Using Dialectical Behavioral Therapy (DBT) Mindfulness Skill to Manage Pregnancy and Infant Loss Grief Overwhelm (Copy)
If you have experienced the loss of a pregnancy due to miscarriage, termination due to medical reasons, stillbirth, or infant death, you may be overwhelmed by your emotions right now. I was. There is a reason the pain is often referred to as “unimaginable.” The loss of a pregnancy or infant is a devastating experience. People find themselves completely unsure how to manage their immense emotions. This can lead to substance use, isolation, anger, depression, self-harming behaviors, and/or suicidal thoughts and actions.
But the good news is, Dialectical Behavior Therapy (DBT) skills can help.
What is DBT?
DBT is an evidence-based practice that was developed to help people experiencing extreme emotional overwhelm. It emphasizes mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills can be incredibly helpful throughout your grieving journey.
In this post I’d like to focus on the concept of mindfulness. While all of the skills are helpful, and I’ll likely explore them as this blog continues, I’m starting with this narrow focus for a few reasons. First, the period immediately following the loss of a pregnancy or infant is a crisis period. That means the focus is simply getting through the next moment. Mindfulness skills are meant to help with that. Second, in DBT, mindfulness skills are the first thing they teach for a reason. They are considered “core skills” because a mastery of mindfulness is essential for being able to move through the other DBT skills. And the final reason I am focusing on mindfulness is because of one of the very specific grieving challenges that comes with the loss of a pregnancy or infant. This has to do with the that fact that this type of grief has a tendency to pull people into the past and future in a uniquely distressful way. We’ll get more into this one below.
What Is Mindfulness? What Is Mindfulness NOT?
Mindfulness is often a misunderstood term. So let’s start by addressing what mindfulness is NOT. It is NOT “mindlessness.” It does not mean you have to “clear your mind” or “empty your mind of all thoughts.” It does NOT have to involve meditation, closing your eyes, or anything to that effect. It does NOT look any particular way. All it really means is “staying present.” That’s it. Mindfulness is the act of paying attention to the present moment without judgment.
So what’s the big deal with staying present? Isn’t the present overrated? I mean the past holds nostalgia and the future holds hope, right? Not during acute grief! Particularly grief following the loss of a pregnancy or infant. This is that unique aspect I mentioned. The past holds painful memories. Memories that parents have a tendency to replay while thinking “If only..” or “What if...” These phrases are torture to a grieving parent who is grasping for answers. They can lead to immense guilt as they feel like they should have been able to protect their innocent baby. And thoughts of the future are just as painful as parents think about all the plans that will never happen. I will definitely explore this past/future feature of the grief process more in-depth at another time as this is a topic all by itself. But for now, let’s just acknowledge that thinking about the past and the future can be particularly painful after the loss of a pregnancy or infant.
Now please understand, processing these painful thoughts surrounding both the past and future is meaningful and helpful in the grieving process. However, this is often best done over time and in safe therapeutic spaces. Immediately following the loss, or during moments of increased emotional distress, thoughts of the past and future may make things worse.
So, staying in the present moment may help reduce some of the emotional overwhelm. (And the good news is that present is the only timeline we currently have any control over!) But, as most of us know, it’s not that easy to just tell your brain “stop thinking about the past/future.” That’s not really how the brain works. Let’s face it, the brain is not a very good listener. So that’s why we use active mindfulness skills to guide the brain rather than just give it a verbal direction. These mindfulness skills are often referred to “grounding techniques” as they gently help us connect with the present moment – think literally feeling your feet connected to the ground you are standing on.
Two Mindfulness Skills You Can Use Today
Mindful Breathing: I know. Breathing…Ugh. I get it. People always talk about breathing like it’s a miracle drug. It used to frustrate me too. But that’s because I just didn’t understand how powerful the breath really is. It actually directly regulates the heart rate. I’ll spare you the detailed explanation of the sympathetic nervous system and parasympathetic nervous system (for now). But think about it like this, we tend to take short, rapid breaths when we are engaging in physical activities. And then when we are done with those activities, we tend to breathe much slower and deeper. During this period of deep breathing, we can often feel our heart rate decreasing. In moments of acute stress, or emotional overwhelm, we can use this same tactic to tell our brains “it’s time to slow down.” This let’s our brain know that the current moment is a safe place to be and. It also gives us something in the present moment to focus on - the breath.
How to Practice Mindful Breathing: Simply focusing on your breath is enough. Do what’s comfortable for you. Inhale deeply, hold for a moment, and exhale slowly. It doesn’t really matter how long you inhale or exhale for. Do what feels soothing, nourishing, and comfortable for you. Allow yourself to feel whatever emotions arise without trying to change them. Again, the goal is not to clear your mind. The goal is to be in the present moment.
Progressive Muscle Relaxation: This is similar to mindful breathing in that you are trying to induce a calmer emotional state by manipulating your physical body. There is really no way around the fact that your mind and body are intimately connected. Negative effects on one tend to have a negative effect of the other – and vice versa. So during periods of acute emotional distress due to pregnancy or infant loss, when our emotions are overwhelmed, our bodies are usually overwhelmed too. They may feel tight. Tense, Achy. (And this doesn’t even account for the physical pain associated with miscarriage, D&C, D&E, or delivery!) By acknowledging and actively releasing some of that physical overwhelm, our brains tend to gain some relief as well. Again, by using the knowledge of our mind-body connection, we are gently guiding brains to be focused on the present, while also letting them know we are safe and open to an improved emotional experience.
How to Practice Progressive Muscle Relaxation: I suggest sitting in a comfortable seat or laying down for this. Start by doing what’s called a “body scan.” This just means taking a few seconds or minutes to notice how your body feels. Start at your toes and move upwards. Hit each muscle group. Just notice areas of tension or discomfort. Once you get all way to the top of your head, go back to your feet. Scan your body again, but when you get to each new muscle group, tense those muscles as tightly as you can for a few seconds. Release. Notice if anything has changed from when you first scanned. Don’t forget your facial muscles!! If you are anything like me, those muscles carry a lot of tension! You can tense and relax as many times as you want. See if each time brings more and more relaxation. Let yourself experience whatever emotions arise without trying to change them. Again, the goal is not to clear your mind. The goal is to be in the present moment.
