By fertility experts from Spain.
The fertility journey is not only a physical challenge – but also an emotional one. In order to navigate it safely, patients have to learn how to take care of their feelings and deal with them. In this webinar, Kaveh Mir-Tahmasebi, MBA, MSc, Executive Coach at PSI Executive Coaching, is talking about he and his wife’s fertility journey and shares tips and advice on how to cope with turbulence and uncertainties while struggling to conceive.
When we start a journey that is to take from where we are to where we want to go, we usually make sure that we are prepared for it as much as possible, despite possible obstacles. The same is with the IVF journey – but our biggest baggage here are our emotions.
How are you feeling? That’s the question Kaveh Mir-Tahmasebi starts his presentation with and he does it on purpose. In fact, that is the question only we know the answer to. No search engine or virtual personal assistant can help us with it and it might provoke a whole bunch of various responses. However, two thirds of people have a hard time coming up with a ‘feeling’ word. The most commonplace answers are: “Fine”, “OK”, “Busy” or “Tired”. According to Kaveh, it is puzzling that the question asked so frequently is so hard to have a very clear response to.
One of the reasons for this might be the fact that most of us have never been trained on the emotional side as much as we have been trained on the intellectual side – and it refers for example, to our school education where knowledge is considered more important than feelings. Another possible cause is the fear of being perceived as weak – especially, if we feel bad and we would have to communicate negative emotions. But being able to identify and express one’s feelings with the right language is, in fact, one of the most important skills in life. It is especially useful in one’s IVF journey.
People who embark on the IVF journey are required to have various resources, such as knowledge of medical terms and procedures, funds or access to various clinics. But, according to Kaveh the most important resource for IVF patients should be the right level of skills around emotions. It would be hugely beneficial for them to become a so-called ‘Emotion Scientist’, having the ability to identify, understand, label, express and regulate feelings during this difficult time of their lives. As a result, the journey itself could become a bit easier – despite its overall complexity and challenges along the way.
In order to understand how people struggling to conceive feel and react, you have to be one of them and Kaveh knows this experience very well. When he and his wife decided to have a baby, they did not expect what life had in store for them. They thought their story would be nothing but typical – but they were wrong. They were trying for their first child for three years and only after the fifth miscarriage did they managed to achieve a desirable result. Soon after they tried for a second child and experienced another three miscarriages. Then, on the ninth try, they managed to have their second son – and decided to stop trying for more kids as the journey they were on was simply too exhausting.
When Kaveh is asked how he survived the hard time, he often uses the iceberg metaphor. On the tip of the iceberg, there were things that he and his wife were paying a lot of attention to, such as the choice of a doctor, medicines and treatment options. In other words, they focused on the visible part of the challenge. However, what was not quite obvious was the body of the iceberg, meaning the emotional fluctuations that each of them had to experience individually. It was even more challenging when they wanted to communicate and make decisions together. The emotional part was all hidden and Kaveh and his wife were too busy to notice it, as they were focusing on the things that were easier to see and understand.
As one may expect, such a situation caused a lot of problems. They realised that, instead of regulating and expressing their emotions, they were just ignoring them. Kaveh thinks that if it wasn’t for various interventions that they took at the time, ignoring the emotions could have caused them more problems than actually the miscarriages themselves. The experience he gained from his personal journey made him explore the subject more thoroughly and led him to important conclusions he’s decided to share with others.
According to Kaveh the IVF journey has a number of characteristics that make it challenging and unique. The very first one is turbulence – it means everything changes so rapidly that at some point one may feel they have no capacity to actually deal with the change. Secondly, there is uncertainty. Despite the impressive advances in reproductive medicine nowadays, IVF patients feel that no matter which of the interventions they undertake, it still has 50% chance of success at its best. Thirdly, there is the dimension of novelty. Kaveh claims that most of us have never learned about how to have babies as much as we’ve learned about how to prevent ourselves from having babies. Hence, when we embark on this journey, everything is new to us and we have no idea on how the events are going to unfold. Finally, there is ambiguity – even though we take certain steps and follow certain indications, we still do not know what the final result will be in our case.
