Coping Archives - Page 3 of 4 - Kate Gegg, AM, LCSW

June 23, 2021March 27, 2023

Secondary Gains

If you have been trying to make a change in your life, but find yourself unable to sustain it, you may want to consider “secondary gains”
Secondary gains are the positives or benefits associated with something that is otherwise problematic in our lives
Often, we are so focused on how a behavior, choice, or response is “a problem” that we don’t see how it benefits us
Sometimes there are perks to thought patterns, reactions, ways of relating, or behaviors that otherwise concern us or the people around us.
We may not be aware of the perks, and it can take active reflecting and internal exploration to identify how we may be benefiting from something we or others in our lives identify as problematic
For example: Maybe our angry outbursts help us regain control, or help us feel powerful at a time when we’re feeling helpless. Maybe our excessive drinking helps us feel confident and enables us to be relaxed and in the moment in a way we otherwise struggle with.
Sometimes, our secondary gains are actually concepts that we hold onto – concepts that help us manage in our lives and in the world at large.
If you are finding yourself stuck, and unable to make a change despite your best efforts it’s time to consider if there are secondary gains.
Once you’ve identified them, you may need to reconcile how to receive those “gains” elsewhere from other concepts, actions, or behaviors, or if that’s not possible than face the losses that may come with making the change you want or need to make.
Further explanation in post and detailed examples in comments.

Despite our best efforts and intentions sometimes we find ourselves unable to make a change. We can get stuck in a pattern of doing something we desperately wish we could stop. This can apply to any change we want to make, from how we think about things, to behaviors, to substance use, or relationship patterns. We know our choices, responses, or how we are handling ourselves is not what we want, yet we cannot stop or break the pattern or cycle and engage in a new way of being.

As a therapist, when I hear about situations like this I will find myself curious about possible “secondary gains”. Secondary gains are some added benefit, something positive, some way in which some part of this pattern or cycle actually DOES benefit you.

When I start asking clients about this, I often get a lot of “nothing. There are no benefits. I hate that I do this and I wish I could stop”. It can be hard to “flip the script” and start thinking of how something you dislike about yourself or your choices actually serves you or benefits you.

Even for problematic patterns, behaviors, or choices there may be positives too, positives that we would lose when we make a change, and positive that draw us back into the cycle again and again. These positives are the “secondary gains” that can make change difficult.

So, while it might be something we wish we weren’t engaging in, sometimes the only way for us to make a change is for us to allow ourselves to consider how we ARE benefiting from it. To do this, we often need to actively suspend our narrative that “it’s bad” (even if we know it’s problematic) and give ourselves permission to list out what is good, helpful, unique, or powerful about it. That work, of being honest with yourself about what is “good” about this “bad” thing can bring about some difficult truths, but it is essential for you to get in touch with them to get over the road-block of secondary gains.

Once we can get in touch with how we are benefiting, we can figure out how to get those benefits in other areas of our lives, or process and accept the losses that will come with making a change.

Notes:

Example: Imagine you want to slow down your drinking. You’ve make a lot of efforts to cut back, but you can’t seem to stick to them. It might be helpful to consider what you would lose if you cut back on your drinking. Maybe alcohol helps you relax in a way nothing else does, maybe it drowns out your anxiety in social situations. If you work on increasing your capacity to relax, or decrease your social anxiety you may no longer need the secondary gains of alcohol and it may be much easier to cut back.
Example: You can’t seem to stop snapping at people in your life (i.e. yelling) when you’re frustrated, overwhelmed, or upset. You know this is an issue, and you feel ashamed about it, but you can’t seem to change the pattern. Perhaps it’s helpful to consider what you gain by KEEPING the behavior intact. Maybe it’s the only way you know how to release your own emotions and it feels like your feelings won’t settle until you let them out in this way. Maybe you hold a fear that if you don’t yell at someone they won’t change, and so it feels (on some level) like this is the only way someone can “learn their lesson”. Maybe when you snap and yell it’s actually a way you regain control, since everyone else’s behavior instantly stops. If you can work through the ways in which you actually feel safe, protected, and in control by snapping and then work to find other ways to feel safe and in control in those moments without the snapping behavior the snapping will be much easier to change. This may mean working on decreasing your reliance on the control you feel when your anger erupts.
Example: You’ve gotten into a pattern of cheating on a spouse or partner. You feel terrible because you believe in monogamy but you find yourself again and again drawn towards someone outside of your relationship. It may be time to consider what you DO gain either from the person, how the person makes you feel, the outside relationship, or the experience of courting someone. Maybe there is something enlivening in the risk taking, maybe it helps you feel attractive in a way you haven’t for sometime, maybe you find yourself more able to be honest with a stranger than with your partner and you crave that ability to be honest in your life. You may need to work to find ways to incorporate those positives into your life and / or your relationship. If you can give yourself permission to explore what you are gaining by the behavior and the relationship(s) it will be much easier to change the pattern(s).
Example: You find yourself in a pattern of getting overwhelmed with obligations or responsibilities. You feel like you can’t say no to things because you feel guilty when you do, but time and again you find yourself burned out. As much as you try and set more boundaries you can’t seem to and the cycle repeats again and again. It may be time to consider what the secondary gains are here. Maybe you actually feel proud of yourself for being able to “manage so much”, and maybe it boosts your self-esteem to “get so much done”. You may also enjoy telling others or telling yourself about the list of accomplishments, and you may also feel like “this is what is means to be a good friend / family member / colleague etc”. So despite your burnout and misery, you may not be able to make the change without first finding other self-esteem boosting experiences and without working through this concept you’ve held onto about what it means to be a good support to others.
Example: You’ve fallen into patterns of helplessness in relationships. You ask for things before trying for yourself more often than not and its hurting relationships in your life. This may become hard to change if there are secondary gains to the helplessness. Perhaps you take comfort in people stepping in to help you, perhaps its how you reassure yourself that you’re not alone. It may be a way in which you feel powerful or in control by asking something of others and having them provide. You may feel scared of failure if you were to try doing things more independently and while you know this tends to rub people the wrong way and hurt your relationships, you don’t feel you can let go of the pattern. Facing how this way of being benefits you, and working to build in those benefits in other areas of your life will make it much easier to change the behavior.
Secondary gains are not the only barriers to making changes. See this post on “how change happens” for more help understanding barriers to change.

