We Need To Talk About Miscarriage

So previously I posted about a talk I gave on Thursday 8th October at 7pm in partnership with Speak On as part of their series “We need to talk about mental health” which focuses on a range of mental health issues people are struggling with during the covid-19 pandemic. Baby loss awareness week runs from 9th – 15th October and this year in particular I wanted to contribute to the efforts to raise awareness of the mental health impact of miscarriage, and share some ideas on how Acceptance and Commitment Therapy and Compassion Focused Therapy could help reduce distress relating to pregnancy or baby loss and related to trying to manage emotions around pregnancy after loss.

If you would like to hear the talk, you can now watch it on YouTube using this link –

Below is a more general link to the other talks on mental health awareness which are being organised by Speak On over the next week –

https://www.eventbrite.co.uk/o/speak-on-30579274956

ACT, Grief and Pregnancy Loss

Often when we think of grief, we think of the loss of a loved one, a friend or family member. Those of us unlucky enough to experience miscarriage also experience the loss of a loved one we never got to meet. Those of us who experience stillbirth experience the loss of a baby that never got the chance to grow up. This week the local media covered a horrific tragic accident where a 91-year-old lady drove her car onto the pavement, killing a 3-year-old child and injuring a mother. I can’t imagine the pain of losing a child in that way, my mind blocks it to protect me when I think about it. I was on the exact spot the accident happened with my own child a few days before the accident – there but for the grace of god go I. I have felt as though a cloud has been hovering over me since hearing the news and noticed worry that I may know the child since they were the same age as my daughter. My thoughts then moved on to acknowledging that whether I personally know the child is irrelevant – a mother is still without her child tonight. My experience with grieving is that the pain of loss is there to show us what we value. I have been feeling vicariously sad this week because of my love for my own children. Rather than wallow in grief, I have also learned that my sad and angry feelings can become a springboard for acting on my values, which was the sentiment behind writing this blog. I will be forever in Steven Hayes’ debt for writing “Get out of your mind and into your life”. I read the book when I was grieving the loss of my dad which happened during my clinical training, and if I hadn’t I’m not sure I would have found a way to both move forward with the grief and complete my training while doing so. My husband celebrates his 40th birthday this month and that day will also be the 11th anniversary of my dad’s death. Later in the year, the anniversary of when I first met my husband also marks the anniversary of my first miscarriage. Love and loss go hand in hand.

During Covid-19, we have been unable to attend a family funeral due to restrictions in place and I know lots of other families will have been in the same position. Funerals offer a ritual to mark the loss even for those of us who are not religious or seeking comfort from religion, and I feel for those who will have been denied that opportunity. Funerals are also an opportunity to support loved ones and connect which is key to actively coping with grief. There have also been many more people experiencing other kinds of losses during Covid-19 – the loss of the chance to experience an ending of primary school, the loss of the chance to finish high school, the loss of the chance to sit final exams in an exam hall at Uni, the loss of a long planned for wedding day, miscarriage or baby loss in isolation too. There are also other times in our lives we might experience a grief reaction, for example when told we have a chronic condition like dementia, or that our loved one does, or as a parent when we learn that our child will develop with a difference, like autism or a learning difficulty. Having set the scene, I thought I should move on to some ideas about how we can cope with grief and loss.        

Elizabeth Kubler Ross five stage model

  • Denial (avoidance, confusion, shock, fear)
  • Anger (frustration, irritation, anxiety)
  • Bargaining (searching for meaning, seeking connection, drive to share experience)
  • Depression (overwhelmed, helpless)
  • Acceptance (exploring options, planning for the future, moving on)

It is helpful to note these are not stages you go through in order, and it is common to go back and forth and cycle through them. It is also helpful to know it can take ten years to reach Acceptance – and that’s within the normal range, not a sign there’s anything the matter. If you’re currently in denial about a loss you’re probably not reading this now. If you’re currently working through anger, you might have noticed some typos in my work and be finding them annoying – if so, please do tell me as I also hate typos but because I’m permanently sleep deprived I’m less good at detecting them just now. If you’re bargaining, you might be reading this in an effort to make sense of your loss like I was when I first learned about ACT. If you’re looking for meaning, the diagram at the top of the page – the pregnancy loss Grieftrix – might be particularly helpful (see below for more on that). If you’re working through depression, you may find there are too many words on the page for you to process now – it’s OK to take your time. If you’re at Acceptance you may be like me in that you’ve spent a lot of time in the other stages before getting to this one, and you may have had to work through some very dark days. Wherever you are in your head, I hope you can allow yourself to just be where you’re at for a moment – however you are feeling is OK if you are grieving.     

