Becoming More Mindful: Where to Start?

Photo by Tanushree Khanna on Unsplash

We live in a fast-paced society where it feels like there's rarely (dare I say never) enough time. I know I'm not alone in this feeling; I hear about it daily from friends and family, and of course the clients I counsel in my practice. The overwhelm is folded into the lives of my clients who are struggling to conceive, those grieving, the women who are adjusting to the reality of motherhood, the men who feel a ridiculous amount of pressure to provide and succeed financially. Sometimes the greatest stressors come from within, our attempts to be the best partner/parent/daughter/brother/insert role.

Mindfulness has been a buzz word for the past decade or so and shows no sign of leaving center stage of the $3.7 trillion global wellness market (Reference). And there's good reason-- midnfulness is touted as the antidote for aging, perfectionism, anxiety, depression. The list goes on. But for those unfamiliar with mindfulness, learning what it is and what it isn't, and figuring out how to bring it into your life can cause more of those feelings of overwhelm we're trying to conquer. After all, won't adding something else to your to do list make you even busier?

That feeling of being busy and rushing all the time, there's a choice in that. At least that's what the gurus of mindfulness tell us. With a mindful approach, we get to decide how we interact with the world around us. Mindfulness helps us to slow down and  to pay attention to our thoughts, behaviors and reactions. Mindfulness allows us to respond rather than react.

How to Be More Mindful

So how do we bring mindfulness into our daily lives? Like all things we strive towards, we must develop a mindfulness practice to reap the rewards. We must schedule a time, then stop what we're doing, and sit. Starting with a guided meditation can often be a helpful place to begin for those who have no prior experience with mindfulness. Below is a short 5-minute guided mindfulness exercise. It's one that I introduce to clients in my practice and in my infertility support groups: 5 Senses Mindfulness Exercise. I didn't write it myself, but it's my recording.

I like this exercise because it allows us to recognize the many ways we can be mindful in our own bodies each and every day. By attuning to the senses we can invite ourselves to stay in the present moment when we're eating, resting, gazing, walking, listening-- grounding ourselves wherever we may be, whenever we need it. 
 

The Wandering Mind

Photo by ANDRIK ↟ LANGFIELD ↟ PETRIDES on Unsplash

I like to remind my clients that there's no right and wrong with mindfulness; it's simply about cultivating awareness. Many people incorrectly believe they're "doing it wrong" because their mind wanders. This is normal as our minds are made to think. The practice of mindfulness is to simply guide your attention back to whatever it is you are doing-- breathing, pushing a grocery cart, taking a shower. Yes, each of these activities can be done mindfully. But let's start with sitting.

So find yourself a quiet place to begin. Push the button below when you're ready. You will need to download the link in order to play it on iTunes. I hope this experience allows you to slow down, if even for just 5 minutes

Whether you're a busy parent or longing to be one, mindfulness is an invaluable tool to help cope with the stressors of daily living. If you’re looking for a therapist in the San Diego area, I’m happy to help. Feel free to reach out by phone or email and we can talk about ways you might benefit from counseling. 

Making Mother’s Day Meaningful For You

As a therapist, and a mother, daughter, friend, neighbor and sister-in-law, I’ve supported countless girls and women through the emotional rollercoaster that Mother’s Day often brings. While we were all brought into the world by a woman, she’s not always the one we call mom. Some children are lucky to have one or more caring women in their lives who are regarded as a mother, or a mother figure. But everyone is not so fortunate; some children grow into adulthood never having experienced this type of maternal bond.

Growing up, one of my closest friends lost her mother to cancer when we were in 7th grade. Since then, I’ve always looked at Mother’s Day through a different lens. Intuitively I knew at that time that this holiday would be hard for her each and every year for the rest of her life. In graduate school and through my training and experience over the past 15+ years I’ve learned about the importance of the mother-daughter bond and the many ways that this bond can be impacted through developmental and situational life traumas.

