GP Bridges Therapy and Continuing Education

"Building Bridges Across Relationship Barriers"

Loss, Grief and Transition

This course should take approximately 6 hours to complete. Our goal is to provide you with a quality experience. If you have questions, or are experiencing technical difficulties, please contact us at gdpbridges@gmail.com or (209) 476-0714.

Please note: You are expected to read all material completely prior to taking your course assessment.

Transition Challenges in the United States

Public identification with national change intensified in 2006 and 2007 with the collapse of the real estate bubble.  Home owners found themselves unable to pay their mortgages when their sub-prime mortgages reverted to regular interest rates.  Former U.S. Federal Reserve Chairman Alan Greenspan provided a gloomy outlook of double digit declines in home values and a delayed recovery for the recovery of the real estate market; other predictions compared the decline to those experienced in the Great Depression.  Home owners were suddenly faced with mortgages they could not pay or homes that were alarmingly upside down in value, an increasingly unsettled employment environment, and, ultimately, unavoidable loss and unexpected change.    The solution to these challenges included abandoning homes they had invested in heavily both financially and emotionally and making other significant, sometimes dramatic changes in their lifestyle, including the option of moving in with other family members; something that would not have even remotely been considered in prior years.   The incidents of change related stress increased as the economy continued to exhibit unstable patterns.  Change became a consistent factor of daily living.  Additionally, the national unemployment rate in June of 2011 stood at 9.2%.  That there has been a substantial increase in economy driven stress is not in question, but what is the extent of the impact on those affected by this, combined with other changes in their life?

One of the better known adages states:  “The only constant in life is change.”  The adaptation and consistent adjustment to varying types and degrees of transitions inevitably requires giving up the old, and moving toward the new.  The emotional impact of change is determined to a large extent by the degree of perceived threat, the depth of loss, demands involved, and the perception of uncertainty associated with transitioning.  The difficulty associated with change is compounded since it requires giving up the familiar and moving toward the unknown, assessing the price we are willing to pay, understanding the challenges we will encounter during the process and the long term impact change will have on our life style.  The complexity of the emotional and physical reactions to change, the effect of transitions, and the associated cost, has the capability to have long term results.

Transition Related Stress and Illness

Developmental scientists describe stress as "the set of changes in the body and the brain that are set into motion when there are overwhelming threats to physical or psychological well-being." In assessing the role of stress in disease, there are three broad traditions that can be distinguished.   An assessment of environmental events or experiences is referred to as the environmental tradition; this is associated with substantial adaptive demands.  A focus on an individual’s subjective ability to cope with the emotional demands required by events is referred to as the psychological tradition.   From a psychological standpoint, stress symptoms may be manifested as depression, isolative behavior, distancing behavior and/or argumentative behavior, irritability, spontaneous crying episodes, insomnia, and hyper somnolence.  The third tradition is referred to as biological tradition, a reference to the activation of certain physiological responses, shown to be modulated by psychologically and physically demanding and stressful situation.   Physical symptoms include tachycardia, diaphoresis, nausea, increased urgency to urinate or defecate, increased flatulence, fine motor tremors, coughing while sleeping, which can be secondary to gastric acid or GERD (gastro esophageal reflux disorder), gastric ulcers, and duodenal ulcers.   Asthma attacks have frequently been associated with stressful events.  Stress inducing events that are considered to be most impacting on health are rated as marked or moderate long term events.   

In response to perceived stress-induced change, parts of the brain that regulate emotional control, biological functioning and the autonomic nervous system automatically react, resulting in a series of neurophysiological, or mind/body symptoms.  The amygdala (fear-emotion responder), the hippocampus (event memory), and the prefrontal cortex (behavioral control) interact.  As a result, the sympathetic and parasympathetic nervous systems are quickly impacted.  This is considered to be the first phase of the body’s response to change; if positive change is not perceived, the second phase, or chronic resistance, will become evident.  At this point, it is generally believed that andrenocordical secretions decrease and physical symptoms, such as headaches or intestinal distress, appear.  Of even greater concern, research suggests that prolonged stress may compromise the immunological system, leading to more severe and even life compromising illnesses including stomach cancer.   The impact of untreated stress related illnesses may also include episodes of suicide attempts, suicide ideation, divorce, and poor relationships at the home and at the workplace.