Factors that link to complex grief reactions

  • Being female
  • Being older
  • An unexpected or violent death
  • Death of a child

It is interesting to note that if you have experienced a miscarriage or a still birth, your experience likely covers 2-3 of these common risk factors, yet the NHS doesn’t currently offer specialist services for women who experience traumatic grief reactions after miscarriage other than going through Adult Mental Health Services where research indicates that women report the practitioners there don’t always have specialist understanding relevant to baby loss (see Miscarriage page for more on that).

The Pregnancy Loss Grieftrix

Sorry if you’re at the anger stage and finding repetition of content annoying, but I had the thought that it might also be annoying to have to refer back to the top and went with the lesser of the evils. I wanted to explain more about how to use this image to make sense of your own pregnancy loss, if that’s something you need to do.

First, look at the lower right quadrant. If you’ve lost a baby, what name did you give? I know during pregnancy all mine have had nicknames. The lost ones over the rainbow are baby Kauai, baby Rainbow and baby Serendipity. What were your pregnancy hopes and dreams?

Next, look at the lower left quadrant In your grief, what thoughts and feelings come up for you when you think about your lost pregnancy? Some of mine were regret, fear, guilt and anger. I also remember struggling with birth announcements and the need to maintain a coping front.

Then, look at the top left quadrant. What do you tend to do whenever the difficult thoughts and feelings come up – avoid talking about pregnancy, babies and/or miscarriage? avoid people who might bring these topics up? avoid trying to get pregnant again? distract yourself? throw yourself into work or exercise? comfort eat? seek solace in wine? All normal, all with long term costs if you keep them going though. What are the benefits vs costs to you of continuing to avoid your feelings and thoughts?

Next, reflect some more about your pregnancy hopes and dreams, perhaps also the qualities you had hoped to develop as a mum and the love you have to offer a child. Then, look at the top right quadrant. If you’re ready to consider an alternative to avoiding painful feelings and thoughts, how can you connect your pregnancy hopes, dreams, the qualities you hoped to develop as a mum and the love you have to give with living a life you value? Who could you connect with today to share this with – who else do you know who has experienced miscarriage or stillbirth? Would connecting with a counsellor be helpful, either through a charity like SANDS or through a referral from your GP to Adult Mental Health Services? Are you someone who wants to get involved in baby loss awareness campaigning on social media? Who do you already have in your life now you can share your capacity for love with – your partner, your friends, your family, other children?

Lastly, look at the heart in the middle – that’s you – you’re big enough to contain all your thoughts and feelings, and complicated enough to need a range of coping strategies at different points in time as you work through this. You’re also worthy enough of compassion and care, not least from yourself. It’s OK if right now you need to just be where you are – just know that there may be a chink of hope ready to filter through the cracks when you’re ready.

Ten Tips on Surviving Grief

If you are still reading this far, you might be particularly interested in how ACT might apply in coping with grief, so here are some introductory thoughts inspired by Russ Harris’s writing –

  1. Allow your feelings and thoughts to be there. This might include being open to shock, anger, despair, hopelessness, emptiness or loneliness. Whatever you feel, make some room in your life to let yourself have it. While you do that, make time to rest and cut back on demands on you if you can.

2. Accept that there will be times of feeling overwhelmed, especially in the early days. It might help to think of this as standing in giant tidal waves which might knock you over, but you will still be there when the wave passes. You may want to remind yourself of the saying “This too shall pass”.

3. Learn some mindful noticing skills to anchor you when the waves hit – for example, practice noticing what you can see, hear, feel, taste and touch when you are calm – when you are overwhelmed, it becomes easier to call the noticing skills to mind with practice.

4. Values – What really matters to you and how can you get more of that into your life? What small step could you take towards that starting today?

5. A powerful question to ponder – Suppose you could choose – 1. You never have to have these painful feelings ever again – but it means you never get to love or care about anyone or anything again either. 2. You get to love and care about all sorts of people and things – but when you lose what you care about, you will feel intense pain. Which option would you choose? While acknowledging your loss and allowing your feelings about it, keep an awareness of what you still have in your life that you value, particularly considering relationships.