At this point, Kaveh introduces the concept of the TUNA journey which – compared to the so-called ‘norm journey’ – is far more bumpy and unpredictable. In the TUNA journey, the emotional response is very rapid, the peaks are much higher and the rate of change is much faster because of all the four dimensions: turbulence, uncertainty, novelty and ambiguity. The journey is full of emotional fluctuations when one quickly goes from optimism to pessimism – and back. That’s why being equipped with emotional skills is even more important than when we are navigating through the norm journey where these four dimensions do not exist or – at least – are not so much exaggerated.
The IVF journey is bumpy and unexpected – and so are the changes in IVF patient’s emotions. Kaveh uses David Rock’s SCARF model, being a summary of important discoveries from neuroscience about the way people interact socially. The model is made up of Status, Certainty, Autonomy, Relatedness and Fairness and describes social needs (domains) that all people have. If these five domains exist in our life, we feel relaxed – but when they do not exist, we feel psychologically threatened. And if we feel threatened, our normal reaction becomes fighting, fleeing or freezing.
Status is about relative importance to others and the sense of status goes up when one feels better than other people. However, in the IVF journey, patients often question their status, wondering if they are good enough – as, in fact, they are not able to do what others do naturally (meaning: conceive). The next domain, Certainty, is related to the human need to be able to know and predict what the future is going to be. Kaveh says that our brain has a pattern recognition machine that is constantly trying to predict the near future – but, as we all know, the IVF journey is unpredictable. So the need of certainty is not being met and, as a result, it intensifies the feeling of being threatened. The third domain of the SCARF model is Autonomy. Kaveh describes it as the perception of exerting control over one’s environment. And for us, people, it is very important to feel that we have a choice. Of course, within the IVF journey, we do not have as much choice as we could possibly want. We often feel that the range of available options is limited for us – and it only amplifies the feeling of a psychological threat. Relatedness, the fourth domain, involves deciding whether we are in or out of a social group we want to belong to (and we all want to belong to some group!). The sense of belonging feels like a reward – but when we feel that we do not belong to the particular group, it feels like a threat. In the IVF journey, we compare ourselves to the so-called ‘norm’ group (meaning: parents of kids) and we quickly realise that we do not fit it. The last domain of the SCARF model, Fairness, is something we all naturally crave for. As humans, we want to feel that we have been treated fairly. If we perceive our situation as an unfair one, we feel threatened. In case of IVF patients, the question “Why me?” keeps coming up – and coming back. If all of this is not managed properly, it could result in stress. Stress generally occurs when a demand exceeds our coping ability. And, as Kaveh proves, the lack of five SCARF domains in the IVF journey would create a perception that a demand is much higher than our ability to cope with it. As a result, the levels of stress rise and we can end up in the negative stress (distress) area. This entails a lot of physiological and psychological symptoms. The former refer to the weakening immune system while the latter include the feelings of hopelessness, distraction, disorientation or simply loneliness. That’s why it is so important to properly deal with one’s emotions before embarking on the IVF journey.
According to Kaveh our feelings are very important and deserve to be addressed respectfully. They are sometimes disruptive and unproductive – but we need to be able to identify them, understand them and use them in a healthy and productive way. Feelings that we experience throughout the IVF journey cannot be ignored and suppressed as it does not work. Unfortunately, ignored emotions don’t heal themselves but they pile up like a debt that eventually is due.
In order to help us prepare ourselves emotionally for the IVF journey, Kaveh presents the RULER model based on five useful skill sets. First of all, we have to Recognise ours and other people’s emotions. Once we do it, we need to Understand their source and the influence they have on our behaviour. Thirdly, we should try to Label our emotions by finding proper vocabulary. Fourthly, we should learn to Express our feelings to invite empathy from others and, finally, we have to Regulate them in order to be able to deal with them and make informed decisions.