The degree of reaction to unsolicited change has long been thought to be dependent on the personality type of those involved.  It has been well established that “Type A” and “Type B” personalities respond differently to stress.  Given the intensity of their response to stress, Type A personalities tend to suffer more stress related illness.   The emotional and over reactive characteristics associated with Type A personalities suggests that they are more susceptible to particular diseases of adaptation, including ulcers, hypertension and heart disease.  Conversely, the calm and analytical approach taken by Type B personalities is generally attributed to the rarity of cardiovascular disease they experience before middle age.  Cardiovascular disease is currently the primary health concern in the United States.  

The possible influence of stress on illness has been a focus of study by the professional community since the 1950’s. Many studies use the Schedule of Recent Events created during that era. From 40 to 100 major stressful life events including the death of a loved one, loss of a job, divorce and moving were included as part of several scaled instruments given to respondents who were asked to report events that happened to them, normally within the last year.  The more events they experienced indicated a greater degree of stress.    Although early tests were not considered to be state of the art, they did provide a weighted list of stress inducing events.    In one study, over 5,000 medical patients were assessed to determine if a link existed between stress and illness.

On the basis of a synthesis of the scientific literature and advice from its public health partners, the CDC has defined health related quality of life (HRQOL) as “an individual’s or group’s perceived physical and mental health over time.” Citing a direct correlation between perceived mental and physical "healthy days" and chronic illness, a collaborative program was initiated in 1989 by the Division of Adult and Community Health (DACH) in the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).  The Division worked with the Centers for Disease Control and Prevention (CDC) Disability Prevention Program, Women’s Health Program, National Center for Health Statistics Questionnaire Development Research Lab, and Epidemiology Program Office to develop and validate a compact set of measures that states and communities could use to measure HRQOL.  The resulting measures reflected an integrated set of four broad questions on: 1) self-rated health, 2) number of recent days when physical health was not good, 3) number of recent days when mental health was not good, and 4) number of recent activity limitation days because of poor physical or mental health

 

(see BRFSS “Health Status” questions at http://www.cdc.gov/nccdphp/brfss/).

The Impact of Stress on Emotional Health

In 1995, CDC and several state and community health agencies began to collect data using an additional 10 item set of health perception and activity limitation questions.  These questions include measures for pain, depression, anxiety, sleeplessness, and vitality.  Data was used to provide more information on specific, potentially remediable, causes of poor health related quality of life indicated by the first four global measures.   In one national study, nearly one third of Americans said they suffered from some form of mental or emotional health problems every month, including 11 percent who said their mental health was not good more than seven days a month.  Findings reflected that young adults reported consistently worse mental health versus the oldest age groups as evidenced by results indicating Americans aged 18 to 24 years were at greatest risk of incidents of poor mental health days of all adult age groups represented.  Those who experienced 14 or more poor mental health days during the previous 30 days noted stressors that included being unable to work, separation from their spouse, an annual household income of less than $15,000 and having less than a high school education.

Qualitative results from the interview process involved in scaled assessments were largely determined by the subjects’ adaptive ability to acute or chronic events.  Acute “events” and chronic stressors, called “difficulties”, were included in the assessments.  “Events” are considered to last less than a month and “difficulties” are events that are generally accepted to last more than a month.    

Challenges associated with unsolicited and undesired change can be overwhelming, possessing the potential to temporarily destabilize healthy emotions which, in turn, may lead to anxiety or depression.   While anxiety may result in physical agitation, depression has the opposite effect.  Immobilization and moderate to severe depression may result in a “flat” affect.  Simple decisions might become difficult; sessions of crying will become more prominent, often accompanied by an intense and debilitating fatigue.   In addition, there may be a tendency to withdraw from those around them as they face emotionally draining feelings.  Those facing difficulty with change may also experience any of the following:

  • A feeling that life is “out of control.”
  • A strong sense of loss.
  • Vulnerability:  The re-emergence of old baggage.
  • Emotion driven decisions with a focus on gaining control in areas that are not critical to successful transitioning.
  • Relational stress
  • Despair
  • Hopelessness
  • Depression
  • Diminishing self esteem
  • Difficulty with maintaining new structure – an inability to develop a “new plan” to deal with change.
  • A loss of identity
  • Emotionally “dying on every hill”, unable to ascertain between minor and major issues.
  • A feeling of “losing ground” in life or a sense of “drifting”.
  • Fear associated with changes in self due to depression.
  • Guilt/blaming self
  • Feelings and thoughts associated with self harm or hard towards others.  (Note:  Always assess for crisis issues and possible intervention to decrease suicide or homocidality.  Educate the client about ways they can stay safe if they are feeling harmful.  Develop a “safe” social network of people they can conduct for support, phone number for suicide prevention lines, and knowing when to call 911 or going to the local emergency room if they are feeling imminently harmful to themselves or others.)