6. Develop self-compassion – this takes real courage to allow ourselves to be vulnerable but is such a powerful tool when we’re grieving. If you find it tricky to do this, that’s normal – but what would you say to a friend going through what you are?

7. Watch out for unhelpful stories or life rules you’ve told yourself for a long time or society may even have told you which are now unhelpful. For example, “My life is worth nothing if I can’t have children” or “I’ll never heal from this” or “it’s all my fault”.

8. Find meaning and positive energy to move forward from within your pain. Your grief – perhaps about your miscarriage – tells you two very important things: a) you’re living, and b) you have a lot of love to give. Tune into that and connect with your values to keep going with life, doing the things that matter to you. And take your feelings of loss and memories of your pregnancy with you, carrying them as gently and carefully as if they were a kitten in your arms.

9. Consider how you can grow as a person from this experience. What is there to learn about forgiveness, compassion, letting go, acceptance? How might your own experience benefit others that you care about? It’s amazing how many more women have miscarriages than there are women who openly discuss their experiences. There are great opportunities to support and empower one another here.

10. Consider a grief ritual to mark the loss of a pregnancy, regardless of how soon it ended. You are marking the loss of hopes and dreams, even if it ended early. For example, light candles, write a poem or journal, bake a cake, make a memory box or scrapbook.

ACT and grief resources

The link below takes you to a powerful blog post written by Russ Harris after his son was diagnosed with autism on the grief reaction he experienced and how ACT helped him cope

https://contextualscience.org/blog/act_grief

The link below takes you to a YouTube clip illustrating the “Grieftrix” which is an ACT way of understanding grief. It’s fairly straightforward and accessible if you’re reading this as someone keen to make meaning from their experience, although the clip is aimed at ACT therapists.

The link below takes you to a video on YouTube from a series of videos by Tom Lavin on using ACT to deal with a range of difficulties – this one is on the topic of grief. He talks about how grief is often underneath mental health difficulties, and that to deal with the mental health difficulty we need to feel what we don’t want to in order to feel the grief. He also talks about how love is key to the meaning in life, and that people we love die – so since love and loss are inextricable, we can either have both or neither. He talks about how saying “yes” to living a meaningful life, we also need to say “yes” to being willing to experience the pain of loss.      

Last but not least, if you are grieving it may be of value to seek therapy at this time in your life. If that’s where you’re at, your GP can refer you to a mental health service if that is appropriate. If you’ve experienced baby loss, SANDS offer specialist counselling. Alternatively you might want to try the BABCP or the Association of Contextual Behavioural Science website to search for a therapist trained in either CBT or ACT.  Do also feel free to take a look at the Further Help page if you need more resources.  

Workability

Photo by Pixabay on Pexels.com

Another important ACT concept is doing what works rather than either repeating unhelpful patterns that have short term payoffs but long term downsides in terms of what you value, or pushing yourself so hard to do what you want to achieve that you end up adding excessive stress and exhaustion to your suffering.

So after my second miscarriage, I faced the thought that this could be my pattern – get pregnant easily and lose the pregnancy just as easily. A cruel fertility twist. It occurred to me conceiving might need to be a long game, allowing space for other areas of my life too. So rather than get frustrated at having to wait for a period, I tried to use the time positively to catch up with friends, host BBQs, enjoy some runs in the beautiful countryside where I live and focus also on work. This boosted my wellbeing much more than just allowing myself coffee and wine. From that perspective, we also booked a trip to Australia. I planned that if I wasn’t pregnant we could enjoy wine tours, and if I was, I’d be happy to forgo them. It helped me feel I’d set it up as win-win rather than all or nothing on getting that second line each month. As we got closer to the trip and I got the necessary period, I considered following my reverse compass and skipping trying for a month, but then decided to “not try, not prevent” as a compromise – and what happened next?

Useful questions to test the workability of what you’re doing

Why am I doing this?

Is doing this getting me closer to my goals?

what am I trying to achieve here, and is what I’m doing helping or hindering me?

Is what I’m doing making my quality of life richer or poorer? In what way? Which aspects of this matter most to me? To my family? To others?

What are the benefits of this course of action to me? To my family? To others?

What are the costs of this course of action to me? To my family? To others who I care about?

