Getting a difficult medical diagnosis is challenging at best. Elizabeth Kubler Ross wrote extensively about the five stages of grief that accompanies the experience of loss. Although her work originally described the reaction to the death of a loved one, the same cycle applies to those experiencing health issues requiring surgical intervention.

Elizabeth Kubler Ross’s Five Stages of Grief:

• Denial: “This can’t be happening to me.”
• Anger: “Why is this happening? Who is to blame?”
• Bargaining: “Please God make this not happen and in return I will ____.”
• Depression: “I’m too sad or down to do anything.”
• Acceptance: “I’m at peace with what happened.”

This is a simplistic model of what any of us experience when we are struck with a tough reality that we need to integrate into our consciousness. The process of getting a difficult diagnosis or dealing with any loss issue is considerably messier and less predictable than the one Kubler Ross describes. Nevertheless all of these five stages appear eventually on the horizon of one’s experience.

Learning about a difficult medical diagnosis can be challenging, but like most things, being prepared makes the process a lot less daunting.

How to prepare for surgery and manage post-operatively:

• Keep a positive attitude. People who are facing surgery undoubtedly experience fear, worry and anxiety. Keeping a positive attitude can help lessen those emotions. Write a few affirmations pertaining to your surgery and repeat them often. Focus on a positive outcome. When your mind wanders away from a positive outcome, give it a gentle nudge back. Peggy Huddleston illuminates mind-body techniques that help patients mentally prepare for surgery and in turn, heal faster.

• Use meditation as an effective tool to mentally prepare for surgery and to handle difficult situations after surgery. When meditating focus your thoughts on breathing, calmness, and healing.

• Talk about your fears and apprehension with a relative or friend. Verbalizing your feelings can make a profound difference on your inner experience, even when nothing changes externally. A partner or friend you can talk with openly and honestly will diminish the intensity of complicated feelings around a surgery.

• Rely on your faith. If you are religious put your trust in God and leave the surgery in His/Her hands. Ask family members and friends to pray for you during the surgery and afterwards for a full and speedy recovery. Even if they do not share your religious beliefs you can still derive benefits from other’s prayers. Have faith in the surgeon’s ability as well as your body’s ability to heal.

• Consult with your physician regarding any concerns you have about your health condition or the surgery. He/she can answer any questions you may have and help to alleviate your fears. Your physician will understand your feelings and will be happy to reassure you in any way possible.

• Surround yourself with loving, supportive people. You may feel like keeping your upcoming surgery to yourself but it may actually be best to share the information with friends and co-workers. If they are aware of your health condition and surgery they will no doubt support, encourage you, and offer their assistance to help you and/or your family. Knowing that you have people who love and care for you can be the best preparation.

• Get informed. Learn everything you can about your health condition and the surgical procedure. Being informed is being prepared.

• Talk to other people that you trust who have had the same surgery. Glean from those conversations kernels of information that might be of value to you while keeping in mind that no two people experience a surgery in the same way.

What strategies do you employ to get through periods of grief and anxiety?

Physical activity has always been a saving grace for me. As a teenager I loved swimming in the summers and running along the beach with my dog whenever I could.

One day while meandering through the Brooklyn College bookstore I discovered a book on the practice of yoga. As I read that book, gleaning various breathing techniques and dynamic postures, something clicked. I learned to stretch and move through space while deepening my breath and gradually becoming more skilled at slowing down.

Growing up in NYC I knew that I needed to acquire some tools in harnessing my energy and exercising in a purposeful way. My yoga practice seemed to bridge the gap between exercise and mindfulness.

Over time, I alternated brisk walking with the occasional run. My body, in time, rebelled against anything but modest running but I remained faithful to walking. During the kinder New England weather I continue to swim and bike. Even when I skip days or occasionally weeks, I always manage my way back to exercising. I am grateful for having incorporated these physical activities into my life, as they have always served me well psychologically and physically.

The dilemma for me is not how do I motivate myself to work out, but rather what to do to boost my spirits if I cannot break a sweat and feel the multitude of benefits that I derive from movement.