Post Traumatic Stress Syndrome

It is estimated that approximately 70 percent of adults in the United States have experienced a traumatic event at least once in their lives.  Up to 20 percent of these people develop PTSD.  It is generally accepted by mental health professionals that initial emotional reactions to trauma and change indicates some recovery should be evident within a month.    Post Traumatic Stress Syndrome (PTSD) may be diagnosed if there is a complicated recovery from events that lasts anywhere from one to three months following the traumatic event.  PTSD has three sub-forms: acute, chronic, and delayed-onset. 

Subtypes of PTSD 

Symptoms of PTSD fall into three broad types:  Re-experiencing, avoidance, and increased arousal.  These are characterized by an intense physical and emotional response to reminders of the event produce symptoms that may interfere with daily emotional well being.

            DSM-IVR Criteria for Post Traumatic Stress

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person’s response involved intense fear, helplessness, or horror.  (Note: In children, this may be expressed instead by disorganized or agitated behavior.)

B. The traumatic event is persistently experienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hyper vigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Depression

It is not unusual for feelings associated with loss and anxiety to increase the progression and persistent maladaptive thoughts that can lead to depression or anxiety.

There are two major types of depression, endogenous depression, and depression from external stressors such as life trauma.  To experience life trauma is not unusual; the resulting impact, however, varies depending upon the individual reaction and coping mechanisms put in place.  Conversely, Endogenous depression has a hereditary component and it takes little to no stress to exacerbate the condition. 

Based upon the DSM-IV-R, a person is considered to be clinically depressed if, in a two week period, they experience five of the following nine symptoms during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.  (Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.)

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Depression - Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Depression - Recurrent

A. Presence of two or more Major Depressive Episodes.

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.

Transitions Associated with Loss and Grief

Understanding the concept of attachment furthers our ability to comprehend grief.   Psychological theories about attachment have been suggested from the late nineteenth century.  Sigmund Freud contributed the first attachment theory in his 1917 book, Mourning and Melancholia.   Significantly influenced by Freud, and drawing on concepts from ethology, cybernetics, information processing, developmental psychology, and psychoanalysts, John Bowlby (1907-1990) formulated basic tenets of the theory, dramatically influencing our thinking about a child’s tie to the mother and its disruption through separation, deprivation, and bereavement. 

In the 1980's, studies on the attachment theory were extended to adult romantic relationships, with between three and five styles of attachments identified.  Some researchers in their studies on the theory of attachment suggested a parallel between the degree of attachment and personality types, with an emphasis on the degree of thoughts of self versus thoughts of others.  Overall, findings suggested that the degree of loss and grief is directly proportional to the degree of attachment with sudden and accidental deaths more likely to have the greatest impact on grief.   Attaching psychic energy to any object, whether it is the representation of a person or psychic element, is referred to as cathexis; decathexis is the result of an intense loss and manifests itself through a gradual weakening and separation from the emotional attachment. 

 

Reference to this attachment/detachment process was first noted implicitly in Studies on Hysteria, published in 1895 by Sigmund Freud and Josef Breuer and was referenced throughout the remainder of Freud's work.  

Grief may be experienced during any unsolicited life changing transition.  Losing a job, changing health issues, divorce, and other life impacting changes produce varying degrees of loss and grief.   Anywhere from three to seven stages associated with the grieving process, although focused primarily on death and dying, have been identified during the history of grief research; however, the use of stages to describe the grieving process is debated by some mental health professionals who believe that the disparate response of individuals to grieving are not given adequate emphasis in the grieving process.  For clinicians who do apply the stages of grief in some degree to life changes, it is key to note that not all who are facing loss go through each stage as part of their healing process and, if all are experienced, they may not necessarily be experienced in sequential order.   Other feelings of loss experienced during the grieving process may be evident, including shock and Disbelief, sadness, guilt, anger, and fear.

Freud repudiated the old theory that time heals all wounds.  In his studies, Freud identified three clinical observations regarding the grieving process:

1. Grieving is a normal adaptation to loss.

2. Grieving persons must persistently confront the reality of their loss.

3. Successful grieving requires hard work—"grief work."

Imbedded within the identification of grief are categories, or subtypes, of grief.  Initially, there are two types of grief, anticipatory and unanticipated. 

