Emotional distress is a part of life and serves a necessary function in terms of alerting us to problems that need to be resolved. Everybody therefore needs to be able to experience and tolerate a certain amount of distress. Trying to avoid unpleasant thoughts and feelings can actually lead to an increase in the experience of them, the more you try to avoid an experience the more it seems to pursue you. This more than likely has an evolutionary purpose because as long as the distress is avoided the source of the pain remains unresolved.
Experiencing distress and working to resolve the problem behind it is the only way of reducing pain in the long-term. However, sometimes when you are in the middle of an extremely distressing experience, you can easily get swept away by it. You can feel so overwhelmed that the only option seems to be to block out the distress using eating or self-harming behaviour; physical distress/experience being more tangible thus more easy to tolerate than emotional distress/experience.
This however prevents you from identifying the source of the distress and being able to take steps to tackle it. You opt for immediate and brief respite at the expense of longer-term problem resolution and relief. With time this becomes your knee-jerk reaction to distress, other options become impossible to see and as with any experience that is avoided, the more you avoid distress the more uncontrollable and overwhelming it becomes.
Distress, if allowed to will dissipate with time. A useful way of thinking about distress is as a wave that has to be ridden .Distress tolerance is a set of skills that enables you to ride the wave, to survive unpleasant emotional experiences without making them worse. Like impulsive, self harming behaviours (e.g. bingeing and vomiting, self harm, alcohol and drug abuse) they can be used to modulate negative thoughts and feelings. However unlike such behaviours they will not trigger further distress. Although the techniques described here are intended to serve a similar function to that of impulsive behaviours, initially at least they will not be as effective. They will need to be personalised and practiced regularly in order to maximise their effectiveness as distress tolerance techniques.
These CBT Counselling skills will help you to gain control over your feelings, stay safe and step back. Once you can step back from your distress, you can see other options.
There are three different types of distress tolerance skills, practice each so that you can discover what works best for you and so develop your own individualized and alternatives to current harmful behaviours.
1. Cognitive Techniques
Thoughts are important in determining our feelings. Strategies which address their role in distress will therefore be extremely important in assisting you to experience and feel in control of their emotional pain.
Thought stopping
Thought stopping is a very simple strategy derived from the anxiety management literature. With practice it can be an excellent and immediate way of pushing a negative thought out of the mind space. However, its impact is brief and thus needs to be followed up by other strategies that aim to occupy the mind space for a longer period of time.
Exercise:
• Place an elastic band on your wrist. As you notice your distress levels rising snap the elastic band and imagine the word STOP in red capital letters flying into your minds eye pushing all other thoughts and feelings out. Repeat this exercise each time your distress levels rise.
Refocusing attention
We only have a certain amount of mind space and so one way to modulate our emotions is to temporarily push out the negative thoughts that are triggering distress and fill it with neutral/positive thoughts so that there is no longer any space for the negative emotion. Refocusing attention involves deliberately directing your attention away from the negative thought and towards a neutral mental activity which will occupy the mind space thus pushing the thought that is causing the distress temporarily out of awareness. There are a number of different mental activities that can be engaged in to achieve this aim:
i. A detailed description of the surrounding
Focus your attention on your surrounding environment. For the next 5 minutes completely fill your mind space with this task. If you notice your mind wandering from this task, as it inevitably will, make a note of where your mind has wandered and then gently refocus your attention on your surroundings. Look to your right. Now slowly scan your environment naming (in your head) as many object as you can. Now look straight ahead of you and focus on the first object that falls in to your line of vision, focus on this object to the exclusion of everything else. Describe this object as if it is the first time you have every seen it. What colour is it? How big is it? What shape is it? What is its texture like? Now, if you see any written words in your environment focus on these words to the exclusion of everything else. Read each letter backwards as if you where seeing these letters for the first time.
ii. Names
Think of the names of as many cities as you can .Now think of all the girls names you can think of beginning with A. Now all the boys names you can think of. Now name as many objects beginning with C as you can”.
iii. Numbers
Take the number 100; subtract 7 and notice the new number; subtract 7 again and notice the new number; subtract 7 and notice the new number. Continue with this exercise until your distress diminishes
Grounding phrase
This is a phrase that reminds you that you can survive the current distress, that it will pass as all feelings inevitably do. You are trying to access a kind, nurturing and reassuring voice. This is by definition difficult, if not impossible to do at times when negative, often excessively critical thoughts are triggering distress. So it is important that this voice is accessed outside of these times (e.g. during the group) and recorded on a flashcard. You can then carry your grounding phrase around with you and read it whenever negative thoughts cause you to feel distressed. If you struggle to access this nurturing voice think about what you would say to someone you really care about if they were distressed or how you would speak to a small child.
2. Sensory Techniques
These skills focus on managing distress through self-nurturing and kindness.
Triggering opposite emotions
First identify the type of emotion that is causing the distress. Labelling the emotions transforms it from an overwhelming experience into a tangible target for intervention. Once the emotion has been identified work out what the opposite emotion and select an activity that will trigger this opposite emotion. Engaging in this activity will trigger the opposite emotion, counteracting the distressing one.
Soothing the senses
One way to reduce emotional distress is to learn to comfort ourselves through soothing each of the five senses; vision, hearing, smell, taste and touch.
