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Surviving Intense
Emotions
Distress Tolerance: Helping Students and Staff Cope
with Overwhelming Emotions
Helena Mackenzie, PhD, LPRegion 5 Mental Health Specialist
Stressors Are Everywhere…
JC Student Stressors
• Away from home/friends
• Fitting in with peers
• Relationship challenges
• New rules/structure
• Dealing with drama/gossip
• Academic/trade pressure
JC Staff Stressors• Too much work/too little
time
• Staff cutbacks
• Frustrating interactions with students
• Hearing traumatic stories
• Lack of resources
• Changing rules/regulations
Making A Crisis Worse
Ways that Distress Can
Lead Us to Make Things Worse…
Using alcohol/drugs
Screaming at
someoneCutting
Getting in fight
Eating too
muchBreaking Somethin
g
Distress Tolerance Skills:Surviving A Crisis Without Making It
Worse
• Distress Tolerance Skills are used to help us cope and get through periods of overwhelming emotions and pain in healthier ways to avoid additional suffering
• Use when we can’t change a distressing situation (because we are unable, unwilling, or it’s inappropriate)
• Other skills (problem solving, emotion regulation, interpersonal effectiveness) may help us later prevent or “fix” the situation, but not when our brain is “off line” due to intense emotion
Distress Tolerance Skills are one of four sets of skills taught as part of Dialectical Behavior Therapy (DBT), an evidence-based therapy developed by Marsha Linehan, PhD, ABPP
Dialectical Behavior Therapy
Wise Mind
“Between Stimulus and response there is a space, and in that space lies our power
and our freedom”
--Victor Frankl, Man’s Search for Meaning
Distress Tolerance Skills
The Four Basic Skills
• Distraction
• Self-Soothing
• IMPROVE the moment
• Pros/cons
• Pleasurable activities
• Do basic tasks and chores
• Pay attention to others
• Replace your thoughts
• Count something. Anything!
• Leave the situation
Distraction:Distress
Tolerance Skill #1
Turn Away From Painful
Emotions
Distracting with Pleasurable
Activities• Doing something that
feels good can help distract from painful emotions…• Go for a walk• Listen to music• Play a game• Call a friend (don’t talk
about the crisis)• Take a nap• Play a sport• Take a shower• Read a magazine
Distract Yourself With Tasks and Chores
• Clean your room
• Organize your CDs
• Do your homework
• Organize your closet
• Return phone calls
• Fill out forms/paperwork
Distracting by Paying Attention
to Others• Do something for someone
• Take attention off yourself by people watching (describe details of what you see)
• Think of someone you care about. Look at picture and imagine telling them you care
• Thank someone/express gratitude
• Listen to someone else’s problems and comfort them
Replace Your Thoughts(Distract Your
Thoughts)• Remember happy, fun,
exciting memory in detail (all senses)
• Sing song lyrics
• Look outside and describe what you see in nature or recall an image of nature
• Imagine your wildest fantasy coming true. What would it be.
• Read a favorite saying, supportive message, prayer to yourself. Repeat.
Distract Yourself by Counting
• Count your breaths
• Count the tiles on the ceiling, cracks in the wall, students in the class, whatever
• Do basic math. Count or subtract by sevens.
• Count the letters in your friends’ names and spell them backwards
Distract Yourself by Leaving
• Sometimes emotions are so strong that you need to walk away and put distance between you and the situation
• Walk Away
• Take a Time Out
• Put yourself in a new environment until calm
Match Your Method to Your Level of Distress• If you are completely
emotionally overwhelmed, distracting yourself by doing homework is not realistic
• Distract from self-destructive behaviors by..• Hold an ice your hand• Splash cold water on your
face; take cold shower• Snap a rubber band on
your wrist• Throw rolled up socks
against the wall• Run up and down stairs
My Distraction Plan
• Next time I’m feeling overwhelmed and distressed, I will…
• 1.
• 2.
• 3.
• 4.
• 5.
• 6.
