Distress Tolerance Skills for Surviving 2020 and Beyond
One of the beautiful things of being a therapist who practices Dialectical Behavior Therapy (DBT) is the fact that it normalizes the usage of emotional skills whenever necessary. Most DBT therapists enjoy supporting each other as we try to utilize skills to navigate challenging experiences, because we all have them, don’t we? As the number of coronavirus cases grows, many people will be digging deep for emotional skills in the next several months. When we are in a place of crisis, there are specific tools or skills that can be utilized to manage a response to crises. In the world of DBT, we call these distress tolerance skills. Another key trait of DBT is the utilization of acronyms to increase recall of these skills; what would be the utility if we couldn’t connect with them when needed?
Situations that entail extremely high levels of distress can best be managing utilizing TIPP skills. We will break down each of the components as follows:
T= Temperature. The human body is built with these amazing sets of reflexes and ways of altering our physiology to adapt to extreme circumstances. Temperature change utilizes one of these reflexes, called the "dive reflex.” In the dive reflex, any time your face is plugged into cold water, blood will rush to your brain and heart to protect your two most vital organs (more information on it can be found here). In situations of extreme distress, if you plunge your face into cold water, you can use the diver reflex to change the intensity of your emotions. Specifically, any time you experience extreme emotion, fill your bowl with cold water and add some ice. Plunge your face into the ice water for about 15-45 seconds. You can also use a bag with ice pressed to your face and hold your breath. You will feel emotional intensity quickly shift as your body takes care of the essentials and pulls resources away from less important areas.
I= Intense Exercise. Whenever we are in a situation where we perceive threat, one of the things that our body is looking for to reflect management of that threat would be a burst of cardiovascular exercise: an experience of fight or flight. Often, the situations that trigger our distress response do not allow us to actually fight or flee the particular threat. However, we can mimic the fight or flight response by engaging in high intensity exercise, for even a brief amount of time. Most animals do not fight or flee for long periods of time- it would simply be a burst of fighting or running to escape the threat. We can mimic this activity by running the stairs in our building or sprint up the street and get the same payoff in change of mood, my favorite is to run a hill sprint or two. The key to its effectiveness is intensity, and most people will experience a meaningful change in distress within 4-5 minutes of any intense exercise.
P= Paced Breathing. Paced breathing involves breathing very slowly and deeply, reducing respiratory rate from a normal 18-22 breaths per minute down to a rate of 4-7 breaths per minute. When we breath slowly and deeply, our heart rate and blood pressure start to go down, which allows for more of a sense of calm. Although this can feel like the last thing you might want to do when you are in a state of distress, this activity can meaningfully shift your reaction to a current stressor, and regular practice also allows for lowering your overall response to stressors that may occur. Some specific ways to practice this skill can be found here.
P= Paired Muscle Relaxation. Paired muscle relaxation allows you to calm down by combining tensing and relaxing muscles along with your breathing. While you are inhaling, deeply tense muscles, notice the tension, and then relax while exhaling. You often are much more aware of relaxation only after having tensed muscles. It is helpful to utilize different muscles as you move through your body in this exercise, and this activity is also best with regular practice. The advantage of regularly practicing this activity is that you also will be more tuned into your body, and may recognize distress more quickly, which gives you greater choice in your response to triggers.
Although the acronym makes the most sense as TIPP, it is almost more effective to imagine utilizing these skills in reverse order. Regular practice of paced breathing and paired muscle relaxation allow for more resilience when stressful circumstances occur, so should be utilized on a regular basis. When emotions grow more intense, it is helpful to be able to engage in some high intensity exercise. When we have really exceeded our capacity to cope, then temperature can be your emergency escape valve. All of these tools create the capacity to control responses in a wide variety of circumstances, which allows you to be in control of your emotional reactions. The end result is major capacity to tolerate distress, even in a pandemic. Which one would you practice first?
Resources
Find more information about DBT in Charlotte at the DBT Charlotte website: https://www.dbtcharlotte.org/
More information about DBT and DBT trainings are at Behavioral Tech: https://behavioraltech.org/