Facing an injury has an emotional impact

Recently I suffered an injury for which I ended up needing surgery. Several months have elapsed since I have been able to do my usual routine, which I’ve come to rely upon for stabilizing my moods, energy, concentration and, dare I say, sense of self. Physical exercise puts so many things into perspective for me, that it is hard to identify all the ways I have recently been blindsided due to my lack of activity.

The question is what does one do, when there is an injury, surgery or disability and when one cannot resort to the powerful benefits of this elixir.

“No exercise,” the doctor ordered. This did not completely sink in until after the surgery. “We’ll see how things go in a few weeks.” My heart sank. At first I thought I’d just stay in bed, write when possible, and in a week I would get back to my routine. Toughing out the depravation of those “feel good chemicals” (serotonin, dopamine and epinephrine) through lack of exercise wouldn’t be that challenging. I quickly learned that the healing process would take longer than anticipated and that I needed help.

7 important lessons for feeling good when you’re unable to exercise.

1. When you are injured and/or bedridden, ask friends for help, especially from the ones that make you laugh and feel good. Laughter and good energy from friends releases those feel good chemicals.
2. Allow your wonderful friends and neighbors to help with meals. I don’t like to ask for help, but I’ve learned it vastly beats the alternative. When you ask you not only get the help needed, but it is generally fun. The giver and the receiver both benefit.
3. Remind yourself to say and repeat affirmations, because whatever you are going through will improve and you will feel better with a positive mental attitude.
4. Watch movies that make you feel good and laugh. Laughter also boosts your immune system and will help you to heal faster.
5. Write in a gratitude journal all the things in your day that you appreciate. This will keep you out of the darker place of feeling sorry for yourself, especially while you can’t work out, blow off steam and are dependent on others.
6. Several minutes of meditation 1-2x day will help you to relax and put things into perspective. Sometimes an injury and being laid up give you the opportunity to rethink priorities.
7. Allow your body to relax, rest and sleep. You’ll heal faster and feel more charged when the time is right for a gradual transition back into physical activity. In other words, do everything you can to honor your body, mind, spirit and friendships during the healing process.

What do you do to manage most successfully during those times when you can not exercise?

“Mindful” exercise, walks or workouts are flow activities. They create a shift in consciousness through physical activity. Think of physical activity not just as a way to stay fit or look better, but as a sacred time for you to devote away from the pressures of everyday life. Your body needs to be exercised and your mind and spirit need to be rejuvenated – all of which can be accomplished in taking a mindful walk, yoga or Pilates class, a bike ride, swim, dance class or a multitude of other forms of exercise.

Getting yourself set to be fully present in your work out brings added value to the experience. Perhaps a moment or two of abdominal breathing first can help you to change gears and become more aligned with the physical activity you are about to undertake. For example watching the rise and fall of the breath for a couple of minutes before exercise gets you more in the mood and probably allows for a more efficient and fulfilling workout.

Even a brief meditation (2-3-minutes) can have a significant impact on moving you away from the stress of everyday life and more into the zone of getting an optimal workout.

Similarly saying an affirmation before working out can also foster a shift in perspective and allows for an experience that is more deeply engaging. Saying a positive self-statement helps align the mind, body and spirit in the exercise. An example of an affirmation about yourself and what is to come might be, “I feel fully in my body and am going to have a great workout.” Then visualize yourself in that way for a moment before engaging in your workout. Notice the results.

In other posts I have discussed the positive benefits of meditation and abdominal breathing and affirmations in the psychological, physical and spiritual domains. When you bring these mindfulness tools and combine them with exercise the effects can be multiplicative.

How might you enhance the effects of your next workout?

Did you know that April has been designated as National Stress Awareness Month? Most Americans feel stress in their everyday lives but do not pay much attention to its consequences. The impact plays havoc with our minds, bodies, relationships and overall health and well-being.

Health care professionals across the country annually come together to increase public awareness about the symptoms, causes and cures for our modern stress epidemic. The Health Resource Network (HRN) sponsors this national, cooperative effort to inform people about the dangers of stress and the strategies for developing greater resilience.

