Feelings Skills

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FromTreating Traumatic Bereavement: A Practitioner’s Guide, by Laurie Anne Pearlman, PhD; Camille B. Wortman, PhD; Catherine A. Feuer, PhD; Christine H. Farber, PhD; Therese A. Rando. Copyright 2014 by The Guilford Press. All rights reserved.

HANDOUT 8 Feelings Skills

Feelings skills are inner abilities that help people remain internally steady in times of distress. A loss often brings up strong emotions. For this reason, feelings skills are a foundational part of this treatment. Having specific skills to deal with intense or even overwhelming emotions will help you to experience your emotions more fully and with less discomfort or fear. These skills will help you throughout this treatment and recovery process. There are three feelings skills that are essential to this internal steadiness: inner connection (which helps people to stay connected to images and memories of loved ones), self-worth (which helps people to maintain a generally positive and stable sense of being “good enough” individuals), and feelings management (which helps people to handle strong feelings). We describe each of these skills and ways to build them below.

INNER CONNECTION

Inner connection is the feelings skill that allows us all to carry images and memories of loved ones with us, even in their absence. When we wonder what a beloved grandparent, former teacher, or friend might say, we may hear words of love, comfort, or support that reflect a strong sense of inner connection with these “loving others.” That connection can help us through challenging times, guid- ing us and enabling us to feel less lonely.

Why Is Developing or Maintaining Inner Connection Difficult? People who didn’t experience much love or affection when they were growing up may not have many positive or loving figures to draw on in times of distress. Even if you have had loving connections with others, you may feel sadness, guilt, or anger when you think of your deceased loved one. This can get in the way of feeling that person’s love and support for you.

How Can You Develop or Maintain Inner Connection? It’s important to be creative in thinking about who your “loving others” are. Such a figure may be a friend or family member, a former teacher or clergyperson, a pet, an admired public person, or an imaginary character. The “other” doesn’t have to be alive, and you may never have met. If one of your “loving others” is deceased, thinking about that person may bring sorrow or other feelings. If so, you might want to try to allow yourself to feel the emotions and try to keep this person’s love with you while reminding yourself of loving things the person would say to you and the special connections you had with each other.

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From Treating Traumatic Bereavement by Laurie Anne Pearlman, Camille B. Wortman, Catherine A. Feuer, Christine H. Farber, and Therese A. Rando. Copyright 2014 by The Guilford Press. Permission to photocopy this handout is granted to purchasers of this book for clinical use only. Purchasers can download and print additional copies of this handout from www.guilford.com/pearlman-materials.

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Copyright © 2014 The Guilford Press. All rights reserved under International Copyright Convention. Guilford Publications No part of this text may be reproduced, transmitted, downloaded, or stored in or introduced into 370 Seventh Ave., Ste 1200 any information storage or retrieval system, in any form or by any means, whether electronic or New York, NY 10001 mechanical, now known or hereinafter invented, without the written permission of The Guilford Press. 212-431-9800 800-365-7006 www.guilford.com FromTreating Traumatic Bereavement: A Practitioner’s Guide, by Laurie Anne Pearlman, PhD; Camille B. Wortman, PhD; Catherine A. Feuer, PhD; Christine H. Farber, PhD; Therese A. Rando. Copyright 2014 by The Guilford Press. All rights reserved.

Feelings Skills (page 2 of 7)

Exercises for Strengthening Inner Connection You can strengthen your sense of inner connection with your “loving others” by practicing calling upon them in your imagination when you feel good. Then when you need support, it will be easier to draw on this resource.

INDEPENDENT ACTIVITY: INNER CONNECTION

Find a quiet spot to sit where you can be comfortable and uninterrupted for at least 20 minutes. Write down the names of three positive figures (for example, people you know or have known; animals; figures from history, public life, religion, or fiction). Imagine one of these characters comforting, encouraging, or supporting you. What advice might this individual give you about yourself, your behaviors, your relationship with your loved one, and your life? How might this person demonstrate understanding or compassion for you? When you finish imagining, take one of these positive words or phrases and repeat it to yourself several times. Then practice using that phrase when you feel lonely or lost.

