How a clinical psychologist can help

2016, Responses from: Leena St Martin and Hannah Blakely

It can be so challenging trying to manage the fluctuating emotions that endo brings. I can feel fine one day and then the next I wake up feeling anxious or melancholic. What advice or suggestions can you give on how to manage these fluctuating emotions?

Leena St Martin: Regarding managing fluctuating emotions, the first point I would make is that it is entirely normal to experience a broad range of emotions. Usually it is helpful to acknowledge and explore the emotion rather than brush it away. In the therapy session I might use the following steps to help people work through why they are feeling a particular way. Firstly, I ask my client to notice what was happening just before they began to feel melancholic, anxious etc.  Was there a particular thought, memory or image which passed through their awareness?  Is their mood also affected by physical pain, lack of sleep, hunger, or other physical/environmental factors?  If so, what do they need to do for themselves to support their body and brain in the given moment?  (e.g. they might need to eat, apply a heat pack, change their position, reduce noise/stimulation etc.)

If there was no particular physical/environmental factor triggering their mood change, then I encourage my client to explore the emotion further by asking more about it e.g. how intense is the melancholy, what size is it, what shape is it, what attention does it require?  Do they need to recollect a sad experience and do some journaling? Do they need to visit a special place to honour the emotion? Do they need to discharge the emotional intensity physically first? If the client is in a situation where it is simply too overwhelming or unsafe to explore the emotion, then techniques like distraction and distress tolerance have a part to play. There are some excellent on-line tools describing these techniques

Hannah Blakely: Emotions may fluctuate for a number of reasons, including management of both physical (e.g. pain, bloating, medical management) and psychological (e.g. fear and pain avoidance, sleep disturbance, relationship and sexuality) aspects of endometriosis.

Try not to supress or push emotion away. The more we try to avoid and supress, through perceived relief in the short term the more likely our emotions will ‘bubble up’ and have an effect with greater intensity than before. Research has shown when we feel melancholic, anxious or flat in mood, depending on how tolerable or intense they are; doing enjoyable activity mindfully can help change and improve our emotion. First, notice the emotion you feel. Try not to judge that emotion as we know the attributions or judgement we make is the part that sticks for future experiences of the same emotion. Following noticing, the next step is shifting your attention from focus on mood to doing something else that you may get pleasure from. If we remain focused on the unpleasant emotion it can continue – a bit like ignoring a child tantrum- keep an eye on it – notice what is occurring but not giving attention to it!

The enjoyable activity need not be excessive, but must be manageable and achievable. For example; some people find going for a walk helps to shift their attention and focus from internal emotion to focusing on the external environment (what’s going on right now around you). Others enjoy reading, taking a hot bath, using a special hand cream, baking etc. When doing the activity take a moment to notice any change in your emotion. It may not occur the first time however, keep trying as over time this may help shift that mood that’s dragging you to one that could help you get on with your better day.

What are some good ways to support people I know with Endo who also have depression or anxiety (or both) as a consequence of their health issues?

Leena St Martin: Supporters can be helpful to the endo-sufferer who is experiencing depression and anxiety by listening attentively and validating their emotional experience (e.g. by making statements like “it makes sense you feel x today”, “what could you do for yourself today to feel better/differently?”). If suicidal thoughts are mentioned, take these seriously and ask whether the sufferer would agree to speak to a professional. Once again, there are excellent on-line tips available

Hannah Blakely: Living with endometriosis may feel for some at times emotionally overwhelming and among other things may contribute to anxiety and depression symptoms. To support those who are struggling with depression or anxiety the following tips may be helpful.

Being available to listen and validate their experience can be very therapeutic. Using phrases and questions like “it sounds like this is really difficult for you…” or “what would you like me to do to support you right now…” may let them know you are interested in what’s happening for them.
Depending on how they respond another idea may be getting them involved in activity to help shift the focus from their mood to being closer to focusing on other things – and potentially feeling better.
Checking how your friend is feeling is important particularly if their mood’s low and they are having suicidal thoughts or talking about harming themselves. In this case encouraging them to tell their family or friends and visit their GP who can support them to get specialist help.

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