Anticipatory Grief and Unanticipated Grief

Anticipatory grief occurs when there is prior knowledge that a death or loss will taken place.  The grieving process begins psychologically prior to the actual loss.

Unanticipated grief is in response to an unexpected death or loss.  The complication of unanticipated grief lies in the lack of time provided to grasp event. 

There are varying reasons why the normal process of mourning evolves to complicated mourning, including difficult circumstances surrounding the death such as other significant losses within a short time period, how the person has grieved in prior experiences, the personality of the bereaved person, and the circumstances surrounding the death as well as the strength of social support.   While it is difficult to ascertain the length of time and appearance of  a "normal" grieving cycle given the differing reactions by those experiencing loss, abnormal grief, sometimes referred to as complicated bereavement impacts the recovery of the bereaved or those facing significant losses in other areas of their life.  Complicated grief is found in approximately 3 to 25 percent of loss survivors.  Patterns of pathologic or complicated grief are described in comparison to normal grief and differ from the normal pattern of grieving. They include descriptive labels such as the following:

Empirical reviews have not found evidence of inhibited, absent, or delayed grief and instead emphasize the possibility that these patterns are more indicative of forms of human resilience and intrinsic strength.  Evidence does, however, support the existence of a minimal grief reaction, evidenced by few, signs of overt distress or disruption in functioning. This minimal reaction is thought to occur in 15% to 50% of persons during the first year or two after a loss.  Empirical support also exists for chronic grief, a pattern of responding in which persons experience symptoms of common grief but do so for a much longer time than the typical year or two of grieving. Chronic grief may look very much like major depression, generalized anxiety, and possibly post-traumatic stress and is thought to occur in approximately 15% of bereaved persons.

Complicated Grief

In addition to these theoretical and empirically supported patterns of grief reactions, much emphasis has been placed on distinguishing normal grief from complicated grief.

The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) includes bereavement as a diagnosable code to be used when bereavement is a focus of clinical attention following the death of a loved one. In current form it does not consist of formal diagnostic criteria and is generally considered a normal reaction to loss via death. In an attempt to clearly distinguish between normal grief and complicated grief, a consensus conference has developed diagnostic criteria for a mental disorder referred to as prolonged grief disorder, proposing that it be included in the next revision of the DSM.  The following are the proposed diagnostic criteria for complicated grief:

Criterion A: Person has experienced the death of a significant other, and response involves three of the four following symptoms, experienced at least daily or to a marked degree:

o    Intrusive thoughts about the deceased.

o    Yearning for the deceased.

o    Searching for the deceased.

o    Excessive loneliness since the death.

·         Criterion B: In response to the death, four of the eight following symptoms are experienced at least daily or to a marked degree:

o    Purposelessness or feelings of futility about the future.

o    Subjective sense of numbness, detachment, or absence of emotional responsiveness.

o    Difficulty acknowledging the death (e.g., disbelief).

o    Feeling that life is empty or meaningless.

o    Feeling that part of oneself has died.

o    Shattered worldview (e.g., lost sense of security, trust, control).

o    Assumption of symptoms or harmful behaviors of, or related to, the deceased person.

o    Excessive irritability, bitterness, or anger related to the death.

·         Criterion C: The disturbance (symptoms listed) must endure for at least 6 months.

·         Criterion D: The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

There is no formal diagnostic category for prolonged grief disorders in the DSM and these criteria have not been formally adopted. However, these criteria assist in specifying symptoms, providing a measure of the severity of symptoms, and better note how to distinguish complicated grief from normal grief. The grieving period duration of "at least 6 months" is not universally accepted by all mental health professionals and it is suggested that the time period of 6 months to 2 years may be more accurate. The presence of certain symptoms that are not characteristic of a "normal" grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode. These include

·         An Intense, pervasive sense of guilt;

·         Thoughts of suicide or a preoccupation with dying;

·         Feelings of hopelessness or worthlessness;

·         Slow speech and body movements;

·         Inability to function at work, home, and/or school;

·         Seeing or hearing things that aren’t there.

 

Transitions Associated with Divorce and Loss

Emotions experienced during a divorce can be equally intense and confusing.  While there may be cognitive recognition of the fact that emotional recovery will occur at some point, paradoxical emotions may contradict that knowledge.  The end of shared dreams and a pattern of comfort and familiarity are equal to the loss associated with death and dying.  Even if the divorce was necessary in order for one or both parties to live an emotionally healthy life, the loss experienced can be painful and confusing.   There may an unreasonable feeling of guilt, due partially to an over analysis of events.  There may also be a temporary belief that there has been a loss of “the love of a lifetime.”   Ensuring emotional self care during this time includes factual, not emotion driven, thinking, goal setting, and an understanding of the loss process.