SELF-WORTH

Feeling worthy or deserving of life and good fortune even when times are difficult is a sign of positive self-worth. It comes from a secure base or deeply felt sense of security in childhood, where adults treat children with love, compassion, and respect. As children grow up, they take in that positive regard and come to feel “good enough” about themselves. It doesn’t mean never having a bad day or feeling bad, but it does mean that even when people feel bad, they know (or can recall) that they are still reasonably good human beings. When they do something they know is wrong, they feel guilty. Guilt is a natural, and sometimes even useful, feeling. It’s easy to confuse bad feelings about what you did or did not do (guilt) with bad feelings about yourself as a person.

Why Is Developing or Maintaining Self-Worth Difficult? People who grew up in homes where adults or peers were unsupportive or harsh may have taken in negative messages about themselves. This makes it difficult for them to feel like “good enough” per- sons, especially when things go wrong. It may be natural to move to self-blame or feelings of worth- lessness when bad things happen.

How Can You Develop or Maintain Self-Worth? Associating with people who respect you, treat you with dignity, and bring out the best in you is an important way to develop a sense of self-worth. In addition, treating yourself with respect, doing things that are consistent with a positive self-image, and not doing things that diminish you in your

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Feelings Skills (page 3 of 7)

own eyes can increase your self-worth. Acknowledging your mistakes, apologizing, and making amends when you do something wrong can help to build your sense of self-worth as well. Building skills and developing your knowledge and talents can also contribute. Finally, helping others and treating them with respect, compassion, and dignity can increase your own self-worth.

Exercises for Strengthening Self-Worth The next time you are in the company of someone who likes you, ask yourself what that person values about you. You may also ask that person the same question. Notice how you feel when you offer someone else assistance or support. What does that say about you as a person?

INDEPENDENT ACTIVITY: SELF-WORTH

Make some notes about the kind of person you would like to be—your “best self.” This is your ego ideal, something to which you aspire. When you consider various actions in advance, try to follow the path to your best self. As you act according to this path, your sense of value and self-respect will grow. Think about something you did (or did not do) about which you feel bad or guilty. • Write for a few minutes about what happened, why you made the decision or acted as you did, and what your subsequent thoughts have been about your choices. • Think about or write down a few things you might do to make up for your mistake. • Identify one or two things that seem possible to do and not too challenging. • Experiment by doing one of these things, and see whether you feel better about yourself.

FEELINGS MANAGEMENT

Feelings management refers to the ways people cope with emotions that are particularly challenging. (We use feelings and emotions interchangeably here.) When most people experience happiness, they will express it easily. An emotion such as anger may be more difficult for some people to express, especially if the anger is powerful. If they have trouble experiencing intense anger, they may “bury” it or try to pretend it’s not there. Some people are so good at this that they aren’t even aware that they are angry. Emotions—even strong ones—help you to stay connected to yourself, to others, and to the world. This is important because emotions provide you with information about both the world around you and how you relate to that world. If you are feeling angry, for example, this feeling might reveal that there was an injustice or that someone wronged you. Your anger might be a way of recognizing and standing up to the injustice. If you are not aware of it, however, you will miss this connection. There are four steps involved in feelings management, each of which will be important to you throughout this treatment and beyond. The steps are recognizing, tolerating, modulating, and integrating feelings. (continued) 283

Feelings Skills (page 4 of 7)

Recognizing Feelings Recognizing feelings means being able to sense emotions as they arise in your body and to label or name them. You may find this step to be easy, difficult, or somewhere in between. You may also find that you are able to recognize some feelings more readily than others. Past experiences may help you to identify a specific emotion. You may know that a particular type of experience (such as loss) is often connected with a certain feeling (such as sadness). These links can be another pathway to recognizing your feelings.