Some common short term payoffs that trap us in unhelpful patterns

The feel good factor of a couple of drinks – trouble is when you add a few more the suffering begins

The pleasure and comfort of a chocolate box – eat a few of those, and the suffering begins

Compulsive exercise – initial buzz and self esteem pay offs, long term pain and injuries await

Avoidance – short term relief, long term anxiety awaits

My second pregnancy (aka baby rainbow)

miscarrying for me turned my world upside down, with baby rainbow at the top of my view

Another key skill from ACT I had to use to get as far as my second pregnancy was psychological flexibility – the idea that you need to flexibly use the right skill at the right time and bring your knowledge in when you need it. So I needed mindfulness, defusion, clarity on my values, a broader perspective that my life was bigger than pregnancy and commited action to cope.

My first move was to follow my reverse compass albeit involuntarily by waiting to have a period before trying to get pregnant again. I found that frustrating at the time, and struggled with not being able to go after what I wanted. I also particularly struggled with other people’s pregnancy announcements then – a bit like they’d won a game of tennis I hadn’t been able to compete in due to an arm injury. It was Christmas when I was working through that, and I found it hard to put a happy face on for family and friends when my mood was on the floor. I was sad too that when I was pregnant I’d had visualisations of announcing my pregnancy around then, whereas instead I was grieving the loss of it and not knowing when or if it’d happen again. I also struggled with the well meant cliché s other people who did know about my loss shared – “it’ll happen when it’s ready”, “you haven’t been trying that long” and the also well intended “So are you thinking of having a baby soon?” from people who didn’t. I struggled with my emotions of sadness, guilt and shame around my loss and fear and desperate longing around trying again.

When we started trying again it was New Year and I embraced it like a new years resolution – Ovia, healthy diet, conception vitamins, supplements meant to increase the chances. My other half protested both about taking conception vitamins and my supplements – he was also a bit bemused about the reduction in wine intake. He was unconvinced the effort was either necessary or helpful. I then obsessively watched my symptoms once my fertile window was over until my period was due. I joined a Mumsnet support thread for women trying to get pregnant again after a loss and there I found empathy, validation, compassion and identification – my emotional crutch at that point of the month particularly.

I was flat and disappointed when the pregnancy tests I took refused to show a second line that cycle and then my period started, confirming I wasn’t pregnant. I consoled myself that I could at least allow myself coffee, wine, chocolate and running for a couple of weeks. That then gave me – and my long suffering other half – enough of a boost to try again in my next fertile window.

Another anxious two weeks later and another line appeared on my pregnancy test. It wasn’t as convincing a line as with my first pregnancy but it was definitely there. My heart got hopeful while my more cynical other half told me not to get my hopes up. Sadly, he was right. This time the miscarriage started suddenly at work. I phoned my GP who confirmed I was probably right about it being another miscarriage and mentioned that old school advice would have been to wait 6 months before trying again. I was horrified. I couldn’t have followed that. I also phoned the early pregnancy unit who gave me a follow up appointment for blood tests due to the previous suspicion of ectopic pregnancy and my increased chance of having one. Luckily for me, the follow up appointment ruled that out, but it’s a fear I’ll always carry prior to a scan due to the risk. What I find sad in retrospect is that I hid my miscarriage from my colleagues and went about my work as normal. I was in the same state of shock as with my first miscarriage, which made me numb, pragmatic and want to do something positive I could control, since I couldn’t stop myself miscarrying. It also made me sad that I’d named that pregnancy baby rainbow, and I’d seen a beautiful rainbow that morning on my way to work – like the baby had been saying “bye mummy, I’m off to play over the rainbow now”. I had a feeling she was a girl – I like to picture her swooping and looping with the bluebirds. “Somewhere over the rainbow” is my favourite lullaby which I currently sing to my children at bedtime – I always think of my miscarried babies then too, and sing for them all.

Committed action

Possibly the most important part of ACT. Once you know what you care about and you have the tools to cope with climbing your own mountain to reach it, you set some goals to get you there – following the mountain analogy, like a series of camping posts on the way to reach.

After my first miscarriage, within my value of family my all consuming goal was starting one. Breaking that into steps, it looked something like –

  1. Follow reverse compass by taking a month or two off trying to wait for a normal period before trying again.

2. Enlist other half in the goal of trying again.

3. Use Ovia (period tracker) to increase chances of getting pregnant again by trying on the right days.

4. Resume giving up wine, coffee and running.

5. Review efficacy of plan every month and do what it takes to make it work – even if that brings up some difficult feelings. Commit to coping with what comes up – because it will come up and it will be hard, and there may be times giving up appeals and there’s a need to review whether it’s worth it.

