Dropping the Baby and Other Scary Thoughts

Breaking the Cycle of Unwanted Thoughts in Parenthood

Karen Kleiman, Amy Wenzel, Hilary Waller, Abby Adler Mandel

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000215847
• Edition: 2
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

This accessible guide addresses the nature of the intrusive and unwanted thoughts that can be common in new parenthood, and offers practical answers and advice on how to tackle these.

With fresh material focusing on how to overcome barriers to disclosure and stigma, and updated treatment approaches and case descriptions, this revised edition explains exactly what these negative thoughts are, why they come about, and what can be done about them. Chapters offer information on the specific nature of perinatal anxiety and related disorders, along with take-home points and evidence-based strategies for symptom relief that clinicians can use effectively with new parents.

Written by two leading clinicians in the perinatal community, in collaboration with two promising leaders in this specialized field, Dropping the Baby and Other Scary Thoughts, 2nd edition offers a compassionate approach to breaking the cycle of scary thoughts that is invaluable to new parents and clinicians alike.

SECTION III
Breaking the Cycle of Scary Thoughts

7
THINGS YOU CAN DO TO FEEL BETTER

“It was like one part of my brain was off on its own, attacking the other part of my brain with thoughts that didn’t make sense. I felt like a stranger in my own mind, almost like I didn’t recognize myself. I told no one how I was feeling. Absolutely no one. I believed if I told anyone how I was feeling they would absolutely think I was crazy. I made sure everything looked good on the outside, so I just pretended everything was fine. I mean, no one could tell there was so much going on in my head. But the thoughts would pierce through my brain when I least expected it, usually when I was bathing the baby. Bath time took only as long as I could hold my breath and get it over with. I didn’t know what else to do.”

Jen, 5 months postpartum

Dealing with scary thoughts is not just a matter of willpower, as some claim. Although willpower may indeed be part of the solution, we’ve seen throughout this book that it is more complicated than simply wishing thoughts away. We’ve all heard the truism that if we think positively, we’ll feel better. Sounds good, doesn’t it? Research has shown that one of the most significant attributions for recovery from anxiety or depression seems to be the individual’s belief in his or her ability to take control and be successful (Kinnier, Hofsess, Pongratz, & Lambert, 2009). In other words, if someone believes they will be successful, they are more likely to succeed.

Though we realize it is much easier said than done, great personal power can come from shifting the focus of your energy from fear (negative) to acceptance (positive). For mild-to-moderate degrees of distress, women report that they feel more in control of their lives when they take responsibility for how they are feeling and identify the specific actions they can take to feel better.

In Chapter 5, we discussed the barriers to disclosure, or those things that get in the way of women speaking up about how they are feeling—the ambiguity factor, the critical voice, the sentencing factor, the symptoms factor, the propaganda factor, the community factor, and the what-if factor. All of these impediments combine to create a setting that discourages women from admitting that they are having scary thoughts. In order to bring some relief from your scary thoughts, we turn our attention to specific self-help strategies you can try out on your own, especially if you are not yet ready to disclose your thoughts to someone else. Even though some of these strategies may seem counterintuitive at first, we encourage you to keep these six principles in mind:

• Denying the feelings and thoughts will not make them go away.
• Panicking will make them worse.
• Resistance creates persistence.
• Distraction will help for a while.
• Acceptance is hard but essential.
• Increasing awareness of your feelings and thoughts might feel unproductive or even frightening, but gaining insight is a pathway to empowerment.

What Won’t Help: Counterproductive Reactions

Most women respond to the distress of scary thoughts with efforts aimed to protect them from emotional pain. Some might refuse to believe the thoughts are there (denial). Others might try desperately to make the thoughts go away (thought suppression). Another common response is to react with sudden, intense fear that impairs your ability to function (panic). Although these three responses are common and understandable, they will not help you feel better and in fact can make you feel worse.