INDEPENDENT ACTIVITIES: RECOGNIZING FEELINGS

1. Create a feelings vocabulary. Begin to create a feelings vocabulary by learning the names of feelings and beginning to attach those names to your bodily states. Below is a list of feelings that may help you begin to name your feelings. Use this list to check those you are aware of once or more per day.

angry irritated helpless restless numb lonely heartbroken aching vulnerable enraged regretful detached anxious overwhelmed in despair ashamed lost crushed preoccupied exhausted empty isolated annoyed bitter sorrowful in agony frustrated sad confused guilty depressed hopeless embarrassed insecure nervous scared proud disgusted hurt excited mad panicky happy frightened disappointed cheerful loving eager depleted humiliated calm content 2. Link names of feelings with bodily sensations. Once you become acquainted with names of feelings, you can pay attention to how each feeling is present in your body. For example, sorrow may feel like a pit in your stomach. Another person might feel sorrow as tightness in the throat.

3. Create a feelings intensity scale. That is, assign levels to each feeling state. For example, someone can feel frustrated, irked, annoyed, irritated, angry, or enraged—all of which are different intensities of the emotion often labeled anger.

4. Differentiate feelings from actions. Whereas anger is a feeling, violence is an action. Sad is a feeling that might go with the action of withdrawing. See whether you can create a list of actions you engaged in today, and then list some feelings that might go along with those actions. (continued)

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Feelings Skills (page 5 of 7)

These associations or connections can vary from one day to the next. So being withdrawn today might have to do with feeling sad, while being withdrawn on another day might have to do with feeling lonely or angry.

5. Pay attention to your body. A tight throat or chest may signal anxiety or fear. Practicing labeling certain bodily sensations, and talking about this with your therapist or another person, will help you to learn which emotions go with different bodily sensations for you. You may find that it is difficult to notice your bodily sensations as you go through your day. The following exercises can help you slow down and focus enough to become aware of what your body feels.

Sit quietly and let your attention go to what you are currently feeling in your body. Focus your attention on any place in your body where you notice a physical sensation. What is the name of the sensation (tightness, pain, ache, etc.)? Do this again for each place in your body where you have a sensation. Notice your breath. Attend to how the air feels coming in and out of your body. See whether you can feel the air entering your nostrils, lungs, and diaphragm. Notice how your body feels as the air moves in and out. Write down any names of emotions that come into your mind as you breathe. Move your body. First, move gently—standing up and swaying back and forth, dancing to some music, or bending and reaching. Stop and notice sensations in your body. Let your mind create some names of emotions that might match those sensations. Then try moving vigorously. Walk briskly around the block or do some jumping jacks. When you slow down and then stop, look again for physical sensations, and create emotion names to go with them. Go back to the checklist above (see Activity 1 in this box) and check off the feelings that you are currently experiencing. Circle the three that are most intense right now.

Tolerating Feelings Tolerating feelings means being able to accept and work with emotions as they arise. The following exercises can help you learn to tolerate feelings.

INDEPENDENT ACTIVITY: TOLERATING FEELINGS

Name early associations (thoughts, images, memories) that you have to a particular emotion. Understanding what might have made feelings seem negative or dangerous can be a helpful step toward tolerating them. This step will also be easier if you can step back from the emotion a bit and observe, name, and discuss it. Understand what current situation triggered the emotion. Once the emotion begins to make sense, you can recognize that it is here for a reason and move closer to accepting and even welcoming it.

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Feelings Skills (page 6 of 7)

Try to name associations among feelings (your emotions), thoughts (ideas, things you tell yourself), and behaviors (things you do). Observe any thoughts that accompany the feeling as well as any behaviors that seem to result from, express, or disguise it in some way. Remind yourself that feelings provide useful information. This acknowledgment helps to make them less scary and to remind you that your feelings make sense. Know that emotions exist on a continuum of intensity and always run their course. The next time you have a feeling that you can recognize, take a moment to notice where that feeling is located in your body. See whether you can identify a color, a shape, a sound or song, an animal, or an object that represents the feeling. Try to recall a time in the past when you felt this emotion. See whether you can recall how long the feeling lasted, what intensified or diminished it, and how it began to ebb.

