TOP TAKE-AWAY: Adaptive and Maladaptive Coping Strategies

When confronted with a traumatic event such as a pregnancy loss, it is common for those affected to use a wide array of coping strategies. They may gravitate toward behaviors that bring them comfort and/or temporary relief. These strategies may prove helpful in accepting what has happened to them or may worsen their grief.

Some coping strategies are considered adaptive coping strategies. These strategies may also be called positive or healthy coping, because they are helpful in leading to less long-term grief. 

1. Acceptance - It can be difficult to acknowledge pregnancy loss and accept the pain that may come with it. However, once the loss has been accepted, it can be easier to express feelings to loved ones and make connections to others who experienced similar situations. 

2. Humor - One way to move toward acceptance of the loss may be through humor. It may allow a woman to accept her experience and reframe it in order to see it in a more positive light.

3. Religion - Another way to move toward acceptance of the loss may be through religion, which may afford women the opportunity to use their faith to find a meaning for and explanation of what has happened. 

Unfortunately, other coping behaviors are not as healthy and may result in increasing grief. These behaviors prevent women from accepting the loss and may prolong their grief.

1. Avoidance - During traumatic experiences such as pregnancy loss, it may be helpful at first to not fully process the pain that may come with the loss event. However, if a woman continues to reject what has occurred, it can extend or increase grief.
   
   

2. Self-blame - Some women may try to find an explanation or meaning for their pregnancy loss.  During this process, they may find themselves blaming the choices they have made. Sadly, this can lead to women questioning if they made the wrong choice during the pregnancy and dwelling on it, which prevents them from moving forward.

3. Denial - For other women, it may be helpful to try to prevent themselves from feeling the hurt, pain, and/or devastation that can come with pregnancy loss. However, when women deny their experiences, especially to themselves, they are not allowing themselves to grieve nor to accept the situation that has occurred.

In turn, avoidance, self-blame and denial may hinder a woman’s healing and result in more intense grief.

It is helpful to distinguish between positive and negative coping strategies. 

Recognizing which coping strategies lead to better outcomes may be the first step on the path of a positive healing journey.

Nazaré, B., Fonseca, A., & Canavarro, M. C. (2013). Adaptive and maladaptive grief responses following TOPFA: Actor and partner effects of coping strategies. Journal of Reproductive and Infant Psychology, 31(3), 257–273. https://doi-org.holyfamily.idm.oclc.org/10.1080/02646838.2013.80678

SAY HELLO TO OUR FALL INTERNS!

Say hello to our fall interns! Maria Diaz (left) a senior Psychology Major with two minors in Mental Health Services and Childhood Studies. She will be graduating from Holy Family University in May.  

Ciara Pembroke (right) is also a senior Psychology major who will be graduating from Holy Family this May. She is interested in psychological research, especially work related to mental health and therapy.

We are so excited to have these two, wildly talented students on our team!

TOP TAKE-AWAY: Acknowledging Men’s Response to Pregnancy Loss

The impact on fathers is often overlooked in pregnancy loss. Men’s grief may be missed or ignored by healthcare workers, counselors, family members, and even their spouse. The experience can be as intensely upsetting for men as it is for women. Both partners may experience feelings such as shock, grief, anger, and frustration. This can be compounded by men not outwardly expressing their grief, which can lead others to not fully understand the true feelings men have about their experiences. In turn, this may lead to more emotional turmoil later on. 

There are a variety of reasons why men may not feel comfortable expressing their emotions following pregnancy loss. 

1. They may feel that in order to properly support their partner, they need to minimize their own feelings. 

2. Some might feel that they need to move on from the experience, or they may try to avoid their feelings about the experience by working more or turning to drinking or drugs.

3. Some may even engage in aggressive behaviors, funneling all their emotions of grief and loss into anger. 

There are some ways in which men who have gone through a pregnancy loss can be helped to express their feelings in a healthy way. 

1. For one thing, men should be encouraged to express and explore their emotions about the pregnancy loss as soon as possible, along with women. 

2. If women are offered counseling by healthcare workers, men should be encouraged to join and participate. If they do not feel comfortable participating, it may still be beneficial to recommend one-on-one counseling or therapy for them to start the process of acknowledging their grief. 

3. Education may also be an important part of support and emotional expression. Teaching men about socialization and how depression can be masked by other emotions may help them to understand their feelings and behaviors in a more open way. Simply helping these men to recognize and understand their grief and trauma in a healthy way will help them to be more open and comfortable about expressing their emotions and healing from loss.

Rinehart, M. S. & Kiselica, M. S. (2010). Helping men with the trauma of miscarriage. Psychotherapy: Theory, Research, Practice, Training, 47(3), 288-295. https://doi-org.holyfamily.idm.oclc.org/10.1037/a0021160

TOP TAKE-AWAY: Cognitive Behavioral Therapy (CBT) Strategies for Healing After Loss

The trauma experienced after a miscarriage can be overwhelming. Some women may develop distressing thoughts about themselves and their lives, or isolate themselves, pushing away family members and friends. One form of treatment that may be helpful is cognitive behavioral therapy, or CBT. This form of psychotherapy focuses on a client’s thoughts and behaviors, which can help women heal from their loss in a more effective way. For women who have experienced pregnancy loss, there are three effective strategies used in CBT that can be beneficial: behavioral activation, cognitive restructuring, and mindfulness and acceptance. 

Behavioral activation involves engaging in meaningful and enjoyable activities that provide a sense of accomplishment. Women who have experienced pregnancy loss may sometimes isolate themselves, often for fear of having to share the news of their loss. However, by isolating themselves, women may miss the positive social support that comes from interacting with others. In CBT, behavioral activation starts small, with activities that require no planning, before moving on to more complex and value-driven activities. Some of these activities might include traveling to visit family, or volunteering for a cause they are passionate about.

