Top Therapist Shares 5 Essential Tools for Distress Tolerance Toolbox

Hey there everybody and welcome to this presentation on creating safety with a distress tolerance toolbox. I'm your host, Dr. Donnellice Snipes. In this presentation we're going to identify the reasons you might want a safety plan and discuss tools that you can have in your safety plan toolbox. Occasionally life sucker punches you and you will need support or assistance regaining your balance. Sometimes you may just start feeling overwhelmed and not know where to begin. You feel like you're kind of spinning around in circles. Or you might be getting ready to work through a trauma and want to feel confident that you're not going to go into a free fall. Or you might be getting ready to do something that is anxiety provoking and you want to feel like you've got tools to tolerate that distress. That's really what we're talking about today because. Because the more overwhelmed you feel, the easier it is for your distress to be triggered to an exponential degree. Safety plans help you tolerate distress until you can down regulate your fight or flight response. Your HPA axis. Get out of that adrenaline haze and think more clearly. They don't prevent you from feeling your feelings, they provide you support so you can feel them and not be fearful of spiraling out of control. Examples of when a safety plan might be helpful Flying. Some people are terrified of flying, so having tools they can use to help them endure the distress while they're in flight can be helpful. Funerals can be really difficult for a lot of people, so having tools at their disposal that they know they can use in order to help them get through the funeral without completely breaking down Childbirth. I'll tell you, there were times when I was giving birth to my daughter that I was like, I can't do this. And it was important to use distress tolerant thoughts. Yes you can. To help me get through it. Public speaking. Some people are terrified of public speaking and a safety plan can give you tools and strategies to help give you confidence to get through that activity. And being in a crowd. If you're an introvert. My daughter, for example, is an introvert and even going to the mall can be exhausting for her. So it's important for her to have a plan so if she starts feeling overwhelmed when she's in a big crowd that she knows that she has things that she can do. She's not stuck. Stuck. So I encourage you to think about what other situations you've been in that you felt like you were going to just freak the freak out. Before we get into creating the toolbox, a little note about emotions. Emotions can be triggered by anything. And I've talked in other videos about how our emotions are kind of like our smoke alarm. They tell us there might be a problem or like a doorbell that says there might be something good at the door. I don't know. But more with the distressful emotions. Emotions are our smoke alarm. They are based on our mind's best guess of what's getting ready to happen. They're often not based in fact, they're based in emotion focused reasoning. So we start feeling anxious and instead of asking ourselves, okay, what's going on here? What are the facts that support the belief that I am in danger? Instead of doing that, when we start to feel anxious, we start looking around and going, what should I feel anxious about? So we're looking for information to validate how we're feeling. Remember that thoughts are made of words and images. When you're thinking about what you've got to do tomorrow, when you're thinking about what you're going to get for your Aunt Sally for her birthday, whatever, you are talking to yourself using words and maybe even images in your mind. The interesting thing is that your brain has great difficulty juggling multiple words and images at the same time. So try this. Try thinking about what you have to do tomorrow for work or for school and sing the ABCs at the same time. I'll wait. Now, if you tried that, even just getting a little bit into it, you probably noticed that it's really difficult, if not impossible to sing the ABCs, even though that's a song that is. All of us know is rote memory. It's not something we have to think really hard about, but it's really hard to sing the ABCs and think about what you've got to do for work tomorrow at the same time. That's one of the things that we're going to be talking about what you want to do. Or as they say, the one that grows is the one you feed. So whichever words and images in your brain that are more powerful are going to get your attention and likely get stronger. So the one that you pay attention to, the one that you are focusing on, is the one that's going to grow. So if you're focusing on the ABCs, that one's going to grow. And that other voice, if you will, in your head is going to start to get quieter. It's going to be drowned out by your singing. For your safety toolbox, we're going to talk about distress tolerance skills. Remember, these are not designed to help you completely cope with something they're designed to help you tolerate the distress until you can get into your wise mind and figure out what do I need to do? Or until you can get through the situation, like flying or childbirth, or public speaking and feel like you are in a more relaxing place. So I use the mnemonic tags and it stands for thoughts, activities, guided imagery and sensations. Thoughts. This starts out with guess what? Mindful awareness of your thoughts and feelings. If you notice when you start to feel anxious, if you notice when you start to tell yourself distressing things, you start to tell yourself you need to be scared, then you can start to address