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Transitional Changes

- Some Origins of Anxiety

Anxiety and feelings of stress are symptoms, a response to pressure, the more intolerable or persistent the pressure, the worse the anxiety.  And this does not necessarily mean a single, overwhelming difficulty.  More often it is an accumulation of things.  This cumulative side of anxiety is well documented in Barrie Hopson’s work on transitions, which he has related to the Holmes and Rahe Social Readjustment Rating Scale (Griffiths 1981).  This information is nowhere near as daunting as it might sound.  It can be a particularly useful and comforting piece of knowledge.  It shows, in easily understood terms, how all manner of changes – many of which the majority of us might barely accepts as changes at all – and an accumulation of such changes, can have a profound effect on our lives.

Drs. Holmes and Rahe found that the adjustment that an individual needed to deal with various changes was remarkably consistent from culture to culture around the world, and they gave mean values to a whole range of these (see the abbreviated list below).

They found that illness or a change in health were likely if certain totals were met during a one - year period.  These were; 0 - 149 no significant change likely; 150 - 199 mild stress and a 35% chance of illness; 200 - 299, moderate stress and a 50% chance of illness; 300+, major stress and an 80% chance of illness.  It is estimated that it takes a year to replenish the energy expended in adjusting to any of the changes described below.

These are the scale ratings that apply most:

  • Death of a spouse - 100
  • Divorce - 73
  • Marital separation - 65
  • Death of a close family member - 63
  • Major personal injury or illness - 53
  • Marriage - 50
  • Marital reconciliation - 45
  • Retirement - 45
  • Major change in health or behaviour of a family member - 44
  • Pregnancy - 40
  • Sexual difficulties - 39
  • Gaining a new family member   (birth, adoption, relative moving in) - 39
  • Major change in financial status (lot better, or worse, off) - 38
  • Death of a close friend - 37
  • Changing to different kind of work - 36
  • Major changes in number of arguments with spouse (lot more or lot less) - 38
  • Taking out a mortgage - 31
  • Major changes in work responsibilities - 29
  • Son or daughter leaving home - 29
  • Trouble with in-laws - 29
  • Major change in living conditions (building or remodelling home or deterioration of home or neighbourhood) - 25
  • Change in residence - 20
  • Major change in type or amount of recreation - 19
  • Taking out a loan - 17
  • Major change in sleeping habits (more or less or different times) - 16
  • Major change in number of family get - togethers (more or less) - 15
  • Holiday - 13
  • Christmas - 12

This doesn’t mean that we are then ‘entitled’ to be in deep grief or depression.  It certainly does not present an excuse for the recurrence of an inability to cope, but it does give reasons for anxiety symptoms if they occur during such changes.  It also means that the anxious person has found another way to avoid believing that s/he feels terrible for no reason apart from ‘natural weakness’.

Responses to such changes are not particularly simple either.  Hopson describes the ‘life cycle’ of a transition (a significant life - change), whether it is planned, unplanned, sudden or gradual, as having seven phases.

These are:
  • Immobilisation – feeling overwhelmed by the transition, unable to think or plan.

  • Minimisation – coping by reducing or trivialising the transition, perhaps even experiencing a little euphoria in the process.

  • Letting go – accepting that the transition has happened and cannot be unhappened.  Feelings start to rise again.

  • Testing – trying out new behaviour and situations.  Plenty of energy available but a tendency to stereotype people and things – how they should or shouldn’t be in relation to the change – and to become angry or irritable quite easily.

  • Search for meaning – trying to understand how and why things are different now.  Distancing somewhat from the transition to get a better look at it.

  • Internalisation – absorbing and finally accepting the transition as part of life.

This is not a rigid series.  Getting over bereavement and getting over Christmas are going to involve different time scales and different levels of feeling.  Similarly, people do not move neatly from one stage to the next.  Some may get caught up in one stage or another and progress no further, while others may fall back into an earlier stage after a setback or further life change that occurs whilst they are working through the stages.  People too have different responses to any kind of change such as welcoming or resisting or fearing.  Those of us who are prone to responding in the more negative ways will obviously have additional difficulties.

The important point with Hopson’s work and with the Holmes and Rahe scale is that it is another weapon in our armoury of understanding.  It allows us to anticipate difficulties, and to ensure that new situations don’t come as an overwhelming surprise to anxious people who are already all to liable to react anxiously to the ‘threat’ of change.  Charity workers have talked to many people who have recounted obvious symptoms of bereavement – loss of appetite, sadness, depression, emptiness, loneliness, ‘life is meaningless’ feelings – when discussing a lost job, a lost relationship or even their lost youth and missed chances.  The sad thing is that they had denied themselves the right to feelings of grief, regarding them as some kind of weakness or punishment instead of a natural process.

People are also fond of telling themselves that they should look forward to things such as retirement, moving, the freedom gained by the children leaving home.  In reality, these changes may be painful and start a stress reaction at some level.   A person recovering from an anxiety disorder, and the caring family, must accept that this person will have a fairly tenuous hold on ‘real life problems’ for a while.  New problems will always be arising, some of which can be solved and some of which have to be endured.  It is vital, therefore, that the newly recovered person and the caring family use their insight and knowledge to mark current and potential problems in life:  Builders are coming next month; her friend will be bringing the baby round; the neighbours have a new dog.  If problems are foreseen early, small behaviour tasks can be undertaken or other anti - anxiety or anti - obsessional preparations made.  Certain practical, behavioural tasks will almost certainly have been undertaken during the recovery process and it is absolutely essential that such work is not given up.  It can be modified or reduced of course, but anxiety sufferers who are reaching towards a far better life, should not be encourage to believe that all the work is behind them and that ‘it’ will never bother them again.

Source: Hopson, B. (1981) ‘Transitions: Understanding and Managing Personal Change’, in Griffiths, D (ed.) Psychology and Medicine, Macmillan

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