Self-Soothing:Distress Tolerance Skill
#2What would you do if your partner/best friend was in distress/going through a
crisis?
How would you soothe them?
Don’t make a hard situation harder by becoming your own best critic
Soothe yourself at times of distress
Self-Soothe with Five Senses
VISION: Carry picture of soothing place; make collage of calming pictures; look at nature; carry picture of loved person/animal
HEARING: Listen to soothing music; listen to nature/recording; listen to relaxation exercise; listen to voice that is calming (message on phone)
TASTE: Suck on mint/hard candy; savor cup coffee/tea; chew gum; eat fruit slowly, savoring taste
TOUCH: Rub a smooth stone in your hand; stroke your arms; massage yourself; play with a pet/animal; put on your favorite comfy clothes
SMELL: Wear favorite scented lotion/oil/cologne; smell a scented candle/diffuser; go outside and smell nature; smell favorite food
IMPROVE the Moment:Distress Tolerance Skill
#3• Imagery:
• Meaning:
• Prayer/higher power:
• Relaxation:
• One thing in the moment:
• Vacation/time-out:
• Encouragement:
I for Imagery
• Imagine a place where you feel…• Calm• Safe• Happy• Relaxed
• What do you see, hear, smell, feel/touch, taste?
M is for Meaning
• Reflect on what you value and what is important to you:• Family• Romantic relationship• Parenting• Friends/social life• Work• Education/training• Recreation/Fun• Spirituality/religion• Citizenship/community• Self Care
P is for Prayer/Spirituality
“Sometime I go about in pity for
myself, and all the while a great wind
is bearing me across the sky.”
--Ojibwa saying
R is for RelaxationProgressive
Muscle Relaxation• Tighten each part of
your body for 5 seconds, then completely relax it
• Start at your toes and work upward
Walk, yoga, stretching
• Any exercise that relaxes your muscles
O Is for One Thing in the Moment
Next time you are in distress, ask:
• Where am I right now?
• Am I time traveling to future, worrying or planning?
• Am I traveling to past, reviewing mistakes?
• Am I in the present?
• Redirect attention to present by focusing on breathing, describing internal sensations or external environment
V is for Vacation/Time Out
We all need time away
• Small, simple “vacations” to relax and recharge
• Treat yourself—do something nice for yourself
• Don’t talk to anyone for an hour/afternoon
• Take a nap
• Curl up with your favorite book, music
Time Out• Not only for kids
• Remove yourself (temporarily) from distressing situation
• Calm and self-soothe yourself
• Remember your needs are important
• Go back and face the problem once centered
From McKay, Davis, & Fanning, 1997
E is for Encouragement
Use Self-Encouraging Coping Thoughts “This situation won’t last forever.”
“I can ride this out and not let it get to me.”
“I’ve survived worse than this. I’ll be okay.”
“Feelings will pass. I’ll feel better again.”
“I’m strong and I can deal with this.”
“It’s okay to feel angry/afraid/sad. Feelings will pass.”
“My thoughts don’t control my life. I do.”
My IMPROVE Plan:
List One Way to Practice Each
IMAGERY:
MEANING:
PRAYER/HIGHER POWER:
RELAXATION:
ONE THING IN THE MOMENT:
VACATION/TIME OUT:
ENCOURAGEMENT:
Pros and ConsDistress Tolerance Skill #4
Pros ConsMake situation worse by…Smoking pot
--get to relax--won’t have to think
--get drug tested and kicked out--can’t get up in am--use all my money
Tolerate distress by…Self-soothing
--feel little relaxed--focus on my goals--money for phone--feel better in am
--may not sleep well--won’t be as chilled--harder work
Pros and Cons
Motivate yourself to tolerate distress and not engage in destructive behavior by…
Writing out and carrying with you the pros of tolerating distress and the cons of making it worse..
PROS of Following Distress
Tolerance Plan
--feel little relaxed--focus on my goals--money for phone--feel better in am
CONS of Making it
worse
--get drug tested and kicked out--can’t get up in am--use all my money