Now, I spend my days in my private practice working with women who are on both sides of the motherhood journey—those who are yearning to be mothers, struggling with infertility, and those who have become mothers and are making their way through the transition to motherhood, often coping with symptoms of depression, anxiety and post traumatic stress. I also see women who are caught somewhere in-between on their motherhood journey, those who have lost their babies. Unfortunately no one is exempt from the myriad of emotions that may be stirred up by this second Sunday in May.

MOTHER’S DAY CAN BE PAINFUL

There are many reasons why this day might be hard for you. Not having a mother, or losing a mother can trigger emotions of loss and sadness as the day approaches. Even new moms who are navigating their way through this first year of motherhood aren’t excluded from this conversation. If you’re struggling with a postpartum mood or anxiety disorder, shame and guilt may be overriding any feelings of joy you’d hoped to experience.

Becoming a mother also makes us acutely aware of the ways in which we were or weren’t mothered. These experiences and memories can stir up a well of feelings.  The anticipation of the holiday can spark feelings of overwhelm, grief and loss. Similar emotions may arise for those who are still struggling to create a baby, or bring one into their lives and hearts.

The anticipation of Mother’s Day can be more difficult than the actual day for some. I have found that making a plan is one of the best ways to prepare for the day and to help make the day meaningful to you notwithstanding the pain you also feel.
 

PREPARATAION

I encourage my clients to focus on activities that feel nourishing—curling up with a good book, walking on the beach, eating yummy food, making a recipe that touches the soul like only the smells and tastes of certain foods can do. Taking care of ourselves is the first step.

You may be wondering how to cope with family responsibilities, the obligatory Mother’s Day brunch at Aunt Suzy’s or the BBQ dinner at your step-mother’s. For some, the idea of forgoing a family obligation just isn’t an option. And that’s OK. But I encourage you to check-in with yourself and weigh the pros and cons carefully. You matter. If you decide you must go, consider if you’re able to arrive late and leave early. This is often a great solution if declining the invitation might cause too much family drama. Try to add something to your day that feels supportive, so you don’t go to bed feeling depleted emotionally and physically, which is so often the end result when emotions are thoroughly taxed.
 

CREATE YOUR OWN TRADITION

Whether you’re adding on to an existing event or starting from scratch, consider making your own traditions.  If you’re not sure what that might look like, keep reading. I’ve included a few ideas to help get you thinking and planning for a day that’s special to you. Hopefully one of these ideas will inspire you.

GO FOR A HIKE. Spring is the perfect time of the year in most areas of the U.S. to get outside, soak up the sunshine and breathe in some fresh air. Not only is a walk outside great for the body but also for the mind. Physical exercise has been shown to release endorphins (feel-good hormones), which naturally trigger positive feelings helping to reduce levels of depression and anxiety. The great thing about hiking is that you can do it alone, with a partner and even bring the kids, regardless of their age. And please don’t be put off by the word “hike”. A stroll in nature can be just as good for the body and the mind.

GARDEN. Another great activity to do alone or with others. If your garden has been neglected, weeding can be more gratifying than one might think. Try to embrace the tedious task as a practice of mindfulness, staying present as you loosen each stubborn weed from the grip of mother earth. Allow yourself to sense the soil in your hands, the sun on your back, the sweat trickling down your face. If you’re ready for planting, head to the nursery and find the vegetables, or flowers that catch your eye. Decide if you will plant from seed or not. Imagine the bounty that will grow from your hard labor and attention over the coming weeks and months and how the colors, smells and sounds of the garden will fill you, and perhaps your belly.

GET A MASSAGE.  The benefits of massage are too great to enumerate here. The physical benefits associated with pain management go without saying.  In addition, massage promotes relaxation and stress relief, which directly impact mood. Research shows that touch triggers a cascade of chemical responses, including a decrease in stress hormones, and an increase in serotonin and dopamine levels. The shift in these bio-chemicals has been proven to improve mood and decrease symptoms of depression.

