Distress Tolerance and Nonsuicidal Self Injury Live Chat with Dr. Dawn-Elise Snipes

It's. Good morning, everyone, and welcome back to another installment of our quick tips for living a happier and healthier life. Remember, yesterday we talked a lot about hardiness, commitment, control and challenge and serenity. Today, we're going to move on to talk about distress tolerance skills. Distress tolerance does not mean ignoring how you feel and avoiding it completely. Distress tolerance means acknowledging how you feel in the moment, whether it's angry, happy, scared, whatever it is, acknowledging it and saying, okay, I'm going to put it aside right now until I can get back into my quote, wise mind. Distress tolerance skills help us reduce our HPA axis, our threat response system activation, so we can think clearly. Think about when the smoke alarm goes off at your house. And that's kind of like our HPA axis. It's telling us that there might be a threat. Well, I don't know about you, but when the smoke alarm's going off at my house, I cannot think clearly. It is too noisy. It is obnoxious. I just want it, you know, I don't want it to stop. And that's all I can focus on at that point in time. Once I turn off the smoke alarm, take the battery out or whatever I need to do to get it to stop for a moment, then I can think more clearly about, okay, what's going on. So it's important to recognize that our HPA axis is what gets activated when we think there's a threat and it tells us to fight or flee. It doesn't tell us to think about it. It says fight or flee. Fight or flee. Fight or flee. Well, when we start feeling that feeling, we want to look around and go, okay, let's look at the big scheme of things. Is there actually a notable threat right now? If not, all right, let's take the next step. Let's turn off that smoke alarm so we can think more clearly about how to solve the problem. Distress tolerance skills help you tolerate those powerful, unpleasant emotions until you can get into that logical or that wise mind and figure out how to change the situation, or in some cases, just change your reaction to the situation. Think about if you've ever had. I think most of us have been in the situation where we've had gone, gone to the doctor and had tests run, and we had to wait for those test results to come back. And sometimes it can feel just impossible to wait that long. Your anxiety's up. You want to know the answer. Well, in that situation, you can't make those test results come back any faster than they're already going to Come back. So what do you do in the meantime? Do you spend the next three, five days, week just fretting over it and being anxious all the time? Well, you could, but is that a good use of your energy? Probably not. Is that going to help you sleep, help you feel better, help your mood? Definitely not. So distress tolerance skills are things that you can do to help yourself. Not dwell on that until you have all the facts there and you can figure out, okay, what's my next step? Step? Cancer is the same way. When my mother was diagnosed with cancer, you know, I could have fretted about it and been upset about it and just held on to that emotion, but that didn't do any good. I, you know, took that moment when I got the news that she was diagnosed with cancer and I allowed myself to be upset for a few minutes and then I said to myself, okay, what do I need to do? And the first thing was to clear my head, to use my distress tolerance skills. So what are distress tolerance skills? We're going to talk about four general categories of them. If you have gone through dbt, you know, Linehan has many more different types of distress tolerance skills, but I like to narrow it down when I'm working with people to four general areas. The first one is thought stopping. If you have a situation and you're thinking to yourself, oh my gosh, what am I going to do about this? And you are dwelling, if you want to think about it that way, dwelling or stewing on the negative or the fearful aspects of it, that's just going to keep that HPA axis going. It's going to keep that smoke alarm blaring and make it more difficult for you to think through the logical next steps. So what can you do? Well, you can envision those thoughts like a volume knob, like it's the radio, and envision yourself turning down the volume of those thoughts. That works for some people. For some people, they talk back to their thoughts. They say, you know what? I am not going to think about this right now. So when they start having those anxious thoughts, those angry thoughts come back and, or the resentment, whatever it is, they talk back to themselves. They talk back to those thoughts and say, you know what? No, I'm not going there right now. And you can tell when I talk, when I talk back to those thoughts. You know, I actually do use my hand. I'm like, no, not doing that right now. And the third one I just call the lala. Um, I don't know what else you want to call it, but it is basically occupying your auditory areas of your brain with something else. Singing a song even. You know, when little kids don't want to hear what their parents are trying to tell them, they put their fingers in their ears and they go, la la la la la. Well, that's kind of what I'm talking about here. When. If you've been to some of my other classes, you may or may not know, know that I have this completely irrational fear of bridges, and we can talk about where that came from, yada, yada. It's not important. What is important is I know I have a fear. I know it is a not a rational fear. But when I go over a bridge, you know, those thoughts want to come into my mind, and instead of entertaining them, I do the la la, if you will. I start singing a song. And sometimes it's as simple as the ABCs, whatever it is, to get me over that bridge, literally is what I do. And when I'm over the bridge, you know, I feel better. The thoughts have gone away. You know, magic activities are the next category. So you have thought stopping. Then you have activities. Do things that make you happy. If you are feeling overwhelmed, if you're feeling sad, if you're feeling angry. Okay, let's counter that with the opposite. You can do a gratitude activity. You can go on YouTube and. Or Pinterest or Instagram or TikTok or wherever you go to find funny videos. You can go out. I go outside and I watch the squirrels. I love squirrels. I usually keep peanuts in my. In my desk drawer so I can, you know, throw some out to the squirrels