Denial

One of the first responses reported by perinatal women with scary thoughts is denial. “Maybe if I just pretend it isn’t happening, it will go away.” Denial serves to protect people emotionally. In some instances, it can be temporarily adaptive, such as when someone is forced to deal with the reality of unbearable news. Likewise, this common psychological defense seems to soften the blow of scary thoughts. However, when someone refuses to or simply cannot accept the certainty of a situation over time, denial is viewed as maladaptive. Because scary thoughts are so often accompanied by a feeling of shame and the belief that one is damaged in some way, they often are wished away with fierce determination. Many women who are having scary thoughts believe it would feel better to pretend they weren’t there. Sometimes this is evident from the initial phone call to the clinician:

• “Are you having any thoughts that are scaring you?”
• “No.”
• “Is there anything else you would like me to know before we set up the appointment?”
• “Not really.”
• “Then let me take a look and find a time for you to come in as soon as possible so that you can start to feel better.”
• “Okay … um … uh … I … I’m not having thoughts of hurting my baby or anything. My doctor asked me that and I’m not having thoughts like that.”
• “Okay. Are you having any other thoughts that might be worrying you? It might feel better if you tell me now before we meet. Perhaps I can reassure you, so you don’t have to worry so much in the meantime.”
• “No. Everything’s fine. I’m just crying all the time. I’ll be okay until our appointment.”

Women would rather not admit that they are having scary thoughts, at least not at first. The denial we are talking about here is slightly different from the unconscious, ego-protective defense mechanism taught in introductory psychology courses. Here, the denial is more of a conscious or deliberate attempt to shield one from an experience that feels so unacceptable. The distorted belief is that “if I don’t put words to it, it isn’t really happening.”

The benefit that comes from denial is a short-term reprieve. Essentially, denial grants you time to adjust. After all, having a scary thought, however fleeting or purposeless, can be unsettling. However, the refusal to acknowledge its presence becomes a stumbling block in the long run because it prevents one from taking action that could help alleviate the stress. In this way, denial is self-sabotaging by directly interfering with the management of scary thoughts, as well as postponing relief from them.

Thought Suppression

We’ve seen that denial can surface as an immediate reaction to uncomfortable states of anxiety; it also requires a substantial investment of energy. Because of this, other defenses may be called upon. Thought suppression is the deliberate act of trying to force the unwanted information out of your awareness.

Remember the old brain teaser: “For the next 2 minutes, think about anything you want, but you cannot think about pink elephants. Think about whatever you want, but you must not think about pink elephants!” Of course, everyone reports seeing one or more big pink elephants in the mind’s eye immediately after being told to suppress that image.

Over 30 years ago, a study was carried out to test the prediction that a person’s attempts to suppress thoughts can result in preoccupation with that thought—a phenomenon the researchers referred to as a rebound effect (Wegner, Schneider, Carter, & White, 1987). In this experiment, participants were asked to speak spontaneously for 5 minutes straight, describing aloud whatever came to their mind. Half of the participants were first instructed to avoid thinking about a white bear (suppression) but were instructed to ring a bell each time they said or thought “white bear.”

These participants completed this task a second time during which they were instead instructed to specifically think about a white bear (expression). Another group completed these two tasks in the reverse order, first expressing and then suppressing thoughts of a “white bear.” Participants who were first told to suppress thoughts of a white bear reported even greater indications of thoughts of a white bear when allowed to express those thoughts compared to participants who did not first engage in suppression. The researchers concluded that attempts at thought suppression had a paradoxical effect, suggesting that suppression might produce the very thought it is intended to stifle. Subsequent research has supported this notion and confirms repeated failure by people to suppress unwanted thoughts (Wenzlaff & Wegner, 2000) and associations between thought suppression and a range of symptoms including anxiety, depression, and substance use (Aldao, Nolen-Hoeksema, & Schweizer, 2010). In other words, thought suppression just does not work.

This work has strong implications with regard to thought control as a self-help strategy for perinatal women with scary thoughts. Most perinatal women will admit that their initial instinct is to suppress the thought; quite simply, they want to make the bad thought go away by trying not to think about it. The notion that it is unhealthy and even dangerous to stifle emotions and bottle them up inside is not a new one. But the message here is an important one: the instinctive response to control a scary thought by holding it in or concealing it typically backfires and makes things feel worse.