EAT WELL. Make a point to feed yourself well. We’ve heard the saying too often- you are what you eat. Often feelings of stress and sadness are greeted with foods that are laden with sugar, salt or fat. Bad fat. These foods do little to nourish the body, or our mental well-being. But there are choices you can make that will actually help to boost your mood. Start by choosing meals for the day that incorporate a wide variety of fruits and vegetables. Avoid processed foods as much as possible. Prioritize foods that boost your dopamine and naturally boost your mood like animal proteins, almonds, avocados, bananas, chocolate, green tea, watermelon, yogurt, leafy greens and legumes. Choose non caffeinated tea in lieu of coffee, which can increase symptoms of depression and anxiety.

SLEEP! I’d be remiss not to mention sleep. Indulging in an afternoon nap or heading to bed on the early side can be a great add on to any tradition in the making. We live in such a busy society, and sleep is often the first thing to go. But not enough sleep can cause irritability, anger, stress and low motivation. So allow yourself to take it slow today and catch up on any sleep you may have missed this week.

I’d love to know how your day went and whether this article was personally helpful. And let us know what worked—or didn’t for you. If you found this Mother’s Day particularly difficult, consider reaching out for support from a trained therapist. If you are in the San Diego area, send me a message or give me a call at 619.780.3277 to see if we’re a good fit for therapy. Psychology Today is another great resource for finding a therapist near you.

Four Reasons to Join An (In)fertility Group

In honor of National Infertility Awareness Week, I’m encouraging anyone who’s struggling with infertility to speak up and get the support they need. If you know someone who’s could benefit, please consider sharing this article; you may not know how to help them, but pointing them to resources and letting them know you want to help will be appreciated.

Infertility is often a lonely and isolating time. It’s unexpected, often coming from out of the blue. But it doesn’t have to be like this. There are groups around that can help you deal with the predictable emotional roller coaster of feeling scared, worried, disappointed and sad. 

You may have considered looking for a group. You may have even located one, in your neighborhood, city or even online, but something has gotten in your way of joining. Hopefully reading this article will encourage you to think about the value of joining an infertility group.

Acknowledging the issue of infertility is often the biggest barrier to seeking help. The word itself may at first be scary, And then there's the fear and shame, which help maintain the loneliness and isolation so many experience. We often think we should be able to handle whatever life throws at us alone. But that's simply unrealistic. We are social beings and rely on others for many reasons. 

You may feel uneasy about sharing your dilemma with others. You may be fearful of hearing others’ stories. But here are four reasons why I hope you will consider joining an infertility support group. The old adage, "Joy shared, twice the gain, sorrow shared, half the pain,” rings true for me every time: 

1. EXPAND YOUR COMMUNITY

Infertility is often a lonely and isolating time. Whether you join a group expressly for women, or one for couples, you can expect to meet others who are in a similar situation and can relate to many of the struggles you're facing. Living in isolation can leave us feeling like we're the only ones who feel a certain way. Joining a group helps to validate common worries and emotions that individuals and couples face who are experiencing infertility.
 

2. LEARN COPING SKILLS

Infertility often goes hand in hand with depression and anxiety. Learning how to manage difficult emotions and life challenges associated with your infertility diagnosis is often another benefit to joining a group. Infertility is a crisis and a reproductive trauma, yet most people focus exclusively on medical interventions to reach their goal of having a baby. The emotional impact of infertility is often neglected until the distress is greatly impacting their day-to-day life and relationships.

So what if I told you that learning new tools could help decrease your symptoms of depression and anxiety like stress, worry, sadness, grief and loss? Did you know that deceasing these feelings could have a positive impact on your fertility? Many professionally led groups teach participants a combination of Cognitive Behavior Therapy and Mindfulness skills. Here’s how these skills can help you: 

• Cognitive Behavioral Therapy (CBT), an evidence based treatment for both depression and anxiety, is based on the understanding that our thoughts influence our emotions, but that our thoughts aren't always accurate. CBT teaches us how to challenge our thoughts to make them more realistic. 

• While Mindfulness has been a big buzz word for the past 5-10 years, many are still confused with the objective. Being mindful is about paying attention, slowing down and becoming aware and noticing your thoughts. By slowing ourselves down  on a regular basis we become skilled at approaching difficult moments in a more thoughtful intentional way. Simply slowing down and mindfully approaching stressful situations can have an important ripple effect benefit you in a multitude of ways.
   

