubt – even when that doubt cannot possibly be eliminated. Our fears can make useless actions feel deeply compelling, even when these behaviors have clearly passed the point of usefulness.

We have to learn how to support ourselves in changing our behaviors when they feel important but objectively are not. First, we must consider whether our actions are helpful or unhelpful. If we clearly recognize that our actions are unhelpful, that provides the impetus to make a different choice. If we continue to behave mindlessly, the process of change is not possible. If you catch yourself trying to get certainty, you have the opportunity to consider if this action is going to help you in a meaningful way.

Second, we can choose to view scary thoughts – however understandable, legitimate or warranted – as “thoughts” rather than as inherently important information. If you think “What’s going to happen in a week? Will I be able to leave my home?” This is a string of words that happened across your mind. They don’t need to be addressed. Instead of responding to them, you might just notice that your brain is “thinking” and move back to whatever you were doing before your mind got distracted.
In order to refocus on what’s meaningful to you, you have to be willing to accept the uncertainty that you cannot change. You have to be willing to embrace the unknown and to feel all the queasy, uneasy feelings that come along with that. We try to get certainty because we want to escape the groundlessness of uncertainty. To stop and say “I’m not going to figure that out right now” can bring with it great discomfort.

If we don’t allow for the emotional experiences, though, then we will just return to the unhelpful behaviors. It’s in our nature and the nature of all beings to avoid pain and seek pleasure. Therefore, it’s no surprise that when it comes to the anxiety that arises as a result of something like COVID-19, most of us don’t want to feel it. We grit our teeth, maybe we even gnash them. We clench our fists. We long for and wish after a different experience. We say, “it shouldn’t be this way!”

There are so many ways in which we resist emotions. The trouble is that resistance doesn’t make the emotional experiences go away or change. It just compounds the experience you’re having with resistance and pushes you to engage in unhelpful behaviors. In treatment, we try to approach emotions mindfully – that is we accept our present moment experience non-judgmentally. Instead of capitulating to the aversion that comes most naturally to us, we try to get curious about what it’s like to feel an emotion.

You might start to notice where an emotion resides in your body. Let’s take anxiety for example. You might notice a tightening in the throat or the chest, a tension in the jaw or forehead, increased heart rate, rapid shallow breathing, a lift or churning in your belly. These things aren’t inherently bad. People pay good money to go to amusement parks or watch scary movies to achieve those physical states. People enjoy the experiences of falling in love or exercising, which share many of those sensations as well. If you can just notice these physical feelings with an air of objectivity, it removes the resistance which is the additional suffering. You might even think to yourself “Oh, look, a feeling.” If you’re willing to feel something, then you are no longer a slave to that emotion.

But if you’re unwilling to feel an emotion, like anxiety, then you’ll continue to take useless actions that aren’t consistent with your values. In practicality, that could mean getting sucked back into the news or the rumination – looking up the symptoms of cancer until they’re memorized, and, even so, checking again.

This brings up an interesting question – where would you like your attention to be? This is where values come into play. Take a moment to consider your values. The following are some big questions that you could easily skim by, but I encourage you to take a moment with them.

• What do you want your life to stand for?
• What qualities do you feel are important to bring to the table, regardless of the circumstances?
  

Once you have a sense of this, you can practice redirecting yourself toward behaviors that are aligned with your values. If you feel compelled to turn on the television for the umpteenth time, and you value kindness and compassion, you might consider if this action is kind and compassionate toward yourself. If it’s not, maybe you can exercise compassion and kindness toward yourself in some other way – like by reading a book or stretching. Likewise, if you find that actively ruminating about how long this will last leads to isolation, you might consider if this is consistent with your values. If you put a premium on connection, then it would make sense to drop the rumination and bring your attention to people or animals in your home or community.

One way to support this is through a mindfulness meditation practice. I know, everyone’s probably heard the meditation plug about a million times already, but this can directly support your ability to notice when you’re engaged in unhelpful behaviors and also help strengthen your ability to refocus your attention. This is particularly true when it comes to mental behaviors, like rumination.
Meditation is really simple. With focused-attention meditation, we find an anchor in the present moment. Often, we use the felt experience of breathing as our point of focus, but if that’s not to your liking you can also use a sensory experience like sound or touch as your anchor. We generally close our eyes and direct our attention toward our chosen anchor. If you’re using the breath as your anchor, you watch the breath. Then, invariably, your attention wanders and when you notice your mind has wandered – kudos to you. That right there is the moment of mindfulness. You can gently note that you were “thinking” and come back to the present – come back to resting your attention on your anchor. Practicing meditation once a day can help you to catch unhelpful rumination in the act when you’re going through your daily life. Essentially, you’re developing the muscle of noticing when you’ve strayed from the present moment and returning your attention to the here and now.