Values

Values are one of my favourite aspects of the ACT model and one that distinguishes it from other forms of CBT. When we say values it’s too easy to think in terms of what we should want for ourselves and other people’s expectations of us. It’s also too easy to stop at the basics. the basics that many people might include are perhaps health and wellbeing, family, education, career, friends. For me, creativity, compassion, social justice and authenticity are also important.

When I had my first miscarriage, the value uppermost in my mind was family, and wanting to become a mother. Within that I wanted to be a nurturing one. I’d wanted a child since my late teens but due to the combination of needing to meet the right person, establish my career and financial security first and plan and enjoy a wedding and honeymoon it waited until the honeymoon – because that was my first legitimate opportunity and I was willing to wait no longer. As such I was delighted but surprised to conceive immediately. Initially it all seemed to align perfectly, until it didn’t. It’s important to separate out values from goals at this point – values are more of a compass or guiding light in the dark. Goals can be achieved or not, but you can’t complete a value. And I’d still have valued family and motherhood even if I’d never carried a child to term. I’d have been a mother to those who didn’t make it still, and I’d have needed to look more creatively at ways I could follow my value of pursuing motherhood – maybe nurturing others in my family more, focussing on my marriage, adoption, work with children in need or caring for pets. Or maybe I’d have needed to follow my reverse compass for a while – to take a break from trying to mother and put my energy into an area of my life I also valued but had more control – like my career or my education perhaps. There are many areas of my life I value where I struggle with how little control I have – perhaps never more than with my first miscarriage because having a baby was all I wanted but I couldn’t stop losing the pregnancy. One comfort for me there was the idea that whenever you hurt most emotionally there is often a value underneath. Values and distress can often be two sides of the same coin. So useful questions for me at that point were – am I willing to tolerate this pain and the risk of going through this again to try to have a baby again someday, following my values? For me, the answer was yes.

Drop the struggle

Photo by Gantas Vaičiulėnas on Pexels.com

Another key idea from ACT is that part of what distinguishes humans from other animals is language. Language allows us to have an internal dialogue about our experiences. When children learn to talk, they develop associations between words and objects. For example, they learn the word for cow. They instinctively then want to categorise their experiences but can over generalise often in their efforts, so they might call dogs, cats and horses cows too. That same human language habit can lead to distress for us as adults too. We see associations with our experience automatically and everywhere.

When I miscarried I found other people’s pregnancy announcements tough to take because it triggered my own associated memories of my loss and my fear that I might not conceive again and that even if I did I might miscarry again. I then felt guilty for not feeling happy for others. My instinct was initially to avoid potential triggers – to take a break from social media and social situations which might include pregnancy announcements or happy pregnant mums. The trouble with that is, even then there’s still pregnant women on TV and smiley babies in advert breaks. Reading a book still can include an unexpected pregnancy story line. At work, people might bring the subject up – especially to me as a recently married woman who had been open about wanting a baby soon prior to miscarrying and particularly given I hadn’t shared my pregnancy news due to the “wait to the 12 week scan” convention. So I found it impossible to avoid pregnancy and baby references while still living my life and pretending to be normal. Another approach I tried to avoid distress was to act as if all was well – the trouble with that was it felt like there was a huge barrier in the way of my relationships with just about everyone – I felt disconnected and alone in my grief. I remember crying all the way on my drive into work and all the way home, because it was the only time I could release my grief without impacting someone else.

Another key idea in ACT is about how dropping the struggle to avoid feelings can set you free. Again metaphors can help illustrate. Imagine your distress is a monster and that monster is pulling you to a cliff edge with a rope. Avoidance of distress might have you pull harder on the rope to get free, but the monster just pulls harder back, so you get stuck – and sore. And tired. So what else could you do? You could drop the rope. Accept the monster (aka distress) will be there and go ahead anyway with your life – minus the avoidance effort.

For me, this way of thinking led me to gradually tell other people in my network about my miscarriage so I didn’t have to pretend to be normal as often – which in turn made me feel ok more often and more connected to others when I didn’t. I found it helped to give myself permission to feel sad, even when it was triggered by other people’s happy news, and tried to congratulate people anyway – even if it would take my emotions time to catch up. I also allowed myself a social media break as from an online support group I found, it’s common to find that tough after miscarriage and alright to have time out from anything that makes it harder without adding value. Those things that do add value on the other hand- relationships, family, work – are often more important than avoiding distress. To me, anyway.