3. LEARN FROM OTHERS

It is said, "Knowledge is Power." The treatment of infertility is often diverse and complex. Educating yourself as to the wide variety of treatment approaches and options is important. Joining a group may open your eyes to new options and opportunities.
 

4. FINANCIAL SAVINGS

It's no surprise that infertility treatments can be costly. You're doing everything you can to have a baby and it adds up: consultations with reproductive endocrinologists, acupuncture treatment, appointments with a naturopath, testing, procedures to rule out contributing health issues... And this is all before any costs of medications or other assisted reproductive technology are accounted for.

So how does joining a group save you money, you're wondering? Research shows that women struggling with infertility for 2-3 years have double the rate of depression than their peers without fertility complications (Domar, Broom et al 1992). The good news is that decreasing depression has proven to increase rates of conception by 50%. Joining a group can provide you with new skills to help you to cope with difficult emotions and challenges in relationships that often accompany infertility.

A group isn't necessarily a cure-all, but it's more cost-effective than ongoing individual therapy. By bolstering your support system and learning new coping strategies you may improve your mood and decrease the likelihood of needing an individual therapist as you proceed on your journey with infertility. What do you think, could a fertility group be right for you?

If you’re thinking that a group might be for you and you’re in the San Diego area, you can learn more about the groups I run here. I meet with all new group members before our first group to learn more about you and to make sure it’s the right fit. Give me a call if you'd like to learn more. If you’re outside of San Diego, you can find local fertility support groups through Resolve, the National Infertility Association, and Psychology Today.

Birth Trauma: Strategies for Healing and Prevention

This is the second part of a two part series on Birth Trauma. In Part 1, which you can read here, you met Sara who was fearful of becoming pregnant with a second child. Although she was riddled with anxiety, she was unaware she had a real problem: because she’d experienced trauma after the birth of her first child she feared getting pregnant. Although birth trauma is a real psychological condition, with concrete symptoms and a diagnostic criteria, many people internalize their experience, feeling shameful instead of seeking support.

My chance encounter with Sara was pivotal. A few weeks later she reached out asking for a referral to a local therapist. Through our informal talks I was able to help Sara understand how her unique experience left her vulnerable to experiencing a traumatic birth (also called postpartum PTSD), and that it was not only extremely common but treatable.

Sara, like many women I see in my practice, was unaware that her symptoms were worth paying attention to. The most common coping strategy I hear about is the attempt to ignore symptoms- to sweep them under the rug so to speak. But this approach is rarely successful for very long.

Women who eventually enter my office for therapy are typically struggling with one or more of the symptoms addressed in Part 1 of this series- symptoms that interfere with their ability to function at home or at work.  In this article I’d like to offer some recommendations for healing from traumatic birth and/or preventing a subsequent similar experience. 
 

Treatment of Traumatic Birth, or Postpartum PTSD

While many women who experience some symptoms of Postpartum PTSD will resolve their emotional stress with positive support from friends or family members, others will continue to struggle and will benefit from professional help. Recommended treatment for Postpartum PTSD starts with a thorough assessment by a trained mental health provider.

1. It’s critical to be assessed by someone who specializes in maternal mental health for a correct diagnosis to be made.  Therapists unfamiliar with postpartum PTSD might inadvertently recognize the symptoms as postpartum depression or anxiety. Although some of the symptoms are similar, the underlying experience of a birth trauma calls for a different treatment approach.

2. Both medication and therapy are evidence-based recommendations for treating birth trauma. Many therapies work quickly and effectively with postpartum PTSD, such as EMDR, which I offer in my practice. Narrative, group, and body-based therapy can be helpful treatment modalities.

Avoiding a Subsequent Traumatic Birth 

Whether you're anticipating a future pregnancy or currently pregnant, there are many things you can do to reduce the likelihood of experiencing a subsequent birth trauma.