because I think their little hands are so cute when they eat peanuts. But whatever. So doing things that make you happy, does it solve the problem? Whatever's making you upset, angry, overwhelmed? No, it doesn't. But it allows your body, your HPA axis to calm down a little bit. It turns off or at least turns down the volume of that smoke alarm, if you want to continue to use that metaphor so you can think more clearly about. All right, you know, this is what's going on. What is the best next step? Now, sometimes you may not want to. You may not feel like doing things that make you happy. You may just be in a, you know, place sometimes, just doing things that distract yourself. For me, I will go out and garden. I will pull weeds. If I'm really needing distraction, I will yank out the power tools around my house. My kids know that the larger the power tool is that mama's using, the more that she. More, more she needs A little bit of space. So when I'm really upset, I've got the chainsaw out. When I'm only a little bit upset, I'm just hand pulling weeds. And, you know, that's kind of the measuring stick that they use. Make a list of things that you can do, because when you're upset, you're not going to be thinking, all right, now what can I do that's going to make me happy? Have a playlist on YouTube or tick tock or if you can do a playlist there, I don't know, have things saved ahead of time. You're not going to be in the mood to try to search out something that makes you happy. When you are distressed and do this, you know, 10, 15, 20 minutes, that's all we're talking about. We're not talking about doing it for hours on end, but it takes about 15, 20 minutes for urges and feelings, reactions to dissipate. The third area is guided imagery. And you can, you don't have to do all of these. You can just pick one, that's fine. But some people like guided imagery. They can do it wherever they're at. If you have a bad moment at work and you can't get up and leave and go do something that makes you happy, all right, well, what can you imagine? And I encourage people to think, think again ahead of time of what their quote, happy, happy place looks like. Mine is a cabin in the woods next to a flowing stream. You know, that's, I love the sound of moving water. So when I go to my happy place, I go into my own mind and I think about what are five things that I see in this place, what are four things that I hear, what are three things that I smell, and what are two things that I can feel. When you are focusing all of your senses in this vision that you're creating, it forces your brain to not think about that other stuff. When you're focusing your brain, focusing your senses on that happy place, guess what? Your happy neurochemicals, your gaba, your serotonin, those, those are going to start to be infused and the norepinephrine and the glutamate are going to go down. That HPA axis is going to turn down a little bit so you can, you know, emerge 10, 15 minutes later, five, if you're really good, I don't know, and you will be able again to be in your more logical or your wise mind. Another way you can use guided imagery is envisioning yourself successfully resolving the issue. Maybe you're waiting on those tests, those medical tests to come back. Maybe you are envisioning you're, you're stressed out because you know you've got to go in and have a meeting with your boss. Well, envision yourself, see yourself going through that situation and successfully handling whatever it is. A lot of times if we are upset about something, we envision the worst possible outcome and that is what we call emotional reasoning. You're assuming that because you're stressed about it, it's going to be a big deal and you know, bad things are going to happen. So really look at the facts, the logic behind it and envision a positive outcome. Even if it's going to be something, maybe you, you're getting in trouble for something at work. All right? It happens sometimes. Envision yourself going through it. How are you going to handle it? So you emerge, you know, the other side, none the worse for wear. And the fourth area is sensations. And this is a big one for people who get really stressed out and tend to be more impulsive. They, you know, want to self injure, they want to drink, they want to run, they want to get away. Sensations can be really helpful at refocusing you. My favorite one is, you know, either using an ice bath or holding ice cubes. If you've ever done that, if you've had to ice your wrist or your ankle or anything, you know, that's kind of unpleasant and you're not thinking about a lot of other things at that point in time. Other things you can do. When I work with school aged youth, encouraging them to identify sensations that they can do, they can go to the bathroom and splash water on their face. They in the women's bathroom, you know, we have the stalls, they can go into the bathroom and lean up against one of the stalls, you know, go in the stall inside, shut the door, lean up against it and slide down so your thighs are parallel with the, with the ground. We call these wall sits. And after about 30 seconds your legs are going to start to burn a little bit and that helps you refocus on what's going on. It is a physical sensation that you do have control over and, but it is a powerful enough sensation that you're going to be thinking about it. Push ups, sit ups, running, those are other things that you can do but focus. Finding sensations, something that is powerful enough to draw all of your attention for that, you know, 10 minute period that you need to stop thinking about whatever it is that is upsetting you so much. So you can, you know, let the adrenaline Bleed off, get back into that wise mind and be able to think and ask yourself what? What is the next thing I need to do to improve the next moment? Are there questions? Distress tolerance skills, like I said at the beginning, they are an intermediary step, they are not an end. You're not coping with anything when you just stop thinking about it. The goal is to use the skills to help you tolerate the powerful emotions until you can get, you know, out of that whirlwind of distress and think more clearly. Ultimately, once you finish using your distress tolerance skills, then you've got to figure out, you know, what is the next best thing that I can do to improve the next moment. Your problem solving skills, your coping skills come in handy there. Remember too that vulnerabilities like being over