Reality Check with Grief and Loss and Depression
Recognize the reality of the situation.
Accept the reality, for what it is. Write down the facts.
What happened? _____________________________________________________________
Accept all parts of the grief and loss reality. You have a choice and can decide how to respond.
Describe how grief and loss affect your life today:
_____________________________________________________________
I feel these emotions _____________________________________________________________
I have these thoughts _____________________________________________________________
I wish that _____________________________________________________________
I can talk to____________________ about the grief and loss._________________________
Stay sober. If you can’t stay sober, seek out help and support from AA, NA, or Al-Anon.
Bad decisions about myself or my safety can be challenged when I am not sober.
Consider who I influence: my family, my siblings, my parents, the younger generation, pets, neighbors, people in the community.
_____________________________________________________________
It’s ok to cry.
It’s common to have thoughts, images, or dreams of the loved one who died.
Consider having a ceremony, a church service, or a funeral for the loved one who died.
This will take time. I can go to this grief and loss support group: _____________________________________________________________
Past Regrets
The Mindfulness Response can help manage the triggers that create negative thoughts and feelings. In group therapy, people talked about past issues with regrets, and remorse. The DBT skill “Wise Mind” helped them untangle this snarl from the past.
Wise Mind
Wise Mind is a skill borrowed from Dialectical Behavior Therapy or DBT (Linehan 1993). Wise Mind uses both Emotional Mind and Rational Mind to create intuition. This includes mindfulness and combining emotions with facts to start a new plan or to make a new decision. Wise Mind combines emotions and thoughts and creates a new way of seeing the entire picture. This takes time to do and involves personal patience and self-reflection. The best way to get to Wise Mind is to practice up to 10 minutes of mindfulness.
Rational Mind | Wise Mind | Emotional Mind |
Facts | Combination of both emotion and rational mind | Feelings guide actions |
Logic, data | Intuition, balanced | Stressful, not focused |
Reason, judgmental | Present moment | Reactive |
PTSD or Psychosis Trigger:
I can see myself in my younger years doing things that harmed other people. I was doing all kinds of crazy crap.
I feel so bad about the past.
I have trouble now with my past because I am sober. I
remember abuse from childhood. They took advantage of me.
They don’t respect my thoughts or feelings.
Reasonable or Factual Mind: Emotional Mind & Instant Reaction
Facts: I did things I regret today. I’m mad at myself for the past.
I can see myself much younger and in trouble. I can’t forgive myself for the past.
Facts: I am sober, now. I’m feeling upset.
I am trying to stay sober. I feel alienated from others.
Someone offered me alcohol. I feel angry and violated.
Distressing Reaction Response
Experiential Avoidance or Safety Behaviors and Triggers
The group discussed PTSD or psychosis triggers can create more worry and frustration in the mind. The emotions connect to negative thoughts or cognitive distortions, and this causes a person to feel more difficult emotions, some are anxiety, distress, and depression. Identify all emotions connected to this past traumatic event. There is usually one or two stronger emotions. There can be ten more that also appear. Name as many as possible:
_____________________________________________________________
_____________________________________________________________
One person in the group began to judge themselves and place blame on themselves or others. This created further inner turmoil, and the person avoided situations, places, and people that were connected to the negative thoughts and the traumatic events that occurred in the past.
SHAME: Investigate My Thoughts
The group discussed how difficult this was. One person said having an individual therapist, a support group, and a psychiatrist made it easier. The group discussed experiences of shame and trying to be non-judgmental but needed a support person to stand with them through the process. Sometimes memories trigger other distress, and it is part of the process. Going slow through these issues is recommended.
Shame is associated with past trauma issues. Post-traumatic stress disorder (PTSD) is a group of symptoms that involve memories that interrupt our present-day ability to focus and concentrate (flashbacks) and wake us at 3 am with nightmares of past traumatic memories. Sometimes people wake in fright, crying, or fighting. PTSD triggers can increase psychosis symptoms.
A team approach to recovery is recommended. This would involve a support person, an individual therapist, a “prescriber,” or a psychiatrist and could involve County mental health workers.
Shame and Guilt Feelings
Relaxed Worried Guilt Shame & Stigma Suicidal Thoughts
Calm Sad Anxious Urges to self-harm Voices criticize
The group discussed guilt, shame, and stigma and noticed many negative thoughts that came with them. Many participants noticed that they had deep feelings of being born defective and judging themselves poorly. Discussing self-compassion concepts helped peel away years of shame that encircled their world.
Physical Sensations I Have:
Relaxed/calm: The body feels relaxed, the heart rate is normal, and concentration is focused.
Anxiety/worry: The heart rate is faster, with anxious thoughts that focus on the past or the future, not the present moment, and a loss of focus.
Hyper-vigilant or on alert: Increased heart rate and pulse beats faster. There is intense attention to outside factors, with difficulty focusing on the present moment.
Overwhelmed/panic: There is a racing heart or the heartbeat flutters, chest muscle tighten, chest aches, throat muscles tighten, throat feels as if it is closing, difficulty swallowing, numbing or tingling, hot or cold flashes, stomach aches, butterflies in my stomach, stomach tied up in knots, sweating, nausea, vomit, diarrhea, light-headed, dizzy, ringing in ears, blurry vision, loss of focus, feel like I am going crazy or doomsday is coming, the feeling of dread, crying, shaking, trembling, and feel like I am having a heart attack,
I need to be on alert, so I stay safe. (More thought distortions)
This reminds me of everything that went wrong in the past! It’s happening
again! Oh, no! I need to get out of here!
Psychosis, PTSD, and physical sensations that accompany hallucinations:
Olfactory: Smell, odor, aroma
Gustatory: Taste
Tactile: Touch sensations
Auditory: Hearing noises, voices
Visual: Seeing things that others do not see.
Vestibular: Balance
Interoception: The sensations inside the body, such as nausea or hunger, a full bladder, aches, pains,
Proprioception: The body’s ability to sense its location and movement by muscles and joints: kinesthesia.
What are the thoughts that I usually have?
Relaxed, calm: I can do my daily routine _____________________________________________________________
Anxious, worry: Thought Distortions begin _____________________________________________________________
What if??? If only I had done …. _____________________________________________________________
Catastrophe or Catastrophize: Everything will go wrong!! _____________________________________________________________
Triggers & Fear Levels
Increased anxiety causes people who have experienced trauma, or psychosis to react faster than others. The triggers may cause hallucinations or paranoia to become more frequent. The triggers create intense feelings and thoughts that require immediate response. If you can identify triggers and understand how they create this situation, it will help decrease the intensity and diffuse the situation.
Triggers that I notice: TV, Radio, computers, conversations about violence or crowds, certain places _____________________________________________________________
People who look like a previous perpetrator, describe _____________________________________________________________
Are you able to disobey a feeling of fear or a voice that tells you what to do?
_____________________________________________________________
Can you use distraction skills to focus on something else? _____________________________________________________________
Комментарии