Exercise

Hold a piece of paper in front of you while trying to have a conversation with someone else – does it make it easier or harder? That’s a bit what it’s like when trying to avoid thoughts and feelings, or to keep something secret from people you’re close to.

Self-as-context

One of the important ideas from ACT is that you are the context for your experiences rather than just your thoughts and feelings – you last your whole lifetime while your thoughts and feelings just pass by. What’s happening in your life now is one chapter of it. Not all chapters will be enjoyable, but together they could be seen as making a rich tapestry of experiences that give a sense of who you are. Without any of those experiences you might not be who you are today. I like the film ‘sliding doors’ for showing how even changing small details of how your journey unfolds can make a big difference.

For me, these ideas have been important in a few ways in the context of my miscarriages. My miscarriages are important in my journey as a mother, as that’s how motherhood began for me. I’ll always feel like I’m a mum to a larger brood of children than I’ve carried to full term. The yearning for more children will probably always be with me – fading in and out in intensity but never really gone. I have a much more developed empathy now for anyone facing infertility, pregnancy loss or a future without children than I would have if I’d never miscarried. I’d have less energy for speaking up for those without a voice. Less gratitude for the healthy children I’ve held extra close tonight. Less knowledge of how much fight, strength and tenacity I have in reserve. I’d have had less physical and emotional pain if I hadn’t miscarried. I find it hard to imagine who I’d be as a mum if I hadn’t though and it’s tempting to say I’d be a less good one.

Sometimes though in the coal face of emotional pain and suffering, it might feel during miscarriage like that is all there is. It might feel like that is who you are and who you always will be – that you’re defined by it. I’ve had moments like that.

What I’d say is that mindfulness and defusion can help get enough space from the pain sometimes to see that there is choice in how to respond and what to do with that.

The idea of self as context and how that differs from identifying yourself as being your thoughts and feelings can be abstract but helpful to get to grips with. Metaphors can help.

I live beside hills, so my favourite metaphor is that of a mountain with changing trees, flowers and plants across the seasons and stages of the climb. So in spring, the walk might include April showers and daffodils. In summer, there might be cherry blossom, bird song and bunny rabbits – though it might get a bit hot and sweaty. In the autumn, beautiful bright leaves might fall from the trees as the light shades change in the late afternoon. In winter, the ski slopes might cover with snow and it might get slippery for hikers. I’d put it to you that you are the unchanging mountain underneath while your thoughts and feelings are like the changing seasons. Your experience of miscarriage might be like a rocky eroded path on the mountain – always there but easier or harder to carry depending on the season. Like the mountain seasons, whenever it’s a painful bit to tolerate, if you can hold on another day it’ll often shift once again.

Exercise

Other than a mother through miscarriage – who are you?

Some questions to ponder –

If you could go anywhere in the world, where would you go and why?

If you could invite anyone you wanted round for dinner – who would you have?

In a film of your life who would play you? What would be your best bits? The bits you learned most from? The ones you hurt most over? The moments that healed you?

What words would you want others to say in a celebration of your life if you live to be 100?

What music would you want played in a soundtrack to a film about your life?

If you were an animal in another life, what would you be?

If you were a penny sweet, what would you be?

If you only had one day left on the planet, what would you do with it?

What have you always wanted to learn how to do?

What job would you do other than your current one?

What would an abstract colour painting of your soul look like?

Mindfulness

you could imagine your thoughts are like the lily pads floating on the water whole you are like the heron viewing them from above

My mindfulness practice predates my experience of miscarriage but it’s a good wellbeing antidote for feeling numb, shocked and blocked which was how I felt after my first miscarriage.

Mindfulness is the practice of being fully present in the moment. It can mean meditating, but it could also mean mindful movement like yoga or pilates, or even swimming or running. It could also be mindfully doing the dishes, changing the sheets or brushing your teeth. As long as you’re tuning into your experience in a non judgemental way and just noticing what comes up, it could include anything. Baking, gardening or craft maybe. It’s about noticing what your five senses are picking up on. What can you see, hear, smell, touch and taste? How are you feeling – warm or cold? Relaxed or tense? Comfortable or not? What emotions are you feeling? Tired or energetic? What’s the space around you like? Are any thoughts, memories, images or ideas passing through? You don’t need to do anything about any of this – just notice. Anything you do want to act on – notice that too and do it later.