Ultimately, we’re just trying to bring ourselves back to “now”. No, we don’t know what’s going to happen in a week, a month, a year. While we’d like to know, we also don’t need to know. Most of the time, planning aside, all we need to do is to walk through life, one foot in front of the other, one moment at a time.

Our brains are going to continue to try to get us caught up in what the future has in store for us with COVID-19. Those thoughts – the “what ifs…” – they’ll keep inviting you into conversation. You can mindfully view these thoughts, just as we discussed mindfully viewing emotions. “Oh look, a thought.” You don’t have to engage with it. You can just be the objective observer of what the mind is doing.

Your mind is built to be keenly aware of potential problems and to place attention on possible threats. Ultimately, how you react to the alarm bells in your brain is your choice. You can give them a reasonable amount of attention and then change your actions, or you can continue to accept every invitation to engage in unhelpful behaviors like rumination.

The reality is that we’ve been living with uncertainty all along, we just weren’t as aware of it as we are at this juncture. With everything in flux, our usual sense of perceived security has gone, and in its wake there’s a lot of uncertainty. This needn’t be a problem, though. Uncertainty is our birthright. Learning to live with it is something that can benefit everyone, anxiety disorder or otherwise, throughout this experience and beyond.

There’s a beautiful passage in a book by Pema Chödrön that speaks to the fact that we are constantly in this uncertainty because of the promise of eventual death:

“There is a story of a woman running away from tigers. She runs and runs, and the tigers are getting closer and closer. When she comes to the edge of a cliff, she sees some vines there, so she climbs down and holds on to the vines. Looking down, she sees that there are tigers below her as well. She then notices that a mouse is gnawing away at the vine to which she is clinging. She also sees a beautiful little bunch of strawberries close to her, growing out of a clump of grass. She looks up and she looks down. She looks at the mouse. Then she takes a strawberry, puts it in her mouth, and enjoys it thoroughly.”

~ Pema Chodron
   The Wisdom of No Escape

This is going to be an anxious and uncertain time for many, because we’re more aware that we’re dangling from this precarious vine than we were six months ago, or even a month ago. If there’s a way to take some of your weight off the vine, then do so, but not to the exclusion of tasting the strawberries.
No matter where you are, there will also be the potential for moments of beauty and connection. I talk to people with OCD and anxiety about this regularly, and this also applies to those in the general population with anxiety about COVID-19. Appreciate the moments of joy even if they’re in the midst of struggle. Disengage from the behaviors that don’t help you to live a valued life so that even when the anxiety is looming, you can find contentment at the same time. Take actions that will serve what’s important to you. Don’t miss the strawberries.

• Lauren McMeikan, MFT, is a psychotherapist at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of OCD and related anxiety-based conditions. In addition to individual therapy, the center offers five weekly therapy groups, as well as online therapy, telephone therapy, home visits, and intensive outpatient treatment. 

Comment:
This is such a well written article, referring to essential concepts that we- as cognitive behavioral therapists- use as tools in the treatment of anxiety disorders. The current condition of COVID-19 just makes these concepts all the more relevant to all of us and not just people struggling with anxiety disorders. Let's use this new reality as a universal 'container' within which positive change happens for all!

I. Laniti, Ph.D

Σχόλιο:
Πρόκειται για ένα εξaiρετικά καλογραμμένο άρθρο το οποίο αναφέρεται στα εργαλεία που σαν ψυχοθεραπευτές γνωσιακής-συμπεριφορικής προσέγγισης, χρησιμοποιούμε για την αντιμετώπιση των διαταραχών άγχους. Ξαφνικά όμως, μέσα στη συνθήκη του κορωνοϊού (COVID-19), οι έννοιες αυτές δεν αφορούν μόνο τους ανθρώπους με κάποια διαταραχή άγχους, αλλά όλους μας. Ας χρησιμοποιήσουμε λοιπον τη νέα αυτή πραγματικότητα σαν μια παγκόσμια “δεξαμενή” μέσα στην οποία συντελούνται θετικές αλλαγές για τον κάθε ένα από εμάς!
 

Ι. Λανίτη, Ph.D