Cognitive restructuring for women who have experienced pregnancy loss involves identifying the thoughts and beliefs that these women have, evaluating their accuracy and usefulness, and modifying them to be more balanced and helpful. These women often have beliefs about themselves and their lives that cause emotional distress, such as the belief that they will never be a mother, or that they are to blame for their pregnancy loss. Cognitive restructuring involves asking questions about these beliefs to help women tease through the accuracy and helpfulness of such beliefs. For example, women may be asked to examine a situation where they felt they were judged by someone for their pregnancy loss, consider the other explanations for their behaviors, and decide for themselves what beliefs are more compassionate and balanced.

Mindfulness and acceptance is also an important factor for women who have experienced pregnancy loss. Women with pregnancy loss will often try to avoid their negative emotions or painful experiences. CBT asks these women to learn to accept their emotions, no matter how painful, and show them that they can still lead a quality life even with those feelings. By focusing on being mindful in the present, these women get out of “autopilot” and can catch the subtle changes or triggers that lead to their emotions. 

All three of these strategies are useful in some way to help women who have experienced pregnancy loss to accept their situation, address their emotional distress, and begin to participate in their lives again.

Wenzel, A. (2017). Cognitive behavioral therapy for pregnancy loss. Psychotherapy, 54(4), 400-405. https://doi.org/10.1037/pst0000132

TOP TAKE-AWAY: The Importance of Validation from Healthcare Professionals: Three Strategies for Engagement

Every woman has a unique reproductive journey, successful or otherwise.  When a pregnancy loss occurs, it is important for women to have their feelings validated by those around them, including their healthcare providers.  In many cases, healthcare professionals get it right -- they validate a woman’s experience and are sensitive to the wide range of emotions that can be triggered by a loss.  However, in some cases, healthcare professionals fail to recognize that not all women experience pregnancy loss in the same way.  Women's experiences with loss and grief are complex and not solely related to how long they were pregnant.  Because of this, it may be possible for a healthcare professional to underestimate the significant emotional trauma a woman may experience with an early loss.  Healthcare professionals serve as authority figures whose reactions can affect how women may view their own loss. Thus, it is important that they validate the full range of emotions that women may experience.  

A few ways to ensure women have their feelings validated include:

1. Treating her experience with sensitivity - This is a difficult situation for any woman and it is important to approach her with consideration and sensitivity.
   
   

2. Focusing on her perspective and feelings - However a woman views her pregnancy loss, she needs to feel as though her response is valid and justified and she has every right to feel how she does. The healthcare provider may not share the same view of the situation as the woman, but they must work to keep the focus on the woman’s individual perspective.
   
   

3. Allowing her to lead the conversation - It is essential to allow the patient to lead the conversation. This may feel counterintuitive, because healthcare providers have a lot of expert knowledge that they may want to share. However, it may be helpful to let the woman focus on what aspect of her experience she wants more information about, let her express how she feels, and let her be the one to ask the questions she wants answered. This allows the healthcare provider to tailor the information disseminated to what she needs and/or wants to hear.

When healthcare professionals take the time to take these steps, it can allow women to feel heard, understood, and strengthened.  As a result, this allows women who experienced pregnancy loss to tell their stories instead of feeling shame and guilt. Each woman has her own reproductive story, and as a result each woman deserves her story to be validated in order to feel comfortable enough to share it with others.

Corbet-Owen, C., & Kruger, L.-M. (2001). The health system and emotional care: Validating the many meanings of spontaneous pregnancy loss. Families, Systems, & Health, 19(4), 411–427. https://doi-org.holyfamily.idm.oclc.org/10.1037/h0089469

TOP TAKE-AWAY: PSYCHOTHERAPY: A TREATMENT FOR WOMEN AND THEIR PARTNERS WHO HAVE EXPERIENCED REPRODUCTIVE TRAUMA

Women who have experienced reproductive trauma struggle with having to go on with everyday life after their tremendous loss. They may find it extremely difficult to deal with their loss. They may also struggle with how their partner grieves and copes differently from them, which can cause problems in their relationship. Although pregnancy loss may be very difficult to get through, there is hope. One treatment that can help women and their partners to cope with their loss and strengthen their relationship is psychotherapy. Psychotherapy helps individuals change their behaviors and overcome problems that they face daily.

Every woman has her own unique reproductive story. I am sure at some point in your childhood, you played house pretending to be a mother, tucked your favorite stuffed animal into bed, or had your own baby doll that you took care of like it was your child. Most women have fantasized about their future as mothers; being able to nurture a happy and healthy baby. If a reproductive loss occurs, it can be extremely overwhelming and painful, causing women to realize how their reproductive stories have been in place for most of their lives.

TOP TAKE-AWAY: MANAGING FEELINGS AND EMOTIONS IN PREGNANCIES FOLLOWING LOSS

It is widely assumed that when a woman who has experienced a miscarriage becomes pregnant again, everything will be fine, but that is not always the case. Women must be able to resolve the trauma associated with their prior miscarriage(s) in order to fully engage in their new pregnancy. This article discussed five common strategies women who have experienced pregnancy loss often use to manage their emotions in subsequent pregnancies.

TOP TAKE-AWAY: GUIDELINES FOR DEALING WITH PREGNANCY LOSS IN THE EMERGENCY DEPARTMENT

Many women who have experienced pregnancy loss often state that nurses, doctors and other medical professionals appear insensitive or uninformed when it comes to discussing their pregnancy loss. It has been established in the research that how women are treated by medical professionals can significantly impact their grieving process. Therefore, it is important that women and their families experiencing pregnancy loss are receiving proper support, care and information from their medical team.