Dr. David Palmiter's Blog for Hectic Parents

Though they can inspire similar feelings, depression and grief are different. Grief is healthy while depression is not. Grief involves coming to terms with a loss. Depression involves needless suffering secondary to believing painful things that are not true (you can find several articles I’ve written regarding depression using the search bar above). The more important the loss the more intense the grieving. Healthy grieving is regularly remembering and feeling the loss of the person, across a wide array of memories and experiences, while simultaneously (1) memorializing the person, (2) maintaining effective engagement in life (including self-care) and (3) avoiding unhealthy. self-numbing behaviors. How long it takes to get to the other side of grief varies wildly from person-to-person. But, a general guideline is that it can take one year for the worst of it to be done and two years until it seems like life is mostly okay again. Here are 13 tips for those who are within the first two years of grieving:

1. Find ways to memorialize the person who died. This can be extravagant (e.g., starting a foundation, creating a golf tournament) but certainly need not be. Indeed, sometimes people have made their grieving harder by taking on too much labor too soon after the loss. So, creating photo collages, works of art, videos and so forth can be helpful to memorialize the person.
2. Don’t resist. When it comes to grieving suffering = pain x resistance. Allow the grief to come if you don’t have something you must do (e.g., go to work, attend a child’s recital). This feels counter-intuitive as we fight depression when it comes, as we should. But, grief is not depression. Each tear drop brings you that little bit closer to getting to the other side.
3. If you have a hectic life, schedule time to grieve. When the time rolls around, bring out mementos of your lost love and let the waves come.
4. Try hard to get eight hours of sleep a night. If you can’t, consider tip #13. Everyone has sleepless nights but try to trend towards the eight. A rested body can grieve more effectively. (See this blog entry for some other tips regarding insomnia that might be easily adapted for your situation.)
5. Limit numbing. Try to maintain a healthy diet and keep substance use to a minimum. Comfort foods should really be called numbing foods, and a numb person is not a grieving person. Again, we’re talking about trends. Everyone numbs some of the time.
6. Be active. Try to get daily doses of physical activity. Sleep, diet and physical activity are the legs of the tripod upon which effective grieving is built.
7. Be kind. While it’s helpful to be kind to others (of course), this tip is primarily referring to yourself. For example, don’t allow yourself to beat yourself up for mistakes, including–and maybe even especially–ones that may be haunting you regarding the person you lost.
8. Lean into spirituality. If you are a spiritual person, tap into your Higher Power daily. People do this in different ways: praying, reading, writing, meditating, going to services, talking with a spiritual director and talking with friends can all be helpful.
9. Set boundaries. Set these up with people in your life. For example, you may need to tell co-workers that you prefer to be the one to bring up the topic of your loss. Having someone else bring it up, when you are trying to do something else, could be counterproductive.
10. If others are experiencing the same loss, open up to each other about your shared experience on a regular basis. However, if either one of you doesn’t want to talk about your loss in a particular moment, it’s important to respect that also.
11. Stay engaged. Try to socialize and have fun regularly. You may not feel like doing this much of the time. And, certainly give yourself permission to curl up into a ball with a blanket some nights. But, as a trend, try to do fun things with others on some regular basis.
12. Tap your wisdom. New problems will surface during this difficult time as that’s the nature of life. Each of us have deep wells of wisdom within that we can tap in these moments. For example, ask yourself how you would decide about a problem you are facing if you were living the last week of your life. Or, if you have a child, ask yourself what you would counsel your child to do in the same situation 20 years from now. Another very helpful technique is problem solving, which I describe here.
13. Consider CBT. We all battle with internal enemies. Sometimes we use friends, or self-help books or mentors or prayer or other personal assets to help us with these battles. At other times, meeting with a therapist to do an evidence-based and skill building therapy can be extremely help. Cognitive-behavioral therapy is often the treatment of choice for dealing with grief related challenges. (If you enter “cognitive behavioral therapy” in the search bar above you’ll find a few articles I’ve written describing this treatment approach).

In subsequent blog entries I’ll write some tips for helping a child to grieve, suggestions for those whose grieving is further along, as well as a few other grief related topics.

Research indicates that kids are sometimes born with a temperament that predisposes them to develop an anxiety disorder. This temperament, called “behavioral inhibition,” can be identified in toddlers. Such toddlers tend to have nervous responses to novelty or unexpected changes; they also tend to be more clingy and fussy than their peers when faced with separation from a primary caregiver. Toddlers with this temperament are then at higher risk for developing an anxiety disorder. What follows are six tips for trying to help such a child to not develop an anxiety disorder.

1. Avoid avoidance. This is one of the most important guidelines. This means not avoiding those developmentally appropriate situations that make your child feel nervous. When our kids hurt we parents hurt worse. So, it’s a natural reaction to just let our child avoid any developmentally appropriate situations that make her feel nervous (e.g., being left with a babysitter, getting on a school bus, joining a rec soccer team). Avoiding such situations reinforces the notion that they are dangerous and also tends to promote them becoming even more threatening over time. Moreover, this sort of a coping strategy tends to spread: your child may end up wanting to use it for more and more situations. Barring other complicating factors (e.g., the presence of Post Traumatic Stress Disorder), avoiding avoidance usually comes with initial distress but is followed by calm and a sense of accomplishment. (“Eventual” often ends up being just a few minutes.)

