When we learn to make room for our difficult emotions, we give ourselves the opportunity to react in different ways. Often with anger we yell, swear, throw things (including punches), etc. and typically don’t act in ways that align with our values. When we make space for anger we can clearly communicate that we are upset without doing any of those things.
I know this is a bold statement, but honestly it’s not one that I’ve come up with. It’s one that’s been studied, and it came to my knowledge through the form of a book – When the Body Says No by Gabor Mate. Now, I have done a whole post giving my review of that book awhile back, so that might be something you want to check out before or after reading this today.
First things first, I want to reflect on my own life. As an adult I wouldn’t say I repressed my emotions. Well, sometimes, when I was in my 20s, I would repress anger until it boiled over and spilled out like. Then I was accused of having ‘anger problems’ but really, looking back I was just not expressing it as it came about. On the other hand, sadness, joy, etc. all seemed to come out appropriately. Diving further back, I know there was a time between the ages of 8-13 that I repressed emotions – again, usually anger. Through those 5 years I had a group of friends at school, and one girl in particular was good at manipulating the others into not talking to me for periods of time. Like I mean I had no one to hang out with at school when they did this. It started as just being a day, then a few days, then a week, sometimes a month. It was honestly unpredictable of when it would happen and how long it would happen for. I never knew what ‘I was doing wrong’ and was always only told by them, “If you don’t know, then I’m not going to tell you.” I think this was actually a traumatic experience for me. Actually, my therapist told me it was. However, this post isn’t about that trauma, it’s about repressing me emotions. I think the only way I could get through 5 years of elementary and middle years schooling was to repress. Not show any emotion about it at school. I remember crying myself to sleep at night, but certainly not every night. Luckily, I was enrolled in a ton of extracurricular activities which probably helped me too.
What does repression of emotions have to do with chronic illness? Well, in When the Body Says No, Gabor Mate explains that repression of emotions – particularly anger – has been linked to several illnesses. These include autoimmune diseases, cancer, and ALS. Now, this doesn’t necessarily mean EVERYONE fits the bill, but certainly, in my conversations with others, people readily admit they have difficulty expressing anger in an appropriate and healthy way. Very interesting.
Why does repression of anger cause chronic illness? Well, in and of itself, it does not. However, when we look at illnesses from a biopsychosocial standpoint (this is the mostly widely accepted view in the medical community – both Western and holistic), it is a contributing factor stemming from the “psycho” portion. Bio stands for biological – so any genetic or epigenetic (meaning our genes were changed by our environment) – contributions to illness. Psycho stands for psychological contributors, which can also include personality, management of emotions, how we handle stress, and so on. Social usually relates to the environment, which often includes factors like traumatic events.
What can we do with this knowledge? For me, the best thing I’ve learned to do is appropriate and consistent expression of emotions. This means I don’t ‘boil over’ with rage but rather can notice and accept the feelings of anger, expressing them through words. This is sometimes referred to as emotional regulation, and in my practice it definitely falls under acceptance. There are many ways to learn to do this. The most effective would be going to see a therapist. There’s also the self-help section of the bookstore or library. The practice of mindfulness. Just to name a few. Will doing this help heal our illnesses? Well, not exactly, but it can help lessen the severity and impact of our symptoms on our lives. I think it is a part of the healing process we often neglect, but really shouldn’t. This week’s episode of the podcast talks about acceptance (find it here). If you have questions about it, feel free to DM me on Instagram (@chronically.living_)
I’m going to be the first to admit that when I was younger I often struggled with my emotion regulation. This often came to the forefront in the context of relationships, because I had a “short temper.” I would get angry and yell, pretty quickly. I could always calm down, but I came to realize the older I got that I had to remove myself from the situation in order to get myself to be more calm. I had a really bad breakup geez, almost 5 years ago now, that I also had a difficult time controlling my emotions, especially sadness and rumination. That last time, that was the lesson for me. But we’ll get to that in moment…
First, let’s talk about what emotion regulation is, because I know that some of you may never have really heard the term before. Emotion regulation is our attempts to control the experience, expression, time and scale of our emotions. It has been long known to be important for our mental health, and only more recently explored for physical health. These are also skills that many of us learn as children, but often do require practice throughout our lifetimes. I worked in retail for a long time and as I reflect back I can see how customers yelling at me, for let’s be honest, very small things (I had a lady yell at me once because a competitor had an item for a dollar less but she didn’t tell me before she paid – I happily would have matched it… and by yelled I mean screamed bloody murder) and I realize they were exhibiting very poor emotion regulation, which is more harmful for themselves than the stress it caused me.
