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 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

4. Recall a Time When You Felt Emotionally Overwhelmed…

5. Evolution of the Human Brain (basic)

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

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 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

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 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

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 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

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 IMPROVE Plan: List One Way to Practice Each I MAGERY: M EANING: P RAYER/HIGHER POWER: R ELAXATION: O NE THING IN THE MOMENT: V ACATION/TIME OUT: E NCOURAGEMENT:

31. Pros and Cons Distress Tolerance Skill #4 ProsCons Make 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

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 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

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