Navigating periods of transitions

Autumn, in particular September, is a time of transition in many ways. For some it signifies changes in academic school years, with increased expectations when it comes to exams or homework assignments.  It can highlight a significant move from primary to secondary school or a life change like going to university, starting a new job or searching for a path in the ‘adult’ world. Transitions can occur in many different aspects of life, at any point, and they can feel novel, exciting and thrilling!

Interestingly, the physical sensations associated with excitement like a racing heart, tingling sensations in the body, feeling a warm buzz, getting a dry mouth or feeling light-headed (or ‘dizzy with excitement’) are also very similar to those physical sensations associated with anxiety and fear – the key difference between these sensations is simply how we understand and interpret these symptoms differently, depending on the context and the thoughts/ beliefs we have about them. Yes, going through transitions and big life changes can be exciting! However, such changes can also trigger a mixture of confusing and unpleasant emotions or, in some cases, an absence of feelings where people become ‘numb’ as a way of coping with the confusion and discomfort of change.

The common ‘unpleasant’ reactions to transitions and big life changes

Physical reactions	• Panic attacks • Unexplained chest pains • Headaches • Dizziness • Nightmares/ trouble sleeping due to troubling thoughts • Nausea • Constipation, diarrhoea or unusual changes in bowel movements • Fainting • Unusual aches/ pains/muscle tension • Frequent illness
Emotional reactions	• Intense and persistent worries and fears (eg, not being able to “switch off” from thoughts about the future and what is to come, about past choices, about social pressures and the demand to meet expectations from others or from ourselves). • Irritability and feeling easily frustrated. • Unusual and frequent feelings of low mood and sadness. • Not feeling interested or excited about activities or interests that would usually excite and interest.
Behavioural reactions	• Troubles with memory and/or concentrating • Over/under-eating • Difficulties with decision-making • Not taking care of appearance • Not doing usual activities or interests • Increased loneliness/ isolation • Unusual smoking, drinking or other substance use • Frequent tearfulness and crying • Increased avoidance or procrastination • Increased restlessness • Frequent arguments

There are various triggers for these confusing and unpleasant emotions. For instance, the pressures and demands that can occur during times of transition can affect people in different ways. Whilst we all have demands on us all of the time, it is when these demands and pressures become overwhelming that problems can arise. Academic stress or worry about performance at school or in work is very common with some reports of between 6-10 million school-children experiencing this every year (Barker 1987). Similarly, as many as 440,000 people in the UK report complaints of work-related stress, depression or anxiety that makes them ill (Heath and Safety Executive Statistics, 2015). Social comparisons can also be a source of stress or worry, particularly where an individual might worry about being perceived as different or ‘less able’ than their friends, peers or colleagues as is common when people have physical health and/ or emotional health challenges.

If you have a long-term physical health condition like thalassaemia, there can be additional challenges that come with transitions into new environments (whether this is a new place of employment or study).  These may include making decisions about whether or not to disclose, talk about or get support with studying or working.

Various styles of coping can result from these triggers and emotions. These include behaviours like pushing oneself so hard that self-care and self-management of health conditions like thalassaemia fall by the wayside. Other behaviours include extreme avoidance of situations that can be anxiety-provoking or patterns of ruminative thinking where people go over and over worries or thoughts about upsetting situations in their minds.

If you are going through these changes or you are noticing your child, friend or relative is becoming very anxious, low, withdrawn or they are worrying a lot about changes they might be going through, then ask them if they would like help and support with this. Consider the following tips and options to help or signpost you (or the person in need) to get help with understanding and navigating through any confusing or unpleasant feelings. These support options may also help to overcome any fears, worries or other emotional challenges:

• • Remember ‘panta rhei’, everything flows and change is inevitable. It can be a good change or a bad change and how you cope with the change is the most important thing.

• • Try dealing with one thing at a time. Trying to tackle too many changes or demands at any one time is never a good idea. Try to schedule and plan your time and activities to allow you to cope better with each individual change or challenge. It’s like when you are at school and you are asked to write an essay, you’re often encouraged to start with an essay plan to help you think about where to start and to help you structure your essay well and complete it in good time. Do the same where you can with life’s challenges and any big changes you are going through. Try to focus on one change at a time.

• • Wherever possible, give yourself some time and space away from pressures and demands – don’t avoid them completely but have a healthy break away from them. This could be as little as a break of 5-minutes doing something fun, a calming or relaxing activity or something that distracts away from pressures and demands. You may need help to have a break so if there are people around you who can help you to do this then ask them to help you have a break! Here is a resource about living life with a long-term condition that is available via the NHS Moodzone website: https://llttf.com/home/long-term-conditions/reclaim-your-life/

• • Consider using some of the following online resources to help manage any troubling or unpleasant thoughts and feelings. There are many mobile phone applications and websites that focus on helping you to stay in the present moment and avoid getting caught up in unpleasant thoughts like Headspace or Calm . There are also online therapy and support services for people who find it too hard to fit going to face-to-face appointments into their time, such as IESO digital online therapies or online community forums where you can share your thoughts and feelings with others who might be feeling the same like Big White Wall. Please note that some of these resources may only be available in certain locations and the mobile applications mentioned offer free trials, although some sections of these platforms require further subscriptions or payments for full access.
    

• • Regular exercise or physical activity can help with stress, worry or unpleasant feelings or thoughts. This does not have to mean going to the gym or working out in ways that are intense. Ask your GP or healthcare professional about what is a safe level of exercise for you. For most people, some form or regular physical activity done at home, outside or in a sports facility can help. There is evidence to suggest that physical activity can release chemicals in your brain that tap into positive feelings such as happiness and can help people to feel energised. See this NHS wellbeing guide for more information about the benefits of exercise and how to get started: https://www.nhs.uk/conditions/stress-anxiety-depression/mental-benefits-of-exercise/

• • Talk to schools, colleges or universities about ‘pastoral support’ or student counselling services. Ask employers if they have an employee assistance programmes (EAP). For specific advice and support about disclosing your condition consider talking to:
    • Remploy
    • Employment support programmes via Department of Work and Pensions job centres or via improving access to psychological therapies (IAPT) services (see below for more about how to access IAPT)
    • Citizen’s Advice Bureau

• • Talk to a GP about any further forms of support.

• • Talk to your haematology team for help with managing life changes or transitions.

• • Ask for a referral to a haematology psychologist if this is available in your hospital.

• • Consider a self-referral to an NHS improving access to psychological therapies (IAPT) service: Mental Health Services

• • Consider private psychological therapy options (if it is financially viable for you). When searching, always look for therapists who have been accredited by a recognised therapy association or organisation. In the UK the following websites host accredited therapists:
    • British association for behavioural and cognitive psychotherapies.
    • British association for counselling and psychotherapy.
    • Association for family therapy
    • If you are not sure if a private therapist is accredited in the UK, you can search the national health and care professions council register here.

Contact UKTS to ask about support options and advice.