Here’s what we know about emotion regulation and physical health:
better emotion regulation impacts our overall physical health positively
difficulties with emotion regulation, especially with prolonged negative emotion, can make you more at risk at developing heart disease
emotional suppression and rumination (part of poor emotion regulation) cause lower energy, greater physical pain, greater disability, and overall lower quality of health
difficulties with emotion regulation make it difficult to engage in self-care and health-related behaviours necessary for managing chronic illness
better emotion regulation makes it easier to manage stressors in our lives, meaning less flares and relapses of illness
better emotion regulation increases medication adherence and sticking with diet and exercise regimes
Back to my story. So, I had this breakup and this very poor emotion regulation following it, and then I had a flare so terrible I ended up in the hospital for pain. I was released the same day, and the pain came down a bit, but it really went back to normal levels when I was able to come out of the depressive funk I was in. I can safely say I have not had a problem regulating my emotions since… and I mean really who wants a flare like that again? So, we’ve answered the question why, and there are lots of “how tos” in regulating emotions, but I’m going to leave you with one to try out.
Learning to self-soothe. Again, many of us learn this skill as children, but not everyone does, and often we do less of it as we get older. Some ideas for practicing self-soothing are to do meditations such as loving kindness (click here) or a relaxation practice like progressive muscle relaxation (click here). Expressive writing about the experience (click here), breathing exercises (click here), and self-care strategies like taking a bubble bath, are more ways to lear to self-soothe. There are many other strategies online so I suggest a Google search if you’re looking for more!
Take care, and keep making the most of it! –Kelsey
I love writing (hello, this is a blog after all) and I’ve always found it to be helpful for me in my own life (and health) journeys (that and music). I came across some research on the mental and PHYSICAL health benefits of expressive writing, so I did a bit more digging and damn, we should all be doing more of it! And hopefully, this post will inspire you to do some. Hearing that there are mental health benefits is probably less shocking than that there are physical health benefits to expressive writing, so we’ll start there, but before we get into that, let’s quickly establish what expressive writing is. Expressive writing is simply writing about our deepest thoughts and feelings about an event or situation, without holding back. When people do this, it is often through journaling, and is often free-writing, without too much thinking about it. It can be done on the computer or by hand, really whatever you prefer. The leading pioneer in this research is Pennebaker (too many articles to site them all), but I’ll site some of the other research on the subject (which also references him) at the end of the post.
Okay, so the mental health benefits:
reduces symptoms of depression
reduces post-traumatic symptoms
improves focus and concentration – including in people with ADHD
improves working memroy
improves emotion regulation (which is our ability to control the quality, frequency, intensity and duration of our emotional responses to situations)
and it increases our self-awareness
If these aren’t good enough reasons to do some expressive writing, then maybe the physical health benefits will convince you:
decreases the number of doctor’s visits you’ll have
reduces the number of days spent in the hospital
reduces the overall number of hospitalizations – i.e., people with cystic fibrosis
reduces blood pressure
reduces chronic pain – i.e., cancer and chronic pain conditions
reduces the severity of inflammatory conditions – i.e., rheumatoid arthritis, lupus (SLE)
improves immune functioning – i.e., cancer, HIV
improves lung functioning – asthma
improves liver functioning
improves and speeds up post-operative recovery
improves overall physical well-being
And then, if that’s still not enough for you, there are some other general benefits:
reduced number of “sick” days from work plus faster return to work if you were layed off
increased GPA in university students
improved sporting performance in athletes
Okay, so how does this all work? I mean, I understand how it can improve some of the mental health problems we may experience, because we’re writing about our thoughts and feelings. But how does it improve our physical health? Well, actually the two are related. Remember that stress has a HUGE impact on our physical health, and the mind and body are connecting, meaning that anxiety and depression can also feed into (and trauma can cause) physical health problems. The processes of expressive writing are as follows:
it allows for cognitive processing and restructuring of painful events and situations – cognitive restructuring changes how we perceive emotional stressors (both internal and external)
it allows for repeated exposure – which is controlled re-experiencing of events and situations so that they have less influence over our minds and behaviours
Improving our bodies, improves our minds and vice versa. Here’s the podcast episode on it.
How do we engage in expressive writing? According to the experts we need to write about our deepest thoughts and feelings, without holding back, about situations or events or really anything relevant to us at this moment that are painful. This could be anything from having cancer, to spending time in the hospital to going through a traumatic event. When we sit down to write, it should be for 15-20 minutes at time, without stopping, and be done on 4 consecutive days. Just doing that is enough to lead to all the benefits I listed earlier. It’s possible that more consistent writing could have more improvements, but I honestly didn’t find much on that. So, I’m curious, who’s going to try out some of this expressive writing to see if it helps?
I want to remind everyone that in addition to this blog, if you’re looking for more information to improve your health, I have a podcast: Chronically Living and how to make the most of it, which is available on Apple, Spotify and everywhere else you get podcasts, including this web link. I also have a YouTube channel for those of you looking to incorporate more mindfulness as it has a number of benefits for your physical and mental health as well: Kelsey L Harris Meditations. Until next week, keep making the most of it!
