Managing the Gratitude Imperative
As we approach the holiday season, the spirit of thankfulness has begun to fill the air. However, what do you do when you’re facing difficult times during a season such as this? Jennifer Kilkus Ph.D., ABPP discusses this topic in the following Psychology Today article.
View the full article here.
As the holiday season approaches, I am reminded of how often our experience of this time of year can be shaped by expectations. Cultural messaging is woven into the fabric of the holidays—we are encouraged to “give thanks,” practice positivity, and be “merry.” This can be helpful—in fact, research shows a strong relationship between gratitude and happiness. Grateful people report more frequent positive emotions, stronger relationships, and may be more likely to be optimistic about their circumstances.
Even with the benefits of cultivating gratitude, however, many of us may struggle to maintain this mindset during difficult times. Those navigating cancer during the holiday season have unique challenges. They are often trying to reconcile the physical and psychological effects of cancer, such as fear, fatigue, and sadness, alongside these expectations and directives about positivity and gratitude. For example, I often hear the phrase “I should be grateful to be alive” when I speak with people diagnosed with cancer. This is inevitably followed by a "but ..."
“… But it’s so hard to be positive when I feel so awful.”
“… But I’m also angry that this is happening to me.”
“… But I’m terrified that I’m going to go through all this and die anyway.”
Guilt, shame, and frustration are common when we’re unsure how to reconcile what may feel like completely opposite emotions. So how do we find a middle ground? Here are a few ideas borrowed from evidence-based therapies that provide guidance for navigating contradictory emotions.
Dialectics: Practicing “both/and”
One way to balance seemingly opposite emotions is to practice the concept of dialectics. A foundational component of the evidence-based psychotherapy dialectical behavior therapy (DBT), a “dialectic” refers to the process of integrating opposites. It focuses on the idea that two seemingly opposing ideas can be true at the same time. Working with a dialectic means we’re willing to step away from an “either/or” way of thinking toward something that is more flexible—“both/and.” It would look something like this:
“I am grateful for being alive and that there are treatments available to help me. I am also angry that they make me feel sick and get in the way of doing what I want to do.”
Both are equally legitimate emotions, even if on the surface they seem in conflict with one another.
Acceptance: Stop the struggle
Acceptance and commitment therapy, or ACT, relies on acceptance and mindfulness—or a “here and now” focus—as its foundation. A common strategy to manage painful or contradictory thoughts or emotions is trying to force ourselves to feel a particular way—we may feel compelled to “stuff down” our negative emotions or thoughts in favor of focusing on the positive. This, however, can be detrimental in the long term. Research has shown that denial or minimization of our emotions over time can have a rebound effect and may actually get more intense with efforts to get rid of them.
Using an ACT framework, we would practice taking a curious and accepting approach to thoughts and emotions to build greater tolerance to painful experiences. ACT also encourages evaluating our values. This can be helpful for managing complicated thoughts and emotions, particularly if they are in reaction to the values of others instead of our own.
With our “should, but” thought, an ACT approach would look like this:
Observing and describing our thoughts and emotions: “I’m feeling guilty for finding it hard to be grateful. Guilt feels like it lives in my gut—it’s hot and makes me feel nauseated.”
Noticing what our habitual reaction may be: “I just want to go to bed so I don’t have to think about this anymore.”
Practicing accepting of these thoughts and emotions compassionately, without judging, and without needing to do anything with them. We don’t need to get push them away or allow them to sweep us away: “It's OK for me to struggle now, this is a tough time. I can feel these feelings and still be OK.”
We can then decide what needs to happen next. Is there something actionable we can do that fits with our values? If not, we can practice letting the thought go and focusing our attention on something else occurring in the present.
Letting go of “shoulds”: Cognitive reframing:
When we’re upset, we often engage in types of thinking that are biased or unhelpful. This type of thinking often falls into patterns that psychologists label cognitive biases or thinking errors. Cognitive behavioral therapy, or CBT, uses cognitive reframing as a tool to help challenge or reframe negative thoughts. Cognitive reframing uses Socratic questioning as a way to help us identify errors in our thinking. For example:
Do I have any evidence to support this thought? Evidence that does not support it?
Am I seeing this as “all or nothing” when it’s more complicated than that?
Am I basing this thought on facts or feelings?
Is there any other way to look at this situation?
Using cognitive reframing, our “should, but” thought may start to shift:
“I do have evidence that others think I should feel grateful, as my aunt and my friend both told me that this week. While I am feeling grateful I am alive, I just don’t feel that way all the time.”
“I’m making it sound like I’m only allowed to feel one way about things. I don’t actually believe that. It’s OK to feel more than one thing at a time—this is a tough situation.”
“There aren’t really any facts that say I should feel one way or another. There is no rule that says I have to feel grateful during the holidays!”
You may notice that these different approaches share a lot in common: They are all meant to assist us in accepting our emotional experience and practicing a more flexible, balanced way of thinking. This time of year presents challenges for all of us, especially those living through an acute crisis like cancer. As we enter into this holiday season, I hope these skills can be a helpful start toward letting go of unhelpful expectations and allowing space for all of our emotions.