When I’d just miscarried, sitting still with anything was hard for me. I preferred mindful running as I could then feel – feel the wind in my hair, the cold on my cheeks, hear my feet battering the pavement and smell the rain. It was easier to allow my difficult and uncomfortable thoughts to be there. The ones like “what if I never carry a baby to full term?”, “What if I can’t conceive a healthy child?”, “What if it’s my fault for waiting too long to start a family?”. And those uncomfortable feelings too – guilt, shame and fear. The ones I blocked out with keeping busy at work during the day, but needed to be acknowledged and felt before I could move forwards. Somehow running made them easier to hold and holding them set me free.

Some exercises to try –

Sit with a notepad and write down every thought that passes through for 3 minutes. What do you notice about your experience?

Sit down with a piece of your favourite chocolate. How does it look? What shape is it? How does it smell? How does it feel in your fingers? Lastly, how does it taste?

Put on your favourite music. Choose just one aspect to focus on – maybe the rhythm, the melody or the words. How is this experience – what do you notice?

Some of my favourite Mindfulness resources –

Smiling mind app

https://www.smilingmind.com.au

Headspace app

https://www.headspace.com

Defusion

From the top of the hill, it’s easier to let go of thoughts and to see them for what they are – just thoughts that pass

Here’s some ideas I had to defuse from after my first miscarriage

An early miscarriage is less of a big deal as the physical part is over quickly

WRONG – there’s a loss of hopes and dreams, shattered beliefs about pregnancy necessarily ending in live birth, other people’s emotional responses, real or imagined and the world continuing like nothing has happened and a sense of being expected to do the same since nobody knows what’s happened due to the no pregnancy news before 12 week scan convention – just for starters.

The expectation of silence – not helpful for me. In my view it is there as much to protect others from not knowing what to say or do to support a woman who has lost a pregnancy as it is to protect women themselves. I also don’t like the implication of shame that goes with silence and in turn of stigma associated with shame. I’ve had my emotions bubble over in social situations many times due to pregnancy loss and because of other people not knowing I’ve had my husband brush it off to them as ‘my hormones’. I’ve even done it myself. Doing so made me feel even more shame and frustration. We often compound our suffering when we try to avoid our feelings and thoughts or to hide them and adhering to that rule compounded my suffering.

So what is defusion?

It is the concept that distress is caused by fusing with an idea that is unhelpful to us, where this prevents us seeing a situation clearly and making a free choice to act differently and more helpfully and kindly to ourselves. So for me, I was fused with the idea that other people’s feelings mattered more than mine, that their need to be protected from possibly feeling awkward for a moment mattered more than allowing myself to be honest that I was sad about my loss.

So if we know defusion would help, how do we do that?

For me, writing thoughts down helps me get some space from them. Hence the blogging enthusiasm – if you’re reading this, maybe it helps you too?

I also love nature and the outdoors. Metaphors can also help give you space from difficult thoughts. One of my favourite strategies is to lie on the grass watching clouds, imagining difficult thoughts floating away on the clouds. Alternatively I also enjoy watching crashing waves when my emotions are strong, imagining that the difficult thoughts are crashing over on the waves, passing over.

It also helps to remember that thoughts and feelings are just that. They are passing experiences which come and go, if we let them. We can choose to engage or let go of any thoughts that come. It takes practice to let difficult thoughts go, but I’ve found it gets easier – especially if I try a few different strategies on the same thought.

I also find art and craft can help get space from difficult thoughts – maybe writing ideas down and decorating a jar to put them in, or painting a thoughts as a blob of colour, or as a monster or cartoon character.

Exercise can also help. I love to run, and letting the thought be there while sprinting often works for me in that feeling an endorphin hit while running with a difficult thought breaks the emotional load linked to it and therefore leads to defusion.

It can also help to imagine a difficult thought in a cartoon character voice, high pitched and squeaky, or fast, slow, loud or soft. You can try saying it over and over again until it is just meaningless sounds.

sharing my experience with someone else for me though was key to defusing from my idea that other people needed to be protected from my feelings. I was surprised how many women I knew had miscarried – and just hadn’t talked to me about it before I brought it up. I’ve also yet to talk to anyone who has found it awkward – I’m sure there are people who would, but my mind just offered that thought and the evidence has yet to support it.

A link to a highly recommended self-help book about Acceptance and Commitment Therapy that is available as a PDF online with lots more ideas related to defusion and of course many other ACT concepts:

https://epdf.pub/get-out-of-your-mind-and-into-your-life-the-new-acceptance-and-commitment-therap.html

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