Baikie, K.A., & Wilhelm, . (2018). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338-346. https://doi.org/10.1192/apt.11.5.338 Lepore, S-J., Greenberg, M.A., Bruno, A., Smyth, J.M. (2002). Expressive writing and health: Self-regulation of emotion-related experience, physiology and behaviour. In S.J. Lepore & J.M. Smyth (Eds), The writing cure: How expressive writing promotes health and emotional well-being (p. 99-117). American Psychological Association. https://doi.org/10.1037/10451-005 Stanton, A.L., Danoff-burg, S., & Huggins, M.E. (2002). The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psycho-Oncology, 11(2), 93-102. https://doi.org/10.1002/pon.574
Guided can be very relaxing and many people find it helps with anxiety. It is also helps for regulating emotions in general. I recommend it for anyone who is also struggling with chronic illness, because of the overlap of anxiety with chronic illness. I want to note that this particular guided imagery is not one I wrote myself. I found it mixed in with some paperwork on a CBT group therapy course as a skill that therapists teach to clients. There are lots of other guided imageries out there and I hope to do more in the future.
My mom actually suggested I do a post on mental strength and I thought about it for a bit because I find that it is very similar to resilience, which I’m fairly certain I’ve posted about before. However, I did some research and found that while there are similarities there are differences as well and to be honest, both are pretty essential when you’re a chronic illness warrior and can increase positive mental health. I’m going to give you an overview of each concept and how they tie together and some ways that can help you increase them (many of which I have personal experience with) so that we can all grow stronger together in our own separate battles.
First, let’s define resilience. Resilience is our ability to respond positively and to adapt to negative, traumatic, and stressful events, in a way that is constructive. Now let’s define mental strength. Mental strength is our ability to effectively handle stressors and challenges in our lives the best we can despite the situation we find ourselves in. As you can see there are similarities, what I think the biggest difference in is that resilience occurs in the face of significantly impactful events such as trauma, whereas mental strength helps us with less significant (yet still impactful) stressors. We often hear of mental strength in regards to athletes and their ability to practice the same thing over and over. People who are mentally strong like adversity because it’s a challenge not a threat.
The great thing is that both resilience and mental strength can be learned! According to the American Psychological Association (APA), the thoughts, and behaviours involved in resilience can be learned. They state that what makes up resilience includes:
your ability to make “realistic plans” and accomplish them
self-confidence and self-esteem
problem-solving and communication skills
How does this apply to chronic illness? I see it as (1) making realistic plans is including limitations you do have because of your illness but not letting your illness limit you; (2) you can still have self-confidence and self-esteem with a chronic illness; (3) problem-solving and communication actually become more important when you have a chronic illness; and (4) emotion regulation is essential for everyone.
What are some ways we can build resilience? Let’s break each of these down further:
making realistic plans & accomplishing them: includes gaining skills (like going back to school or just learning something new in general); and taking action toward the goals you make for yourself while keeping a positive and hopeful outlook on your ability to accomplish them!
self-confidence and self-esteem: accepting change because nothing stays the same, including your illness; engaging in activities that help you learn more about yourself (try something new, be creative, get as active as you can, etc.); view yourself in a positive way (stop the negative self-talk and write down things you like about yourself); and of course, self-care!!!!
problem-solving and communication: setting goals for yourself; and making connections with friends, family and colleagues because support is important.
emotion regulation: controlled exposure (I would suggest with the help of a therapist); taking a realistic view of crisis situations (I like the phrase, “if that happened, then what would I do?”); and activities such as journaling, meditation and other spiritual practices can help with emotion regulation (I’ll probably do a longer post on emotion regulation at some other time).
So if that’s how we build resilience, what can we do to build mental strength? Turner (2017) states that the elements of mental strength include having a sense of control and purpose of your life and emotions; making a commitment by setting goals for yourself; challenging yourself when necessary; and having that self-confidence. Very similar to what we just talked about for resilience. I’ve got to say that I possess all of these, and I’m not sharing that to make anyone feel like they aren’t enough because they are currently not mentally strong. I’ve had times when I haven’t been strong, it takes a lot of work to get here. My point in sharing is that you can come from a place of anxiety and stress over your health condition and get to a point where you can deal with most things that come your way (I say most because no one can deal with everything perfectly). It just took me a few years of hard work to get here. Here are some ways you can develop your mental strength:
gratitude – write down 5 things every day that you are thankful for. I also recommend taking the free Science of Well-being course offered by Yale University. Here’s the link!
practice mindfulness – in whatever way you like. I prefer meditation and body scans, and throw in the occasional mindful walk.
act “as if” – this is an interesting concept developed by psychologist Alfred Adler. He stated we should act as if things are the way you want them to be (essentially you get to reauthor your life). This one is a bit more complicated and may also deserve its own post.
Before I wrap up this very long post, I want to share research by Pickering & Holliday (2010). They stated that “mental strength contributes to resilience processes and resilient behaviour.” So basically develop your mental strength and you’ll develop your resilience. I mean as we’ve seen there is a lot of overlap between the two so it totally makes sense!
Let me know what you think of mental strength and resilience! Comment on the post or shoot me a DM on Instagram (@janeversuspain). I would love to hear from my readers! For now, keep making the most of it!