Traumatic situations have been proven to affect a victim’s life for several years following the actual tragedy, and often, even a lifetime afterwards. The pain, shock and other jarring emotions that overwhelm impacted individuals are said to come on with such overbearing intensity that one very often finds his or herself succumbing to desperate measures to avoid the frequent disturbances. Avoidance habits include conscious and sometimes unconscious, or sort of involuntary successions into disassociative states or numbness, panic attacks and even the splitting of one’s own personality. Flashbacks are quite common in trauma suffers and so are persistent nightmares or night terrors.
Many people believe that individuals who have experienced extreme trauma should confront their memories and painful emotions head on dealing with them despite the fear it causes, in order to successfully heal. They look at the previously mentioned avoidance techniques as cover ups, per se, that are created by one’s own mind and/or body to maybe deter one from facing the supposed crucial matters that haunt them or even redirect the pain elsewhere. Many psychiatric professionals, however, present a seemingly more realistic perspective on the matter and in addition, offer alternatives to treatment and healing.
Crisis survival techniques fall under the category of Distress Tolerance, according to the therapeutic approach, known as Dialectical Behavior Therapy, or DBT. DBT, pioneered by Marsha Linehan and currently practiced by an elite group of licensed therapists all over the world is used primarily for the treatment of a persistent and difficult Psychiatric disorder called Borderline Personality Disorder and is focused on, but not limited to, preventing suicide attempts and other self-harm behavior. The method of DBT therapy, though, is growing increasingly popular among researchers in the field of Psychiatry and Psychology and new light has recently been shed on the specific techniques this school of thought requires and the broad range of issues it may be used for in addition to its original intent.
One instance where DBT has been especially helpful is in patients experiencing moments of extreme discomfort both emotionally, and physically from certain feelings like anxiety and depression. While enthusiasts of this therapy style agree that facing one’s fear and distressing emotions is important in many cases, they also stress that there is a time and a place to do so. The full-time orchestrators of DBT, as dictated by Marsha Linehan like to propose a “do what works” type of method for dealing with pain and discomfort. Linehan maintains a very strict anti-judgment policy in which the patient must make a concentrated effort to avoid passing opinions, especially critical ones, upon his or herself and others. Instead, she encourages individuals studying this therapy to adapt to the theory and practice of acceptance. Acceptance, according to DBT rules, includes coming to matter of fact terms with the way things exist, with specific attention to the present moment. So in taking a look at the body’s tendency to respond to distress with panic attacks, numbness and other types of these automatic responses implied by many to be temporary remedies or a cover up of sorts that may serve no healthy purpose, a DBT therapist would likely present a more hopeful perspective. He or she would not only accept the body’s need and understandable right to shut down and avoid whatever pain it’s confronted with, but they might even consider these bodily distractions as necessary survival instincts at least for the time being. All DBT therapists of course, create their own individual adaptation to Linehan’s original Dialectical approach but it can be safely hypothesized that many of them would help the patient break his or her dissassociative or splitting personality occasions down into simple, realistic and observational facts. The therapist would explain that this radical reaction that the body experiences, despite any negative consequences, such as the temporary hindrance of long term coping abilities is not merely a cover up but a desperate attempt by the body and/or brain to get itself out of a situation that it is not yet equipped to handle. The therapist would teach that one need be able to handle the pain and instead of prematurely trying to look the fear directly in the face, he/she should acknowledge this as a sign that easing into it will probably be the most successful.
The extreme reactions the body resorts to, though uncomfortable many times, may in fact be more tolerable than facing the trigger. Therefore the DBT therapist would likely describe the situations as “something that works”. And though they probably would admit that the ultimate goal would be to help the patient manage the intense discomfort in a less debilitating way, this shut down works in certain moments. And so most likely the next step is to help the patient come up with some coping strategies that may help him or her deal with some of the distressful feelings on a less dramatic level.
And so, alas, the teaching of distress tolerance strategies according to Linehan’s Dialectical Behavioral Therapy Design. The four major skills introduced under distress tolerance with individual and/or combined goals to essentially get through a crisis or moment of extreme discomfort when the target problem can not be changed right way include distracting, self soothing, improving the moment and thinking of pros and cons. Therapists urge their clients to practice these skills as often as possible, especially during periods of stability so that they are prepared and more advanced when it comes to a crucial time of emergency. It is readily acknowledged that these skills are designed as “in the moment” crisis survival strategies only and not long term remedies. It is their hope that patients will come to master distress tolerance skills so that they can access them and utilize them efficiently during times where other types of therapy, such as confrontation of one’s painful thoughts and/or fears and the in-depth expoloration and recounting of past experiences are not appropriate. Situations in which one is in a professional environment, a social setting, and many other instances that require a high level of functioning and a stable outward demeanor (such as when one is involved in familial responsibilities) are instances where DBT clients are encouraged to use their skills to simply get through the moment.
The strategies under the distress tolerance category go very far into psychological and therapeutic depth, but one of the first set of skills that is taught is known as distracting. While it should be noted that distracting, as with any of the skills in DBT, is extremely complicated and takes much practice and exploration to master, here is a brief overview of the technique, and some ways that DBT clients have learned to utilize it.
DBT practitioners encourage patients to use positive forms of distracting in order to help them get their minds away from emotional triggers that may upset their stability at the moment.
Activities
A few different ways to distract are by engaging oneself in activities. One should focus their undivided attention on the activity alone, and attempt to push away any thoughts that try to come in related to the trigger. Mindless, or tedious activities usually work best for this, such as needlework, washing dishes, filing papers, etc. It is important not to attach any opinions to the activities you are engaged in because doing so opens the door to judgmental thoughts and images related to the trauma.