Modulating Feelings Modulating feelings entails being able to control the intensity of what you experience, rather than feeling as if the emotion is controlling you. The first step in modulating feelings is to notice that your feelings have different levels of intensity. For example, when you’re upset, you may be very upset or just a little bit upset. Noticing what’s going on in your body is one way of observing your levels of upset. The more intense your feelings are, the more likely you are to have strong bodily sensations. Of course, some people have learned not to feel, in which case numbing may be a sign of intense feelings.

INDEPENDENT ACTIVITIES: MODULATING FEELINGS

Breathe. Breathing is a key to modulating strong feelings. The next time you are distressed, try to focus on your breath. After 10 long, slow breaths, see whether the intensity of your feeling has changed. You might also try the breathing retraining exercise described in Handout 7. Name your feelings. Being able to name feelings also helps in modulating them. For instance, if you know that you are sad, you may have some ideas about why you are sad and what may help you to regulate your sorrow. Describe the intensity of the feeling. The next time you are aware of an emotion, write down its intensity on a scale from 1 (very mild) to 10 (very strong). At the end of one of the following exercises, come back and rate the intensity of that emotion again. Examine the emotion. Choose an emotion that you experienced very recently. Try to figure out when you started feeling this way and what was going on around you, between you and other people, and within yourself. • Write down the name of the feeling, and then write down what happened and what you were thinking about just before you started feeling it. • Ask yourself, “What is this feeling trying to tell me?” and write down any responses that come up for you. Choose a calming word or a phrase. You can say this to yourself when you notice the impulse to run away from or bury a feeling. For example, it can be helpful to say, “Calm,” “Breathe,”

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Feelings Skills (page 7 of 7)

“It’s only a feeling,” “Feelings can’t harm me,” or “The name of this feeling is . Its intensity is (1 to 10). That feeling is difficult for me because .” Imagine that your feeling is on a video or audio recording. You can regulate the intensity of your feeling by turning the volume down, rewinding or fast-forwarding it, or letting it play more slowly. You can practice turning it up, down, off, or on. Choose to do something constructive or soothing. When you need help modulating a specific emotion, pick a soothing alternative activity and engage in it. This might include playing your favorite music, watching a favorite movie, going for a walk, praying, meditating, connecting with nature, reading poetry, working in the garden, or the like. Connect with someone who cares. Sometimes talking with a friend about what’s going on for you can help you modulate your feelings. At other times, you may simply want to spend time with a friend or family member, not necessarily talking, so that you don’t have to be alone with your feelings.

Integrating Feelings Integrating feelings means connecting emotions with their context and incorporating them into the narrative or story of your life. You can learn to integrate your feelings by paying attention to the broad context of the feeling. Spend some time exploring a particular emotion within the context of your life story. This can happen within therapy, within an intimate relationship with a supportive other, or by yourself.

INDEPENDENT ACTIVITY: INTEGRATING FEELINGS

Journal writing (which is a way of speaking to yourself) can help enormously with integrating feelings. Try writing about a situation in which you noticed a particular feeling. Allow your writing to lead you, and try not to worry about whether the writing makes sense as you write. Choose a particular feeling that you had in the past day or two, and try to answer the following questions about that feeling:

Where do you experience that particular feeling in your body? What was the context that gave rise to the feeling? What are some of your past experiences of the feeling? When do you remember experiencing this feeling before? What was going on then? Are you aware of a connection between this feeling and any physical or psychological needs you may have? With what information does this feeling provide you? What new thoughts or feelings come up for you now as you reflect on the context of this feeling? What does this feeling say about you as a person? Can you see how this feeling might fit into your identity and life in the future?

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