1. Include your partner in this process. While it might seem obvious to some, others may feel isolated by their initial trauma and not realize the important role a partner can play in providing support and mitigating a subsequent traumatic experience.

2. Hire a doula. Simply put, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. If for some reason the birth is not going according to your ideal plan, a doula will intervene during labor with the intention of alleviating the trauma to reduce a woman’s chances of developing PTSD.

3. Take a childbirth education class. It’s important for women (and their partners) to be educated about what is supposed to happen during childbirth and what happens in the body during the birthing process. Childbirth classes also help to inform expecting parents about options during birth including: pain management, birthing positions, and how to cope with complications during birth.

4. Develop a written birth plan with your birth team. Discuss and include the interventions you are open to, those you want to avoid. Explore your back up plan. Remember to plan for the postpartum period and to consider the support that will help ease your adjustment to motherhood, or to mothering an additional child.

5. Talk to someone you trust. Work through any past traumas with a therapist, or at the very least discuss your history with your care providers to best prepare for the experience of labor and birth.  Meeting with a psychotherapist or body worker specializing in perinatal mental health allows you to focus on beliefs, emotions, sensations and andy past experiences that may influence your upcoming birth.
    

Help Is Available

Birth trauma is highly treatable; the first step of course is to recognize there's a problem.  With help you can avoid additional suffering and complications for both mom and baby. In San Diego, Postpartum Health Alliance offers a warmline with trained volunteers as well as a provider directory to locate trained therapists and other birth professionals. Outside of San Diego, Postpartum Support International can connect you with therapists worldwide who specialize in maternal mental health disorders.

Infertility Support Group

The journey through infertility can be lonely and isolating. Maybe you've lost touch with some of your friends or they just don't understand what you're going through. Even family, while well-meaning, often don't get it. 

The anxiety and stress can feel overwhelming. You're not sure what your next step is and how to navigate this stage of your life- this stage you never imagined having to go through in the first place. Maybe you worry you're too depressed to be around a group of other women. But remember- these women GET it! 

Join me, Rachel Rabinor, Licensed Clinical Social Worker and Dr. Elizabeth Winter, Licensed Naturopathic Doctor and Midwife for this 6-Week Mind/Body Infertility Support Group. 

Share as much or as little as you like. Listen to others. Feel the power of community. Reach out for support during this challenging time in your life and know you are not alone.

Dates: 
February 21 + 28
March 7, 14, 21 + 28

Cost: 
$275 ($225 before February 1, 2017)

Throughout the six weeks we'll explore issues related to fertility, including the impact on identity, self-esteem, sexuality and relationships. You'll have the opportunity to learn and practice relaxation and other mind/body coping skills each week. While we can't change the stressors you experience each day, we can help you learn to manage your response to allow you to live more comfortably and engage with life more fully. 

Women experiencing both primary and secondary infertility are welcome.

Registration required. 
 

Birth Trauma: Is THAT What I've Been Experiencing?

I met Sara and her 4-year-old daughter, Claire, at our local playground earlier this week. Claire instantly gravitated to my 5-year-old son and within moments they were chasing balls together, holding hands and laughing. Having just moved to San Diego from Boston, she was excited to meet us.

Like many mom-conversations go, Sara asked about the age difference between my two kids and how I felt about it. She told me that although her daughter was begging for a sibling and her husband was also ready, she wasn’t prepared to get pregnant again just yet. She was conflicted about her timing tho, noting her age and the pressure she was feeling to have another baby.

I empathized with her situation and shared some of my own personal experience, as well as my professional experience as a psychotherapist supporting women on their journey through motherhood. I offered myself as a local resource given my knowledge of San Diego’s network of reproductive health providers.  

A few days later we met again by the swings. Sara jumped right into the conversation, saying, "you know, I think I could probably use some help from someone like you. I'm pretty sure I suffered from some postpartum stuff and that's what's holding me back from having another baby." She went on to tell me about her difficult pregnancy, challenging labor and unplanned cesarean birth that left both her and Claire in the hospital for several days. The experience was distressing and she was anxious about becoming pregnant again. She had wanted an unmedicated, natural birth and was understandably afraid of having a repeat similar experience with her next child.