This paradox was described in Therapy and the Postpartum Woman (Kleiman, 2008) using the metaphor of a filled water balloon. Imagine trying to control a wobbly water balloon resting precariously in the palm of one’s hand. Your instinct is to grab it as it rolls from side to side. But in doing so, you find that the overstuffed balloon either pops out of your gripping fingers and onto the floor, or it bursts right within your grasp into a sopping mess. Either way, control has been lost. The only way to gain control over an unsteady water balloon is to release your fingers, slowly open your hand, and let go of the tight grip. This exercise demonstrates the paradox of control. Letting go when you are overwhelmed and frightened is difficult and can feel counterproductive, but it works. We say more about letting go at the end of this chapter.

Panic

Negative self-talk can trigger or aggravate a state of acute anxiety. Karen refers to this as an “uh-oh” response: “Oh no, I’m having that thought again. Uh-oh, here it comes again. Now I won’t be able to do what I need to do. What if I get sick again like the last time? I can’t do anything; oh no, I can’t breathe. I really cannot breathe.” This snapshot of a paralyzing moment in time demonstrates the power of negative thinking and the manner in which it can escalate from one short exclamation into a blast of memories or associations. If one is experiencing panic, recognizing the thoughts that precipitate this barrage of emotion is an important step toward relief. In the next chapter, we will examine some specific strategies to help restructure negative thinking into more productive patterns.

Panic and negative thoughts have a reciprocal relationship; that is, one contributes to the other. Knowing this can promote both awareness and management of the scary thoughts. If a perinatal woman is in treatment for anxiety or depression, she will notice that as her anxiety is successfully managed, her scary thoughts will likewise decrease in degree and/or severity. This is because, as stated previously, it is not the content of the scary thought that is noteworthy; rather, it is the level of distress it causes. Thus, even though a woman may be preoccupied with the content (“Why would I have a picture in my head of my baby lying in a coffin on the beach?”), trained clinicians will focus their intervention away from the specific content and toward treatment of the emotional experience.

CASE EXAMPLE: KELLY

Kelly recognized that her circumstances were generally positive: “My baby is healthy. My husband is great. I have so much that I’ve wanted. I should feel great, but I don’t. I worry a lot but sometimes just when I think my brain is coasting along for a slow ride, BAM, I smack into some horrible thought about some awful thing happening to my baby or my husband. Right out of nowhere. Then, I freak, I can’t breathe, and I start to sweat. My whole body shakes like I have a chill or something and I start thinking, Shit, I can’t believe this is happening again! And then, I can’t think or move, or help myself. I’m just frozen.”

Here’s an oversimplification of what was happening to Kelly: when a woman experiences a scary thought, she can go down one of two roads. She can say and/or think, “Okay, I know what this is. I understand this is an irrational thought and has nothing to do with what is really going to happen or not happen. I can try to use a coping strategy to manage how I’m feeling about the thought. I’ll try to distract myself. Maybe I’ll call my friend.” On the other hand, she can say and/or think, “Oh my God, why is this happening again?! I thought I was okay. I thought this wasn’t going to happen again. Maybe I really am going crazy. What should I do?!” Kelly’s “uh-oh” response is an example of this second reaction. Unfortunately, that road is more likely to lead to increased feelings of helplessness, loss of control, and panic.

The core principle behind the first response is learning to refocus and label scary thoughts as unwanted and, more importantly, unthreatening. This takes practice and is typically not intuitive. The knee-jerk reaction for most perinatal women, particularly those with a predisposition to anxiety, will be to charge down the second road. It seems automatic, sometimes, to do what’s familiar, even if it accentuates the mental stress.

Choosing the first road requires a deliberate decision to respond differently by modifying the usual response with an unfamiliar, more practical one in order...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• Section I What’s Going On
• Section II Clinical Concerns
• Section III Breaking the Cycle of Scary Thoughts
• References
• Index