Contributing
Contributing is another distraction tactic. The term refers to the act of redirecting your attention upon others. Examples of contributing skills would be doing someone a favor or making someone a nice card for a “just because” occasion. Or writing a letter to a loved one, telling them how much you care. Contributing not only helps distract individuals from their own painful emotions but it helps one build a sense of self respect and gives meaning and purpose to their life. Doing things for others can be very rewarding, especially when the act is unsolicited. This distress tolerance tactic is very effective.
Comparisons
Comparisons is another term that follows under the distress tolerance distracting skill set, but some patients find it difficult to apply. The term comparison in this context basically instructs one to again, redirect their focus on others, but this time, specifically to the situation of others less fortunate than us. This is a particularly tough one because many people find that in the moment of extreme discomfort or distress it is very hard to see any positive side. While one might easily be able to identify obvious advantages their situation has over someone worse off, it isn’t always that easy to rationalize away the pain. With practice, though, and in conjunction with the other distress tolerance skills, comparisons have been indeed proven helpful.
Generating Opposite Emotions
Another very challenging distracting skill is referred to as generating opposite emotions. This calls for performing activities that will help conjure up less negative emotions. Watching a funny movie when angry or sad, for instance, is one suggestion DBT therapists like to give. The challenge is that for this method the individual must figure out what emotion they are feeling so as to determine the opposite one to stir up. This can work wonders if one really works hard at it. Surrounding oneself with such things that elicit more tolerable emotional response is something that while deeply upset, seems like the last thing you want to do, much less are able to do, but it does in fact work.
Pushing away
Pushing away is performed by either physically removing oneself from a negative situation or triggering event (walking away, hanging up the phone, etc) or by mentally blocking the disturbing emotions or thoughts. Linehan stresses that the method of blocking, though admittedly useful and a good example of doing what works should only be used occasionally in desperate situations. Blocking puts the mind and body in a similar state as when it goes through disassociation or numbing, only it is more of an intentional behavior. It can work well though, and if other techniques fail to improve the moment , one should by all means use it. The concept of blocking is hard to explain in words but it is sort of like just shutting your mind off to certain thoughts. If people have a hard time doing this, mental imagery sometimes can help. Such mind exercises as visualizing the negative thoughts or emotions crumbling into pieces and then flying away, for example, or imagining the thoughts as melting away or burning are different methods some people find beneficial.
Distracting with Other Thoughts
This is another method that is much easier said than done. The idea, though, is to keep the short-term memory occupied with other thoughts than the trigger ones. To help implement this technique, some people have found that working on miscellaneous mind jogging activities help. Some examples are trivia games, arts and crafts projects to jumpstart creative processes to distract, writing creative fiction, crossword puzzles, or suduko, etc.
Intense other Sensations
The final distraction technique involves conjuring up alternate sensations to take the mental or physical focus away from the distressing emotions or feelings of discomfort. Out of all of the distracting skills, this one is possibly the easiest and most immediately effective. Utilizing this skill means simply stimulating the senses, usually in a radical enough way to sufficiently keep the mind from reverting back to the uncomfortable one. The most popular distracting sensation technique is probably the use of ice cubes. If one is feeling particularly upset and is having trouble getting away from the emotional and physical discomfort, he or she should try holding ice cubes in the palms of the hands. Other cold objects work just as well, so make use of whatever you have available. Sometimes it is also helpful to run the frozen object up and down your arms or touch it to your face, and allowing yourself to become totally immersed in the sensation it causes. Other intense sensations that are quite powerful include the rubber band bracelet method and the use of touch as distraction. The first involves wearing a rubber band around the wrists and simply snapping it against the skin (lightly of course) to help divert the attention to the somewhat startling, light, and almost ticklish sting. And the other entails making great use out of your touching/feeling sense by doing such things as petting an animal’s fur, putting the hands into a jar of items like coffeebeans or gumballs and finger painting. Be aware though, that these techniques, just like the mental blocking or pushing away strategies, are so effective that if used too frequently, they can potentially hinder one’s ability to properly deal with the trauma. Therefore, they should be used in moderation.
The above skills, with much practice, can be extremely effective in helping one get through particular moments of distress or discomfort and patients are encouraged to use them when needed. The various techniques under the Distracting subset of Distress Tolerance, can be used either as a combined approach to dealing with pain or as individual, concentrated temporary remedies. It would be in one’s best interest, though to practice them all, however, because circumstantial differences often require certain skills more than others. You will find that some of these are much easier than others, and will likely be compelled to use one or two of them much more often than the rest. It is just a good idea to keep in mind the distracting tools as a whole, so that you can access these personal resources when the time calls for them. Therapists often teach their clients the “Wise Mind ACCEPTS” acronym phrase as a way to remember this arrangement of distracting techniques. Wise mind refers to another dialectical teaching that is defined, in short, as a happy collaboration between one’s emotional and rational mind. Anyone studying DBT will be required to look into this in detail at some point, but for now it is enough to just know the term. ACCEPT is an acronym to describe the six distracting skills, as such:
Activities
Contributing
Comparisons
Emotions
Pushing away
Thoughts
Sensations
Distracting is only one of the major categories of skills under the Distress Tolerance heading, according to Linehan’s Skills Training book. For more, one should reference the workbook, which is officially titled, “Skills Training Manual for Treating Borderline Personality Disorder” by, as noted, Marsha Linehan. Keep in mind that while designed to specifically treat those with Borderline Personality Disorder, the theories in this book have been determined to be extremely helpful in treating a very wide variety of mental illnesses and disorders. Many would even argue that so-called “normal” or “healthy” people would benefit from the techniques in the book. So do not let the title deter you from checking it out. Like many already, it may become your new “therapeutic bible”.