Some symptoms of stress:

• Anxiety
• Knot in the throat
• Stomach cramps
• Headaches
• Compulsive eating
• Irritability
• Anger
• Increased smoking or drinking
• Social withdrawal

Stress is a guarantee in our lives. Your reaction to stress is what makes the difference between health and disease. Training your brain and body to react to disappointment, loss and frustration in a resilient way creates a more balanced and happier existence.

Resilience is the ability to self-nurture, self-soothe, self-regulate. For some this ability comes naturally. The rest of us need to cultivate the skill of resiliency.

Some of the most potent ways to manage stress more effectively include:

• Abdominal breathing
• Meditation
• Self-hypnosis
• Getting together with supportive friends and family
• Exercise and healthy diet

The resilient person learns how to tolerate difficult emotions and reframes situations in a positive perspective. For example, “Since I lost my job during a difficult economy, this is my opportunity to work for myself which has always been my dream.” Or “Getting divorced and splitting up my family tears me apart, but this is my opportunity to find a loving relationship and get more of my needs met.”

For less daunting situations, resilience means while stuck in traffic, rather than getting agitated, deciding to listen to music, listen to books on tape, or just go with the flow and take the time to breathe deeply. These are all choices you make throughout your daily existence.

I challenge you to raise your stress awareness and bring more balance, happiness and peace of mind into your world this month.

What will you choose to do this month to lower your stress?

The resilient woman embodies a tenacious spirit and embraces life in the face of trauma, losses and transitions. She lives a courageous life with a vision of purpose, meaning and fulfillment.

The inspiring and fearless photojournalist, Margaret Moth, who recently succumbed to cancer, embodied the spirit of a resilient woman. Pictured here with her camera, Moth embraced adventure and making a difference in the world.

How does one develop the capacity to become resilient when it does not come naturally? Most of us need to learn certain skills and strategies to develop resiliency.

“Our greatest glory is not in never falling, but in rising every time we fall.” ~Confucius

The 10 Keys to Developing Resiliency

1. Build relationships and connections with supportive friends and family members. This contributes profoundly to our capacity for resilience.
2. Engage in activities that give you a sense of purpose and meaning. Having something to focus on outside of yourself enhances your well-being.
3. Practice mindfulness exercises such as abdominal breathing, meditation, constructive rest or self-hypnosis.
4. Take care of yourself physically. Eat a clean diet, exercise regularly and get at least seven hours of sleep. It’s difficult to be resilient when basic needs are not being met.
5. Strengthen your ability to be optimistic by looking for something each day that signals a good outcome. Train your brain to expect positive results.
6. Keep a gratitude journal so that you can track all the elements of your day for which you can be grateful. It does not have to be anything major. A pleasant walk, a good conversation with a friend, a delicious cup of coffee are all examples of life’s pleasures for which we can be grateful. The gratitude journal helps develop a more positive perspective and greater resilience.
7. Be proactive. Rather than hoping and praying that things will change, every day take some steps towards initiating that change. Feeling a daily sense of accomplishment helps us to feel more empowered and able to influence the events of our lives.
8. Maintain perspective. Keep the big picture in mind when things don’t work out according to plan. Resilient people know to expect the unexpected. You just need to remember that setbacks will happen and your job is to keep pushing forward.
9. Add fun and laughter into your everyday life. If it is difficult to find the humor in the context of certain losses or challenges, then look elsewhere to find some comic relief. Humor helps to deepen our capacity for resilience.
10. Engage in flow activities. Flow activities are projects or interests that occupy the mind in such a deep way that we lose track of time. Writing, dancing, yoga, gardening, spending time with friends are all great examples of flow activities.

Developing resilience looks like a full time job, yet most of these suggestions can be incorporated throughout the day and need not be time-consuming. Developing resiliency is a way of changing one’s mindset or looking at life from a slightly different lens.

How is your resilience? What are one or two things you can do to boost your ability to roll with the punches?