2. Promote your child’s comfort as you avoid avoidance. This can be done in any number of ways. One of my favorites is to gradually expose your child to aspects of the feared situation in doses before the due date. For example, you might play soccer with him on the field where the first practice will be held or arrange for her to sit on the empty school bus before the first day of school. You would usually stay within these situations until your child seems calm, using some of the other tips in this article. This can also be done in smaller chunks prior to the due date.

3. Teach belly breathing and pasta muscles. Have your child pretend that his lungs are in his lower belly, instead of his chest cavity, while breathing deeply but comfortably, both in and out. Relatedly, ask your child to make her muscles as soft as a piece of cooked pasta. Click here for a free 15-minute audio training module I created that can promote this sort of muscle memory. These behaviors short-circuit the fight-flight response, which is the brain system that becomes activated whenever someone feels anxious. (When in the anxious situation your child should not tense then relax his muscles, as is done in the training module. That is only done for practice. When in the anxiety provoking situation, only relaxation and belly breathing should be used.)

4. Avoid reassurances, especially those that are excessive. Few things will trigger your child’s anxiety more quickly than your reassurance that a safe situation is safe, especially when those reassurances that are issued with emotion or conviction. I tell the parents in my practice, “imagine I told you not to worry about the ceiling over us collapsing on top of our heads. You’d probably instantly start wondering what sort of a dangerous situation you might be in.” Kids often hear many parental reassurances as, “time to start freaking out!” Moreover, when you are separating from your kid (e.g., leaving the practice, leaving the school), leave as quickly as you can. Your presence, and especially if you are issuing reassurances, will often tend to promote the very anxiety you’re trying to mitigate.

5. Get control over your own anxiety if that’s a problem. This temperamental vulnerability, by definition, usually runs in families. If anxiety is interfering with the quality of your life, you would do your kid an awesome solid by seeking out cognitive behavioral therapy for yourself.

6. Get help if these efforts don’t work! Anxiety disorders in anyone, including kids, is usually very treatable and in a short period of time. The aforementioned cognitive-behavioral therapy can be delivered to kids and teens and has a ton of research supporting its efficacy. For a referral, click here.

Meta-analytic studies are called “studies of studies.” They entail grouping together findings from numerous studies on the same topic in order to reach more substantive and sweeping conclusions.

In the February, 2015 edition of the Journal of the American Academy of Child and Adolescent Psychiatry, a meta-analysis is published regarding psychosocial treatments for teenagers struggling with self-harm (e.g., self-mutilation) and suicidal ideation. The authors of this research are Drs. Dennis Ougrin, Troy Tranah, Paul Moran and Joan Rosenbaum Asarnow.

This is an important piece of research as, and quoting the authors, suicide “…is the second or third leading cause of death in adolescents in the West…” For example, the authors’ review indicates that the annual suicide rate among teens is 7.8%. Moreover, and regarding self-harm “…a systematic review of 128 studies reported a pooled lifetime prevalence of 13.2%…”

In considering the extant research the authors retrieved 389 articles. Their most important conclusions are based on 17 random control treatment trials on 2,176 youth. Their bottom line regarding how teens responded post treatment: “The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%).” The treatments “…with largest effect sizes are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT).”

I have described CBT in other posts on this blog (e.g., click here) and in Chapter 10 of my parenting book. As I reviewed in more depth elsewhere, CBT involves teaching a collection of cognitive and behavioral skills for managing mood, anxiety and stress based symptoms. It is a time-limited and structured treatment approach.

Quoting from the New York University Langone Medical Center: “DBT strategically blends the change techniques from traditional cognitive behavioral therapy with acceptance-based strategies from Zen mindfulness practice.” Mindfulness strategies essentially involve garnering feelings of peacefulness and contentment by tuning into the details of the moment.

Quoting from PsychCentral.com “Mentalization based therapy (MBT) is a specific type of psychodynamically-oriented psychotherapy…Its focus is helping people to differentiate and separate out their own thoughts and feelings from those around them… In …MBT, the concept of mentalization is emphasized, reinforced and practiced within a safe and supportive psychotherapy setting. Because the approach is psychodynamic, therapy tends to be less directive than cognitive-behavioral approaches.”

As I’ve reviewed elsewhere on this blog (e.g., click here) and in my parenting book, most teens who could benefit from mental health services don’t receive it, including kids who self-mutilate or struggle with suicidal thinking. This new research confirms and elaborates on an established finding in the scientific literature: mental health treatments for teens work!

If you even suspect that your teen is struggling with these issues, please consider taking the (sometimes lifesaving) step of seeking out a mental health evaluation. For a referral, click here. For other content pertaining to suicide, just enter that word in the search bar above.