For those experiencing loss:  

·         The importance of "facing facts."  If there has been a divorce then there has been a loss;   subsequently, there will be grieving.

·          Permission should be given to self to experience all of the loss emotions:  Sadness, anger, a feeling of being “adrift” and without the stability formerly experienced.   Although there might very well be succinct reasons for the divorce, there also might be some confusion if not all of the contributing facts are known (e.g.  one of the partners is having a secret affair and uses other reasons to pursue a divorce.)

·         It isn’t always possible to have closure.  One of the most painful experiences is to recognize that it may be necessary to leave critical questions unanswered and things left unsaid that the individual believes would help them to better transition.  This may leave the person feeling as though part of their healing process is missing.

·         Forgiveness frees everyone.     Prolonged anger is unhealthy and keeps individuals from moving forward with their life.  What may be confusing is what forgiveness actually entails.  Some believe that forgiveness is a combination of instant verbal, emotional, and intellectual release.  In actuality, forgiveness is a process that starts with the understanding that it is important to free oneself from the negative emotional bondage.  The components of forgiveness are:

Healthy healing is supported by using the following strategies:

·         Trying new experiences (opening up a new avenue of healing.)  When individuals revert back to routines experienced in their marriage, but without their partner, it can exacerbate the feelings of loss and loneliness.  By seeking new experiences, the individual opens the door to a new foundation for the future.

·         Delaying the dating process.  Loneliness can have a profound, and sometimes disastrous, impact on relational decision making.   Until the individual has had a chance to reflect on their own healing and to establish new goals for themselves they cannot accurately determine what they would like in a partner.

·         Making a conscious effort to keep in touch with those who understand, and who are supportive during the healing process.

·         Avoid perseverating but do allow feelings to emerge in a healthy manner.  One woman shared that when she feels down, she sets the alarm clock for 15 minutes.  In this time, she gives herself permission to work through every negative emotion that she is facing.  At the end of that time, she deliberately changes her thought process to the present and focuses on the progress that she has made.   

Transitions Associated With Loss of Job/Demotion

The National Institute for Occupational Safety and Health has established three categories of occupational stress:  Anxiety, stress, and neurotic disorders (including depression.)  The degree of intensity within these categories ranges from positive (short-lived), to tolerable (short-lived but more extreme) and toxic (stress over longer period of time.)

The impact of stress depends partially on the degree of self identity with the career position; in essence, if the employee’s self esteem aligns more with what they do than with who they are, any type of career change has the potential to impact their perception of self worth and self esteem.  The dangers associated with this become particularly evident if there is an involuntary change in assignment, a demotion, realignment to a separate department and/or different duties, and particularly the loss of a job; any of which have the potential to negatively affect self image.  The impact can be exacerbated if those around them do not share basing self worth and identification on their career and, consequently, do not understand the emotional devastation being experienced.  Consequently, there may not be an awareness that the individual is experiencing: 

·         A temporary loss of identity

·         Reemergence of insecurities and an hyperawareness of lack of strengths in certain areas

·         Unbalanced comparisons between themselves and those who are doing well professionally

·         A sense of disconnectedness and unsettledness

·         An overwhelming sense of “back to square one” and the perception that any progress made in their career has been negated.

 

Transitioning in a healthy emotional manner with job related loss or change can be supported by:

 ·         “Regrouping”:  Taking time to assess true career strengths and weaknesses.

·         Putting in place short term arrangements to survive financially, eliminating unnecessary services with the understanding that the loss is designed to be short term (i.e. cable, fast food, coffee shops).

Seeking out classes to “freshen up” on latest skills on the market

 

Transitions and Emotional Recovery

Those who are experiencing significant changes in their lives will need to develop coping strategies that also support the ability to strategically plan for the future as well as identify areas within their current circumstance that provide stability.

In order to effectively process the impact of transitions and change, it is helpful for those affected to succinctly identify the cause and impact of changes they are experiencing.   While it may be a challenge in this stage for some to avoid turning the identification process into perseverating on the past, three key questions will support a foundation of understanding of events and the ensuing impact:

Although the ultimate goal is the acceptance of change and loss, goal setting for success, and an emotional readiness to do whatever is needed to address the challenges of change, the initial focus should be the ability to articulate and understand why, when, and how change occurred and to understand and move beyond the initial emotional impact.  This process requires healthy problem solving. 

