Surviving Intense Emotions

1. Surviving Intense Emotions Distress Tolerance: Helping Students and Staff Cope with Overwhelming Emotions Helena Mackenzie, PhD, LP Region 5 Mental Health Specialist

2. Pain is Unavoidable“Life is Suffering”--Buddha

3. Stressors Are Everywhere… JC Student Stressors JC Staff Stressors Too much work/too little time Staff cutbacks Frustrating interactions with students Hearing traumatic stories Lack of resources Changing rules/regulations • Away from home/friends • Fitting in with peers • Relationship challenges • New rules/structure • Dealing with drama/gossip • Academic/trade pressure

4. Recall a Time When You Felt Emotionally Overwhelmed…

5. Evolution of the Human Brain (basic)

6. Making A Crisis Worse Eating too much Breaking Something Using alcohol/ drugs Ways that Distress Can Lead Us to Make Things Worse… Getting in fight Screaming at someone Cutting

7. 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

8. Dialectical Behavior TherapyWise 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

9. Distress Tolerance Skills The Four Basic Skills • Distraction • Self-Soothing • IMPROVE the moment • Pros/cons

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. My Distraction Plan • Next time I’m feeling overwhelmed and distressed, I will… • 1. • 2. • 3. • 4. • 5. • 6.

19. Self-Soothing:Distress Tolerance Skill #2 What 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

20. 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

21. Self-Soothing/Relaxation Plan • 1. • 2. • 3. • 4. • 5. • 6. • 7.

22. IMPROVE the Moment:Distress Tolerance Skill #3 • Imagery: • Meaning: • Prayer/higher power: • Relaxation: • One thing in the moment: • Vacation/time-out: • Encouragement:

23. I for Imagery • Imagine a place where you feel… • Calm • Safe • Happy • Relaxed • What do you see, hear, smell, feel/touch, taste?

24. 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

25. 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

26. R is for Relaxation Progressive Muscle Relaxation Walk, yoga, stretching Any exercise that relaxes your muscles • Tighten each part of your body for 5 seconds, then completely relax it • Start at your toes and work upward

27. 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

28. V is for Vacation/Time Out We all need time away 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 • 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

29. 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.” From McKay, Davis, & Fanning, 1997

30. My IMPROVEPlan:List One Way to Practice Each IMAGERY: MEANING: PRAYER/HIGHER POWER: RELAXATION: ONE THING IN THE MOMENT: VACATION/TIME OUT: ENCOURAGEMENT:

31. Pros and ConsDistress Tolerance Skill #4

32. 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 distressand the cons of making it worse..

33. Thank you! Resources: Skills Training Manual for Treating Borderline Personality Disorder (Linehan, 1993) The Dialectical Behavior Therapy Skills Workbook (McKay, et al, 2007)