it at that point. So the earlier you can notice your distressful thoughts or feelings, the earlier you can intervene once you notice that they're going on. It's important to stop those distressful thoughts. Quit feeding them. The more that you repeat them, the stronger they're going to get. So one of the things that you can do is unhooking. When we say I am something, I am depressed, I am scared, I am stupid, then it becomes part of who we are and it's harder to get rid of that. You know, when I am something, it's hard to get rid of that if I'm having the thought now. Thoughts come and go. Think about times you needed to get something at the store but didn't write it down. This is a big one for me. So I don't know, maybe you want to take another scenario. But think about times you needed to get something at the store but didn't write it down. How often does that thought float away? You go to the store, you do your shopping, you get out to your car and you're like, oh crap, I forgot to get the one thing I came here for. I know that's me. I'll have that happen to me even in my own house. I'll get up and I'll start walking into the kitchen and I'm like, I know I was getting ready to do something. Okay? So my point is that thoughts can be very fleeting if we don't pay attention to them. So unhooking, saying, I'm having the thought that this is scary. I'm having the thought that whatever that takes it and puts it out here so you can decide what to do with it, it's not part of who you are. Replace the thought, once you put it out here, you've got to replace it with something or it's going to keep coming back. So replace it with five distress tolerant thoughts. That means five encouraging thoughts, if you will I can do this. I've rehearsed and I know my speech and it will go just fine. Whatever you can tell yourself about how to tolerate the distress if you're flying. Reminding yourself that the facts about the safety of flying are really in your favor. Reminding yourself that the you know, if you hit some turbulence, that turbulence is normal. You know those distress tolerant thoughts that are often grounded in fact instead of emotion. Keep a list with you of five distress tolerant thoughts that that you can consult at any point in time that you start feeling overwhelmed or scared or angry. You can also, if you don't want to use the distress tolerant thoughts sometimes that just doesn't seem like it's hitting the mark that day. Replace it with alternatives like I suggested earlier. Sing you can't. Can't. Or it's a lot harder to think those stressful thoughts and sing at the same time. Not hum, but sing actual sing with words. Pray if you enjoy praying. If you feel like that's helpful. You know, I have my rosary, I will say Hail Mary's. There are a lot of different prayers that I have that I may turn to when I am feeling overwhelmed and I need to just kind of get it back together. Count. Sometimes it's easy as just starting to count. You can count by ones or you can make it even more difficult and count by fives or threes. That again is going to occupy your brain so it's focused on other words, not the distress words. You can also look around and notice and I call this the five things. Notice five things that are green or five things that are brown or, or five things that are, you know, whatever. But again, that is encouraging you not only to use different words because you're going to see something that's green and you're going to say green grass. So those are words. But it's also encouraging your brain to look for images. It's seeing things. So it's replacing distressful images with hopefully positive or at least neutral images. So list three things that you can do when you start feeling distressed that can help you turn your attention away from the distress. It can distract you basically and urge surfing. Just like we talked about. Thoughts can come and go. You know, when we talked about unhooking, you can think of urges and this feeling like you're going to scream or you're feeling distressed. Think of it like waves or panic even like waves, they come in, they crest and they go out again. The only time that you know it can be a problem is if you've got continuing Earthquakes out here that are putting more energy into that wave. So we don't want it. Give the, give the wave more energy. You can also envision thoughts and feelings and urges like clouds in the sky. I still to this day love making little cloud animals. I'll do it when I'm riding in the car or something and just like you can see a teddy bear or a horse or a dinosaur and then it morphs into something else. You don't hang on to it. You don't generally get sad when something else forms. It just, it changes and it moves and sometimes it goes away. Another image that you can use is one of bees. If obviously, as long as you're not allergic to bees, in which case this would be stressful. But if you're not allergic to bees, you know, sometimes a bee will land on your arm if you swat at it. If you try to make it go away, a lot of times you're going to frighten it and it will sting you if you just wait until it's bored or whatever it does. I don't know if bees get bored, but eventually it will fly off and you won't get harmed. And it won't get harmed. So think of your distressful thoughts, kind of like that bee. Think of your urges and your feelings, kind of like that bee. It's unpleasant to have it there, you want it gone, but if you just are patient, it will eventually fly away on its own activities. Focused breathing, I think, should be in everybody's toolbox. And focused breathing is as simple as breathing in for four, holding for four, and breathing out for four. Now, with kids and