Recognising one’s emotions is the most crucial – and at the same time, the most difficult. Without being able to understand what’s happening within us, we will have difficulties in utilising this knowledge to make informed decisions. However, we are not born with an innate talent to understand what we or others feel and why – we have to learn it.
Kaveh talks about one of the tools that can be used in recognising emotions, known as a mood detector. It is a graph made of two different axises: the X-axis being pleasantness and the Y-axis being the energy. By using the proper scale, we can categorise what our feeling is and identify the proper area/quadrant it belongs to. The four quadrants on the graph are marked with the following colours: red, yellow, blue and green. For example, feeling blue means that both energy and pleasantness are low. Red, on the other hand, is linked to low pleasantness and high energy and is understood as anger, fear or frustration. Green, meaning high pleasantness and low energy, is associated with feelings of calm, peace and safety. The last of four quadrants – yellow – combines high pleasantness and high energy and describes happiness and enthusiasm. Kaveh encourages us to keep a journal of where we are in terms of our feelings and – most importantly – how long we stay in each of the quadrants. If we stayed in any of them for too long, it would be a good idea to consider whether it is not the right time to move somewhere else. And if yes, which area we should move to that would serve us best. In Kaveh’s opinion, by knowing where we are, we become aware of what’s happening for us and – even more importantly – we can communicate much better with people around us.
Kaveh is sure that keeping track of where we are in terms of our emotions during the IVF journey is crucial when we want to successfully face the challenges that await us. Additionally, one should always be aware of where our partner is – even if it means completely opposite areas. Otherwise, it is not possible to overcome communication obstacles and find your common language. Finally, assessing how long you’ve been feeling certain emotions will be helpful as well. It is completely all right to experience all the feelings (as none of them are bad!) but we should not stay within one emotional quadrant for too long – at least not more than it’s appropriate for the part of the IVF journey we are currently going through. Thanks to such awareness, we can start planning and be more proactive to shift ourselves within the IVF emotional rollercoaster – and make most suitable informed decisions.
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That’s a fabulous question. I’m assuming that when you say ‘you are in a different colour’, you mean you and the person that’s supporting you. The first step is to identify that you are in a different colour. So when the question was: “How are you feeling?”, rather than saying “Fine”, “Okay”, “Bored” or “Overwhelmed”, we can say: “Red”, “Yellow”, “Green” or “Blue”. Just by knowing we are in different parts, we could get ready for the fact that our emotions are totally different, in terms of how pleasant we’re feeling or how much energy we have within us. It immediately brings some kind of understanding of what’s happening. So now we talked about recognition, the next part is about understanding. As soon as we know where we are and where the other party or whoever supports us is, we then have the ability to understand what the cause of our emotions is. For example, anger typically is a message that comes from inside. It tells us that maybe there is some perception of injustice and unfairness. As soon as I say: “I’m red”, it gives me some indication that somewhere inside – even subconsciously – I perceive something not to be just. And in the same way, we have the underlying cause for various emotions. So as soon as I know that, for example, you’re red, I can start asking the right questions to sympathise with you and to understand why you’re red. Now remember that the third part is labelling. It is when we use the right words to communicate our feelings. If we are familiar with the language of emotions, we can quickly express emotions in an appropriate way for other people to empathy with us, letting them knowing if we feel pleasant or not, if we have much energy or not, what’s the cause of our feelings, what we call it and how far our feelings are from theirs. Immediately, we’ve got much more data to deal with emotions. Generally, when we get emotional, most of us just reacts to it. Sometimes, if we are in the green or in the yellow quadrant, we don’t react because there is no energy. And if there is low energy, it’s very likely that I am more inclined to avoid or even to deny the subject. So your partner immediately knows that it is a normal reaction for someone who is in that part of the graph. And that brings understanding and empathy between people.