Vision:
Focus on nature: take a scenic walk, focus on the vibrant colours of plants/flowers around you, watch fish swimming in a tank/pond, watch birds flying etc
Focus on art: watch a ballet/dance performance. go to a museum with beautiful art
Light a candle and watch the flame
Decorate a room with all of your best/favourite things
Hearing:
Listen to music
Sing/hum to music
Pay attention to the sounds of nature (water, birds, rainfall, leaves rustling)
Talk to others
Smell:
Burn incense
Spray your favourite perfume
Boil cinnamon
Make fresh coffee
Bake a cake
Smell flowers
Taste:
(N.B. This can be a difficult sensation for patients to use initially and so can be excluded until eating has become less emotion driven)
Have a soothing drink
Stuck a peppermint
Chew gum
Treat yourself to food you wouldn’t usually spend money on
Touch
Have a bath
Put clean sheets on your bed
Put a big warm jumper/silky blouse on
Put on body lotion
Wash your hair with nice smelling products
Have a massage
Introducing any new skill/technique can be difficult, however, self soothing maybe be particularly difficult as you may believe that you do not deserve to be nurtured or to have you needs met. It is important therefore to anticipate the negative thoughts and feelings of guilt/shame that you may experience when practicing these techniques and remember that in the longer term they will help you to resolve your problems and move forward from them.
Developing a soothing image.
This involves developing a situation in imagery that you can use to soothe and distract yourself from the actual situation when it becomes distressing. It is important that this image is created and practiced regularly when you are not in crisis so that you are able to access it easily when they really need it.
Exercise:
Close your eyes and become aware of your breathing, breathing in and out of your mouth. Imagining breathing in calmness and relaxation and breathing out distress and tension.
Bring to mind your favourite place and image yourself there. Look around you and take in all of the details of your favourite place, reminding yourself why it is your favourite place. Now think about your favourite time of the year and incorporate this into your image. Focus on the aspect that define this time of the year, the weather, sounds, smells, things your might see. Now adjust your image so that it is your favourite time of the day and become aware of the aspects that define this time of day and the reasons that you enjoy it so much. Now include in your image your favourite person or persons. Focus on that person, your feelings for them and why you have chosen to include them in your image. Now elaborate the image in any other ways that will help you to feel calm and soothed, for example you could introduce your favourite music in to the image, or your favourite pass time. Stay in this image for the next few minutes just enjoying the soothing, reassuring nature of your created environment, absorbing the calmness and pleasure that your surroundings generate in you.
An additional technique that may be useful for those when you feel so overwhelmed by your distress that you are unable to access your grounding image despite frequent practice is to create a ‘bridging’ image. This creates a link from the distressing situation to the grounding image. Examples of such images include: floating away from the distress and towards the grounding image in a boat; taking a glass elevator; an escalator; or being lead towards the grounding image by a good friend.
3. Physiological techniques
The aim here is to reduce distress by interfering with its physiological component through refocusing the senses. This differs from previous strategies because here, instead of introducing stimuli that will trigger a different emotion, you distract yourself from the pain of your internal world by refocusing your attention on your external world. You will be literally physically grounding yourself in your current environment.
Physical grounding
Exercise:
Close your eyes and become aware of your breathing. Focus on your breath as it moves in and out at your nostril. Notice how the air feels as you breath in and then out, notice it’s temperature, how it smells. Now refocus your attention on what you can hear. Listen very carefully to the sounds around you, notice the gaps between sounds, how they blend together. Their volume, pitch, how they eventually fade away. Now notice your feet on the ground. They are literally grounded, connected to the floor. Wiggle your toes inside your shoes. Dig your heels gently into the floor to ground yourself even more. Now become aware of your chair, notice how it is supporting your body, touch it with your hands and notice how it feels. What sort of material is it made, is it warm or cold. Now open your eyes and find an object that is near to you. Pick it up and examine it as if this is the first time you have come across this kind of object. What is it make of, how does it feel, is it warm, cold, rough or smooth. What colour is it? Put the object down. Now clench your fists; notice the tension in your hands. Now release your fists. Now press your palms together, with elbows to the side; press as tightly as you can. Focus all your attention on your palms. Now let go. Finally, roll your head in a circle a few times.
A Grounding position
Our thoughts and feelings influence our bodies. For example when we feel sad or fearful it is reflected in our posture, we may stooped or in some other way make our bodies smaller, subconsciously trying to withdraw from our environment. The direction of influence also flows the other way, so it is possible for the position of our bodies to influence our thoughts and feelings. For example standing up straight, pushing our shoulders back and raising our chins can make us feel stronger and more confident. A grounding position is a physical position in which you feel safe and/or strong. Some people find that curling up is comforting, while others might adopt a more upright stance.
Discover what works for you and then practice it regularly so that you can move easily into it whenever they need to.
A Grounding object
A grounding object is a portable object that can be held during distress as a way of refocusing the senses in the here and now. To maximise the objects effectiveness as a distractor the object must be explored in a similar way to the object focused on in the physical grounding protocol, as if you were coming across it for the first time. It is also important that the object carries some positive meaning for you to assist you in disconnecting from your distress. This, as with most of the other technique will only be effective if personalised and then practiced.
Sensory Distraction
This skill involves unusual, absorbing, but safe sensory stimuli to distract awareness away from painful emotions (similar to thought stopping in its short term nature). E.g. holding ice cubes, crushing egg shells, punching pillows, kneading dough.
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