“I’m such a loser.” “I look fat.” “Why do I always say so many stupid things?” Lisa repeatedly put herself down and reported feeling increasingly despondent when things went wrong. For years she thought of her life in the most negative light and, not surprisingly, was becoming increasingly anxious.

Lisa judged herself harshly for her parenting skills, saying she was a terrible mother especially when conflicts arose with her teenage son. Social situations were also challenging and Lisa often berated herself afterward.

When Lisa came to therapy, we talked about the roots of this self-defeating behavior. Lisa needed to learn how to self-regulate, quiet her critical inner voice when negative thoughts began to intrude and develop the ability to think more positively.

Lisa tried meditation on several occasions but this technique did not suit her well. She desired a skill that felt more active and goal directed. She clearly wanted to work on changing specific behaviors.

Self-Hypnosis as a Solution

Many of us make negative suggestions to ourselves consciously and unconsciously throughout the day. Self-hypnosis involves programming the mind with positive thoughts and suggestions that, when practiced regularly, train us to perceive ourselves in a more favorable way. This can reduce feelings of inadequacy and anxiety as well as promote feelings of relaxation, self-esteem, and self-control.

Self-hypnosis typically uses affirmations or simple positive statements. For example “I am a competent woman and I can handle this.” This statement repeated throughout the day is a powerful affirmation. When used as part of the self-hypnosis technique described below, the mind is even more receptive to such suggestions as it is in more of a trance-like state. Affirmations and self-hypnosis both build a positive outlook.

While a self-induced hypnotic state may not be quite as deep as being hypnotized by someone else, it does allow you to remain in control so that you continue making relevant suggestions to yourself and shaping your behavior.

The Technique of Self-Hypnosis

• Hypnotizing yourself requires only that you have a private environment, at least in the earliest learning stages. Once you become familiar with this method, it can be practiced just about anywhere and anytime.
• Think about a behavior that you would like to change. Create a simple and positive statement about this change. It helps to write it down.
• Eliminate distractions.
• Sit in a comfortable chair and relax.
• Close your eyes and allow your entire body to sink into the chair.
• Count down slowly from 5-4-3-2-1. When you count down, relax your mind and body more deeply. Relax yourself from the top of your head to your feet.
• Feel the full weight of your body being supported by the chair.
• Now repeat the simple, positive statement you created at the beginning of this exercise and slowly repeat it to yourself.
• Involve all of your senses as you imagine yourself in this positive way.
• Spend a few minutes in this deepened state.
• When you are ready, count up from 1-2-3-4-5 feeling more relaxed, refreshed and revitalized than before you began the technique. You might want to repeat those or similar words to help you to ease out of this state of mind.
• Notice how you are feeling. With practice you will become more proficient at eliciting a relaxation response and internalizing these positive suggestions.

While it might be difficult to eradicate negative thoughts completely, we do have the power to create a greater repertoire of positive messages which will become internalized with practice over time.

I recommended self-hypnosis to Lisa as a way of dealing with her negative self-talk. Lisa resonated with this exercise and now practices it regularly. Self-hypnosis continues to help the relationship with her son, in social situations, and most importantly, with her own private thoughts.

Think of a simple, positive statement regarding something you want to change about yourself. Please share your experiences with self-hypnosis.

How to create the practice of mindful walking:

1. Pay attention to standing on both feet
2. Notice the contact your feet are making with the ground.
3. Take a few abdominal breaths.
4. Begin walking slowly with awareness.
5. Observe the action of the feet as they move and connect with the ground.
6. Think about ‘heel’ and ‘toe’ or ’stepping’ and ‘placing down’ as you transfer your weight through each step.

Mindful walking works particularly well for those who find it difficult to sit and meditate. The benefits are comparable. Like the sitting meditation, this technique helps develop heightened awareness, suppleness of the mind, and a greater sense of well-being. Choose a safe, ideally uncrowded place of natural beauty.

Practice several times daily

Abdominal breathing, meditation, mindful walking, constructive rest and building friendships are some of my favorite behavioral strategies for balance and happiness. Click on any of the titles listed at the bottom of this page and learn how to create these practices for yourself.