It’s a very good question. Here we can look at the SCARF model. The SCARF model is about Status, Certainty, Autonomy, Relatedness and Fairness. As humans, we need to have autonomy. If we feel we do not have any choice, our brain sees that as a threat. It’s quite interesting that sometimes this threat could be similar to a physical threat as the same part of the brain gets triggered. So it is very much about our perception of that threat. So if, for example, we are going through this journey and we feel that we have no autonomy, if we are forced to take on the journey – that is the threat. Of course, our brain would treat that as something negative and immediately, all the pleasantness would go down. If we perceive that we have no control, our energy level drops down as well. And this is when we stay in the bottom left quadrant of the emotional graph. How can we move up? If we investigate and realise that, for example, autonomy is the reason, we need to work on that and see how we can bring that feeling of being in control back, to gradually calibrate and adjust the threat level.
Anger, or the red part, is when we feel there is injustice and the lack of fairness. Remember that we’re not talking about the truth here or whether we’re right or not – that’s a different question. It’s about perception – we perceive that injustice has happened and we haven’t been dealt with fairly. Then the normal reaction of the body is to take us to the red quadrant. Red is telling us things are not pleasant. It’s trying to focus us and narrow us down into limited options because it doesn’t want us to spend too much energy exploring things. And it gives us a lot of energy which could have the symptoms that you talked about, for example, the heart rate would go up or the blood pressure would go up. Our body says: “I am getting you ready for the red grid.” The problem there is that if we don’t understand it and we don’t know how to regulate and express it in the right way, we’ll end up in the red part of the graph and we’ll stay there for a long time. And if we stayed there for a long time, we would see exactly what you were saying – meaning some of the biological and psychological symptoms that were expressed. So the first thing to do when we’re in the red quadrant is to try and reframe our perception of where this injustice was happening. If the intensity of that is quite hard, we need to work with someone, using different types of intervention, to try to reframe the scenario for us – so that we can reduce our perception of injustice and unfairness and make it low. Once we feel things are not as unfair and as unjust as we perceived them, we gradually move out of that quadrant. When it comes to me suggesting the right kind of intervention for you now, I think it is probably not a right thing to do. We obviously need to know exactly what’s happening and what’s the level of intensity of the emotions – and only based on that, we can try different interventions to see what’s the right way to shift a person to a different quadrant. But what’s very important is that at least we know the following: “I am in the red quadrant, I’ve stayed there for a long time. If I stay in the red quadrant (or in any quadrant) for too long, that’s not good because I’m going to have physiological and psychological symptoms.”
We all crave certainty. One way to address that craving is by having more knowledge because having more knowledge would hopefully enhance our chance of predicting the future better – by taking better informed decisions. And that is perfectly fine. The only challenge is that it works in a simple world. What I mean by ‘a simple world’ is the world where there is no turbulence and no uncertainty. There is also some reduced amount of ambiguity and novelty- or maybe it’s not there either. With the IVF journey, we know these four dimensions exist. Of course, the more knowledge we have, the more comfortable we’re going to feel because uncertainty is reduced. But we need to know that this journey has got these four dimensions almost embodied within it – regardless of how much knowledge we have. Probably, we might be able to reduce turbulence slightly, uncertainty slightly, ambiguity and novelty slightly – but we cannot eliminate them. And this is where we need to be open to have various feelings throughout the journey and equip ourselves to deal and welcome the feelings and use them appropriately. But definitely, gaining knowledge is great because that helps us with uncertainty.
There are many psychological things in there and one of them is resilience. I was very lucky to have an amazing wife – in all different areas – but more importantly, she’s a very resilient person. I think she taught me how to be resilient and what I mean by resilience is how we respond in the event of adversity and unexpected experiences. Even though some people think you’re either born with it or not, resilience is a skill that one can learn. So something that really helped me in that scenario was to have a role model – my wife – who was showing me how she was resilient at the time of adversity and experiences that we weren’t expecting and we were shocked by. Of course, we were not quite sure how to deal with all of that. But I’ve learned a lot from her skills and I think that by building up our resilience, we were much more comfortable to deal with these unexpected events that were happening to us.