The ability to successfully transition emotionally regardless of the change is impacted by the level of cognitive distortions present.   Types of Distorted Thinking include:

a.        All or nothing thinking:  There is no grey….transitions are totally positive or totally negative. 

b.       Assumptive Thinking:  Incorrectly interpreting situations without supporting information; the tendency to assume losing a job means losing the respect and regard of family and/or friends.   Using other minor incidents to support distorted thinking.

c.       Magnification or Minimization:  Closely related to all or nothing thinking, this type of distorted thinking is earmarked by blowing things out of proportion or denying the existence of  issues that are, in reality, important to face.

d.       The assumption of control through self blame:  Controlling out of control feelings by assuming responsibility.  “If I had only…” when in reality the change that occurred was beyond their scope of responsibility.    Assuming responsibility supports a false sense of control.

e.       Unjustified Blame:  This could take the form of blaming self or others out of context with the situation.  The loss of a job could become a source of contention with a focus on “if you’d only…” when in actuality the company was facing a financial situation which resulted in downsizing. 

f.        Comparison Negativity:  A consistent comparison of loss with another’s good fortune or stability.

g.       Replaying old tapes of insecurity or fear of failure:   An overwhelming feeling of not being good enough, not smart enough, not worthy of positive outcomes.

h.       Collective Negativity:  Combining past and present feelings of loss and sadness, revisiting negative experiences in the past for the purpose of reinforcing negative feelings in the present.

Equally as important in the transition process is understanding the need to initiate changes in areas that negatively impact healthy transitioning.  It is well documented that alcohol or the use of illegal drugs negate progress in addressing recurrent episodes of depression although it is tempting for those who are struggling with the impact of change to alleviate their pain in this manner.   Prerequisite to successfully accepting change include:

1.        The elimination of illegal drugs and excessive use of alcohol.

2.        Establishing a daily routine that is concise and which includes time for conversations with those who provide emotional support, relaxation exercises, routine work (household or work related), and hobbies.  

Building a daily schedule provides the opportunity to regain control and to focus on rebuilding a lifestyle that is healthy, balanced, and productive.

Summary

In 1948, the World Health Organization wrote “Health is a state of complete physical, mental, and social well-being-not merely the absence of disease, or infirmity.”    Support of this belief by the professional community was reflected in “Measuring Healthy Days”, a study by the Centers for Disease Control and Prevention (CDC) in their answer of the question:  What is quality of life?  The study states:  “Although health is an important domain of overall quality of life, there are other domains as well-for instance, jobs, housing, schools, and the neighborhood.  Aspects of culture, values, and spirituality are also key aspects of overall quality of life that add to the complexity of its measurement.“

Given the inevitability of change and transition throughout life experiences, it is critical to develop coping mechanisms that are appropriate for the challenges being faced.   A simple, pointed, quote by Benjamin Franklin delivers a sage message: “When you’re finished changing, you’re finished.”

It isn’t the changes in the world that impact us as much as our ability, or inability, to adapt with the changes.  Change mandates transitions and successful transitions hone the emotional stability we need to survive. 

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Course Assessment

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References

Anxiety Disorders Association of America (ADAA).  Understanding Anxiety.  www.adaa.org/index.cfm.

U.S. Department of Veteran Affairs.  PTSD Research. National Center for Post-Traumatic Stress Disorder (NCPTSD) (Department of Veterans Affairs) http://www.va.gov/

U.S. Department of Health and Human Services. What is Depression? National Institute on Mental Health (NIMH).  January 2009. http://www.nimh.nih.ogv/

Posttraumatic Stress Disorder (PTSD) Alliance http://www.ptsdalliance.org/

U.S. Department of Health and Human Services. Coping with a Traumatic Event. Centers for Disease Control.  National Center for Chronic Disease Prevention and Healthy Promotion.

U.S. Department of Health and Human Services.  Measuring Healthy Days:  Population Assessment of Health-Related Quality of Life.  Centers for Disease Control and Prevention.  National Center for Chronic Disease Prevention and Healthy Promotion.  November 2000.

U.S. Department of Health and Human Services.  Mental Health:  A Report of the Surgeon General.  Downloaded from www.surgeongeneral.gov/library/mentalhealth/chapter4/sec1_1.html.

 Centers for Disease Control and Prevention.   The Changing Organization of Work and Health of Working People (2002).  Department of Health and Human Services.  National Institute for Occupational Safety and Health.