tired, being. Malnourished, being dehydrated, all of those things, being in pain, all of those things can make you more vulnerable to distress. So it is important to recognize what things make you more vulnerable to distress and try to prevent those as much as possible. Because you're going to have unpleasant events, there are going to, you know, life's going to happen sometimes and throw you a curveball. The more prepared you are for those things, the more well rested, well nourished, the more your system is energized and reinforced, the easier it will be to deal with stress. One of the things Kim White Feather is asked a question about self injury and I do have an entire presentation on the YouTube channel on non suicidal self injury. But we need to focus on what is the function of self injury. And for most people, non suicidal self injury is a extreme distress tolerance skill. Obviously not one that we want people to continue to use, but let's look at what it's doing. It is by its very nature controllable. When somebody is self injuring, that is a pain, that is a sensation that they can control when what is going on in their heart and their head feels out of control when they are self injuring. But because of the pain, just like holding ice cubes, it redirects their attention to whatever that pain is. Which is why, you know, holding ice cubes, using those really powerful sensations is a harm reduction or a step down from self injury because we don't want people to injure themselves. But understanding the function of the behavior, all behavior is communication. What is this behavior doing? Some people self injure for other reasons, such as to get attention. But the vast majority of people who engage in non suicidal self injury actually hide their injuries. They're not trying to do it for attention. They're trying to do it to fit figure out how to cope with overwhelming distress. Working with the person who is engaging in non suicidal self injury is really important to empower them and help them recognize the function that it serves. Most people who engage in non suicidal self injury are quite aware of the reason that they do it or how it makes them feel better. They just don't know. They can't think of any other options at that point in time. You know, all they can think of is either I do this or I do nothing. And it's important for us to help them brainstorm alternate techniques that they may be able to use. A lot of times in response to your question about would taking fast acting medication for anxiety in that moment be helpful for a lot of people the answer is no. For some people it may work, but then you risk developing dependencies. Your, your really fast acting benzodiazepines are highly addictive. So you know that has its own set of issues to be, to be concerned with. It may it is an option for some people, but encouraging people to find non pharmacological ways of dealing with that distress. If they are constantly medicated then they may miss out on other aspects of their life that are enjoyable because they are, they're in a, in a haze a lot of the time. I'm not saying that it's not an option, obviously it is an option. But my experience working with people who engage in non suicidal self injury, a lot of them have already tried medications and it didn't do the job, it didn't do it quick enough. They, they need relief and they need it right now. Not 20 minutes from now, not an hour from now when the medication kicks in. Great questions. Are there other questions about distress, coping, non suicidal self injury, whatever you're interested in talking about, you know, if there are other questions, I am more than happy to, you know, try to discuss them with you. Is dialectical behavior therapy more effective than what it's. I do like while I'm, while I'm waiting on the chat window to continue to, to scroll. I do love dialectical behavior therapy and acceptance and commitment therapy. DBT has a lot of great tools for handling just exactly what we're talking about. But you I'm not understanding your question about is DBT more effective for the patient than as opposed to cutting? Well yeah. DBT was actually designed specifically for people with borderline personality disorder who often engage in non suicidal self injury. So there are a lot of techniques and one of the reasons that linehan suggested the sensations was because it provided a controllable, non, non injurious alternative for people who, you know, when they felt completely overwhelmed and needed relief, you know, instantaneously, it gave them an option of something to do. And as I said earlier, remember distress tolerance skills are not coping skills. They are designed simply to allow the brain, allow the HPA axis to turn down so you can get into your wise mind and figure out what the best coping strategy is. And when you're looking at the coping strategy, that means addressing the underlying issue. What is it that caused you to get upset, that caused that emotional discontrol and or disregulation? And what is it that you need to do to address it now and potentially prevent it in the future? Remember, when you're working with people, a lot of people, the vast majority of people unfortunately do have histories of trauma. And one of the results or consequences of trauma is a feeling of helplessness, powerlessness and unsafeness. Fear, lack of a better word, like we talked about yesterday. In order to address that, one of the key factors that we really need to focus on in the recovery process is helping people feel safe and empowered. You know, that is the antithesis of unsafeness and helplessness. We want to help them develop learned empowerment. For if you want to think about it that way. All righty everybody. Thank you for being with me today. I appreciate you tuning in. Remember, if you like these live streams to subscribe so you know when I'm going live, please share the channel with your friends who may benefit or may be interested in these topics. You know, the more people I can get the word out to, the better and that helps me keep the keep the channel going. As always, if there are particular topics you're interested in learning more about. I have over 600 videos on the YouTube channel, so chances are I've probably done a long form video on it. But if you're interested in a particular issue for these short videos or if there's something that I haven't covered in a long, long form video, you can email me at support at allce. Com. Have a great day and I will see you tomorrow.