Abdominal breathing is useful anytime and can be practiced in a concentrated way (5-10 minutes once or twice daily) or whenever it comes to mind. The kind of deep breathing always helps with initiating a feeling of relaxation and a greater capacity to be in the present moment.

Meditation is an extremely effective way to develop a sense of calm, clarity and creativity. There are also a wide range of psychological and physical benefits that result from the regular practice of meditation.

Mindful walking is an alternative meditation practice for those that find the sitting  difficult. It provides almost all of the same benefits physically an psychologically as the sitting meditation. Both techniques can be used interchangeably.

Constructive rest is an antigravity position that is great for practicing the abdominal breathing. In this position diaphragmatic breathing comes easily. You can also easily observe the ‘rise’ and ‘fall’ of the low belly as you breathe.

Building friendships and enhancing intimacy in relationships is vital to our sense of well-being and self-esteem. It’s also been shown repeatedly in the research that having good relationships helps us to live healthier, longer and happier lives. Improving communication skills and making the conscious decision to improve connections with others is guaranteed to have a significant impact on the quality of your life.

Physical Activity meaning any activity that requires physical effort sustained for 10 minutes or more, to improve strength, flexibility and endurance for overall health and fitness.

1. Abdominal Breathing
2. Building Friendships
3. Constructive Rest
4. Meditation
5. Mindful Walking
6. Enhancing Intimacy in Relationships
7. Physical Activity
   

How to create the practice of meditation:

1. Sit in a comfortable position with good support
2. Find a quiet environment
3. Close your eyes and relax your body
4. Watch the rise and fall of each breath
5. Repeat the word ʻinʼ as you breathe in
6. Repeat the word ʻoutʼ as you breathe out
7. Continue to bring your focus back to the breath
8. Maintain a passive attitude about intruding thoughts

Practice 2x daily for 10–15 minutes

Wendy juggles the single parenting of two teenage children, her part-time interior design business, and tries desperately to stick to her exercise routine. She feels frazzled and irritable most of the time. She shies away from connecting with friends as there are simply not enough hours in her day to manage her most immediate commitments. Everyday she wakes up feeling like she is racing to beat the clock.

I suggested to Wendy during the course of one of our meetings that she meditate for a few minutes twice a day, once in the morning and then again before the kids come home from school. I knew this sounded counter-intuitive and yet I thought it needed to be said. Scrambling from one activity to the next and multitasking not only feels daunting, but it is also not particularly productive.

Not surprisingly Wendy felt like sitting still and meditating for a few minutes a day would increase her anxiety about everything she needed to do. Her resistance finally gave way when I told her I thought she would get more done, more effectively and feel better if she incorporated this practice into her everyday life. I encouraged her to meditate for five minutes twice a day as an experiment for the next two weeks.

Meditation is one of the most effective strategies women can learn to slow down and be in the present moment. The research has repeatedly shown that meditating even for brief periods of time helps to: lower heart rate, lower blood pressure, improve the immune system, make more efficient use of oxygen, improve concentration, decrease anxiety and depression, heighten sense of well-being, develop mindfulness and awareness.

Meditation also helps with the management of chronic pain, cancer, gastrointestinal disorders, insomnia, menopause, and a wide array of illnesses and diseases. Meditation most importantly develops one’s ability to experience everyday life on a moment to moment basis.

Learning and practicing a simple meditation technique can dramatically improve one’s health across the mind/body health spectrum.

When you have a sense of control over your own physical and psychological states, you become freed up to participate more fully and consciously in your relationships – with friends, partners, colleagues, children.

Meditation contributes to creating more fulfilling and successful relationships. Being mindful and aware, makes it easier to listen, talk, and connect more thoughtfully and authentically. Meditation also helps you to gain compassion and insights into your relationships.

Wendy did indeed practice the meditation. Consistency was not her strong suit, but she did practice at least one a day and noticed feeling calmer, more in control, less angry and more productive. She even managed to fit in a latte with a girlfriend. Pretty good results for less than ten minutes a day of sitting still!

Click here for my prescription on meditation.

Comment back to me. What’s your experience with meditation?