even with adults, you know, I'll admit I do it. Blowing bubbles can be a great option for focused breathing. Breathing in and trying to blow one great big big bubble. Because that means you have to exhale gently and slowly. So that can be another way to do focused breathing. Obviously, if you're in the middle of the airport, you're not going to start blowing bubbles. But if you can get out, that can be a fun thing to do. Even, you know, well, probably wouldn't want to do it at work. But if you do, you know, you can go out and take a break and blow bubbles, call a friend. You know, that's an activity that can help distract you. You don't necessarily have to talk about what's going on. You can talk about something completely different. But calling a friend and getting that social support, get your blood pumping, walk up and down the stairs, do jumping jacks, do push ups. When you are in fight or flight mode, your heart rate is racing, your respiration is increased. Your body, however, is often sitting still. So there's a disconnect between your body and your nervous system. So when you get up and you start moving around, then when you slow down, a lot of times your body, your respiration and your heart rate will also slow down in sync. So you're basically kind of getting your nervous system in sync with what your body's doing. Play with or pet an animal. Lots of studies have shown how this can be relaxing. It can release oxytocin, it can lower blood pressure. I'm a big fan of emotional support animals. Watch a comedian or a YouTube playlist that makes you happy. I have a YouTube playlist that I call Happiness Nuggets. And they're just a variety of videos that I found throughout the years. I that make me laugh, that make me smile, and when I'm having a bad day, I know I can go there and just click on any random video and it's probably going to grab my attention with images and I am going to be focused on that at that point in time. So I'm not thinking about whatever it is that I need to take a break from. Do something that takes just enough mental energy to occupy your mind. Crochet. That's, you know, not everybody's down with crochet, but crochet takes just enough mental energy, especially if you're doing a pattern. So you're doing, you know, two single stitches and then, you know, a double crochet and then two single stitches or something. You've got to keep that rhythm going. And knitting's the same way. Gardening, if you're pulling weeds, it takes just enough energy to pay attention to what you're pulling. Mowing, you know, especially if you don't want to hit the sprinklers and things. It may take just enough mental energy, even for a short period. Surfing the Internet and, you know, surfing the Internet can get out of hand sometimes. If it starts taking hours and hours, you may try to set an alarm. So after 30 minutes or something, you get off the Internet and figure out, okay, what am I going to do to deal with this? But sometimes it can be something that occupies your mind until your brain can down regulate and you can get into your wise mind. I'm sure there are other activities that might be useful for you, so think about what activities can you do? Guided imagery. I love guided imagery. Colors are one form of guided imagery. If you have pain, for example, you can imagine the color red over top of where that pain is and imagine it slowly turning to a blue color. If you are feeling angry, you can envision the color red over top of your heart maybe, and envision it slowly becoming blue, or inhaling blue and exhaling red. You know, so blue and red are my go to colors, but you get the point. You can envision the stress as one color being replaced by another color that's more calming. You can envision your distress like a sound knob and envision yourself turning down that knob, turning down the volume of your distress. Likewise, you can envision a thermometer and see the temperature of your distress slowly going down. I've had some clients who've envisioned force fields, especially if they're in a crowded area and they get overly distressed by being in large crowds. Sometimes they'll envision a force field around them, protecting them from other people being in their mental and physical space. Angels, fairies, superheroes. Some people enjoy envisioning these beings assisting them with whatever the problem is. Loved ones. I like this one. Envisioning a loved one, alive or dead, giving you a great big hug, or sitting next to you, encouraging you through whatever it is that's causing you distress. Go to your safe place, and I use that in quotes. Envision whatever place you think of as your safe place and identify five things that you see, four things that you hear, three things you smell, two things that you can touch, and one thing that you can taste. Think about your favorite memory. You know, what is one of your favorite times in your life. You know, just transport yourself back to that time and again think about who was there, what was going on, how did you feel and, and sort of immerse yourself in that memory. Or you can even envision yourself successfully accomplishing the task or coping with what's going on. You can envision yourself walking out and giving that speech, or you know, whatever it is that you're getting ready to do to help prime you and give you confidence that you can do it. And finally, sensations. Some people get overwhelmed or overstimulated a lot more easily than others by sights, sounds, smells, temperatures, those sorts of things. If that is, you have things that you can use in order to buffer against that overstimulation. Like if bright lights bother you or flickering lights, like when you're driving down a tree