I spent some time talking with Sara about how her traumatic birth might be impacting her. As I spoke her face softened and her head nodded. She appeared to feel validated by my explanation: that trauma after birth is REAL.

While many around her would like Sara to move on and be grateful for a happy and healthy child, Sara is still reacting to her birth experience with Claire. Although Claire had suffered no long-term effects, Sara did. And her daughter’s health does not negate Sara’s experience and the anxiety and fear left in the wake of her birth experience. As we talked more, I stressed that it’s not the specifics of the birth that is traumatic, but one’s perception of these events. This is such a key aspect of trauma.
 

What Are The Symptoms of Birth Trauma?

Post traumatic stress disorder (PTSD) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a car accident, a natural disaster, or sexual assault. However, a traumatic experience can be any experience that involves the threat of death or serious injury to you or someone close to you, like your baby (birth trauma or postpartum PTSD). Again, it's your perception of your childbirth that matters most.  It is less important whether the hospital staff were in communication about recommended procedures than your interpretation of what happened.

Common symptoms of women who’ve experienced birth trauma may include:

• Feeling socially isolated
• Difficulty bonding with their baby
• Lonely
• Angry
• Depressed
• Irritable
• Difficulty sleeping
• Anxiety or panic attacks
• Worry excessively about the health of their babies
• Worry that their child might die
• Flashbacks or memories that repeat over and over about medical procedures or the behavior of medical staff.
• Nightmares

Why Some People Experience PTSD Postpartum

It’s not always the dramatic events that trigger childbirth trauma but other factors such as a loss of control, the intimidating, aggressive or difficult attitudes of people around you, not feeling heard, or a lack of informed consent to medical procedures.

Risk factors for Postpartum PTSD include a complex mix of objective factors, such as the type of delivery, ability to feed as planned, etc, and subjective factors like those mentioned above. Additional risk factors include:

• Induction
• Length of labor
• Feelings of loss of control
• Unwanted medical intervention
• Traumatic or emergency deliveries/cesarean
• Lack of support from partner or medical staff
• Impersonal treatment
• Not feeling listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth or loss soon after birth
• Birth of a disabled baby
• Baby’s stay in NICU
• Poor postnatal care
• Previous trauma (childhood, with a previous birth, domestic violence)
• History of anxiety or extreme fear of childbirth
• History of abortion or infertility
   

How common is Birth Trauma?

It’s estimated that approximately 9% of new mothers in Western societies experience full blown post traumatic stress disorder. However, research shows that 25-34% experience subsyndromal symptoms (symptoms that don't meet the diagnostic criteria for PTSD)! So while not meeting diagnostic criteria for PTSD, up to a third of mothers experience symptoms like intrusive thoughts and memories that may stimulate feelings of fear, anxiety or helplessness that interfere with daily life. That's a huge number! 

It's important to remember that while mothers most commonly receive treatment for postpartum post traumatic stress, their partners and even their medical providers may also suffer. 
 

Why You Should Seek Help

There are numerous potential consequences for women who experience a traumatic birth. They may avoid routine follow-up medical care because it reminds them of their childbirth experience. Like Sara, they may fear subsequent pregnancies and are statistically shown to be less likely to have subsequent births.

Those who do have another child are more likely to have an epidural or a scheduled cesarean; they are less likely to breastfeed and more likely to experience challenges bonding and attaching with their newborns. They’re also more likely to experience difficulties in their relationships and sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to suffer from depression, which also impacts bonding and attachment with their baby.

In part 2, we’ll look at ways to avoid the effects of birth trauma and ways to support healing. If you’re not sure you can wait to read part 2, please don’t hesitate to give me a call. I’m a licensed clinical social worker in the Banker’s Hill neighborhood of San Diego, California. I’m passionate about helping families cope with trauma and other challenges after bringing home their baby. You can reach me at 619.780.3277 for your free in-person 30 minute consultation.