lined street, if that bothers you, having sunglasses that are dark enough to be able to buffer against that. Have desk lamps where you work or where you live. So if the overhead lights are too bright, too ominous, you can turn on a Softer white bulb that has a lower intensity. Have pictures that make you happy and reflective. I encourage everybody to have at least one album on their mobile device that they can go to when they're feeling nostalgic or when they want to feel nostalgic and kind of transport themselves and have an escape plan if you get overstimulated, even if it's just knowing where the bathroom is so you can go in a bathroom stall and just, you know, shut everything out for a second. Having an escape plan is important. I remember one time I flew into JFK airport and I have never experienced quite that much in terms of hustle and bustle and congestion in any other place I've been in. And I'm an extrovert, you know, I like being around people, and that was overwhelming for me. I was very grateful when I was able to get to a place where it was quite quiet. I can only imagine what it's like for somebody who's an introvert or somebody who is neuroatypical to be in that sort of situation. So always know that you have an escape plan. Sounds Sometimes it can be helpful when you're in a bad mood, when you're feeling distressed to have soothing sounds like classical music or birds flowing water. For my son, it's Gregorian chants. Who knew white noise machines? There are a lot of different soothing sounds that you can have on in the background if that is something that's helpful. Some people, on the other hand, want quiet. They don't want any auditory input. So noise canceling headphones or earplugs can be very, very helpful to them. Also finding sounds that trigger the opposite emotion. You know, sometimes for me, I like metal, so if I am in a bad mood, I will typically put on my headphones and I will just jam to some really loud heavy metal music. And that tends to transport me into a different place mentally until I can, you know, regroup. Smells again. Some people get overwhelmed easily by smells, whether it's perfume or cologne or aftershave or, you know, air fresheners. Keeping a handheld fan with you to handle overpowering smells can be helpful for people who get overwhelmed easily. You can also carry with you in a little tiny snack Ziploc bag scent cloths or wax tarts that you can sniff to replace noxious smells and trigger opposite emotions. You know, some law enforcement officers a lot of times will carry Vicks Vapor Rub with them if they have to go into an environment where it's really stinky. But you can do lots of other smells. Whatever smells and aromas that you like, which is why I say wax tarts. It doesn't have to be essential oils. I actually went to the store today and I got a bunch of another selection of wax tarts because I'm kind of a scent junkie, if you will. And I have one in, in the plugin in my wall right now. This just smells amazing. It's putting me in sort of an amazing relaxed, happy fall kind of mood. Touch is the final sensation that we're going to talk about. And weighted vests can be very helpful because it triggers the release of oxytocin and it can also be calming. So for some people, a weighted vest may be very helpful. You know, they can wear it under their jacket or under their sweater. That's not always practical for people, but if that's something that helps you, obviously that's an option. Having an ice or heat vest or pack can also be helpful. Strong sensations like changing the temperature, like wearing an ice vest or wearing a heated vest can direct your focus towards that sensation and away from the mental distress. And a soft blanket or scarf, I know I have one scarf that, that I absolutely love. It is some of the softest yarn that I have ever experienced and I love wearing that because it just, it's all warm and fuzzy and you know, that's not for everybody. But I like feeling that sensation and it's something that I can focus on when I'm feeling distressed. I, you know, I may not even be wearing it around my neck, I may be running it through my hands, but it's a soft tactile sensation that I can focus on. When you're in the midst of distress, it's often hard to recall these tools, so write them down. Keep a list of your tools on your mobile device. Plan ahead. Don't wait until you're under distress to try to find those funny videos. Make a YouTube playlist. Make a distress tolerant thoughts. Listen. Have a list of phone numbers of the people that you could call. Keep your headphones with you, etc. Many things can be stored on your mobile device or in your purse or a backpack, so you have them with you at all times. And again, if you're going into a stressful situation, get your tool or tools out ahead of time. Like if you're getting ready to go on an airplane and you're afraid of flying, you know, know what your tools are. Have them at the ready. You can even look at a picture of somebody. That's encouraging. Review your distress tolerance mantras. Always know what your escapes are. Now, obviously, on an airplane, there aren't a lot of escapes. But if you are at a shopping mall and it starts to get really busy, or you're at a football game and it starts to get really loud and overwhelming, or where can you go that you feel like you can decompress for a minute? Your safety toolbox can help you move through distressful events and emerge feeling more confident. Once you go through that event, that flight, that activity, whatever it is, and you realize that, hey, I did that. It didn't break me, then that adds to your sense of confidence that you can handle similar situations in the future.