June 14, 2021March 27, 2023

Acceptance

Sometimes the reality we want or believe “should” exist is not the reality that’s in front of us
When we don’t want or can’t accept something we can fight it by hiding from it, pushing it away, denying it, or actively resisting it
This applies to our external reality (including facts about our family, our culture, our country, our jobs, and our lives)
It also applies to our internal reality, including thoughts / feelings we may not like or want to be there, and thoughts / feelings others tell us we “shouldn’t” have.
When we are stuck in the place of non-acceptance, we are in a no-mans-land of desperation, anxiety, resistance without traction, refusal, and misery where we are trying to control, change, and prevent something that already is.
For many of us, the fixation on the reality we wish were true is a distraction – a way to shield ourselves from the pain, shame, embarrassment, loss, or disappointment that would come if we conceded to what the reality in front of us was telling us about our lives or the situation we were in.
When we accept the reality in front of us we can still work towards changing that reality. When we accept we don’t have to approve, or condone.
With acceptance we acknowledge what IS and from that baseline we can make changes in our lives, relationships, or the world around us – rather than being caught in the in-between of what is true vs what we wish or want to be true.
Sometimes the most important thing for us to accept is that we don’t have the power or authority to make or prevent a change we are not comfortable with. When we accept that reality we can begin to refocus on items we do have control over and pursue what is meaningful to us in other ways.
If you have found yourself “cycling”, unable to stop thinking about something, or in a pattern of repetition in your life consider that you may be resisting accepting the reality of something in front of you.

A lot of the distress in our lives is driven by our struggles to acknowledge and accept a reality we do not like or approve of. A “this can’t be happening” mentality can consume us, and efforts to “make it right” or “not let it happen” can preoccupy us. We can just refuse to put up with it as though digging our heels in and not accepting something changes it from being real or true.

As Bessel Van Der Kolk writes of his training, “The greatest sources of our suffering are the lies we tell ourselves’ …be honest with ourselves about every facet of our own experience…people can’t get better without knowing what they know and feeling what they feel”. Our refusal to accept the situation at hand (which includes realities in both our internal and external worlds) creates the suffering Van Der Kolk writes about; we are miserably stuck in-between what we wish to be true and what is. This is when we can get stuck doing the same things over and over – wanting a different result, but not getting one.

We can then be given advice that may not sit right with us, which is to “accept” the situation at hand. For many of us the term accept has associations of approval tied to it, “if I accept it, that means I am saying it’s ok”. So we push aside that advice and continue on in our state of limbo where on the one side we have the reality we wish were true, and on the other side we have the reality that actually is.

If the term “accept” doesn’t sit well with you try concepts like acknowledge, recognize, or observe. When we acknowledge what is happening, we recognize the reality in front of us without condoning or approving of it. We don’t have to like it, but until we can acknowledge it for what it is we can’t start making changes that make us happier, or make our lives or our world better.

For nearly all of us, once we reach that point of acceptance or acknowledgement of what “IS”, a huge burden of distress is lifted. We can be left with loss, pain, and other difficult feelings, but feelings can be resolved, unlike the constant cycling of refusal, desperation, anxiety, and resistance that can stay with us when we are not recognizing and accepting the reality in front of us.

Notes:

Sample statements that can help move you towards radical acceptance / acknowledgement; “this is just what is happening right now”; “I don’t like it, I don’t approve of it, but it is the reality in front of me”; “I want to work to change it, because I’m not ok with it, but I accept this is what is happening and I will do what’s in my power to work towards creating a different reality”.
This post describes radical acceptance as outlined in Marsha Linehan’s‘s skills training manual on pages 176 and 102 Full citation: Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.
The quote is from pages 27-28 of “the body keeps the score”. Full citation: Van, . K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.

June 14, 2021March 27, 2023

Why Meditation

We can work towards having control over our inner world by increasing our ability to control what we pay attention to
For many of us a powerful thought, reaction, or feeling can arise and completely take us over
This is often disruptive, exhausting, and time consuming. We can feel like the thought or feeling is in control of us.
We can dramatically increase our ability to take the intensity out of our thoughts and feelings which gives us more control over our inner experience, actions, and reactions
To do this, we want work to control what we pay attention to, rather than trying to control what comes up for us.
With meditation we can strengthen our ability to select where we place our attention and energy, rather than having our thoughts or feelings decide for us
We can also learn to tolerate our thoughts and feelings without having intense reactions to them
This is NOT learning to “block” feelings, experiences, or thoughts by “tuning them out”.
This is also NOT sitting with a blank mind or a relaxation exercise.
There will be more instruction to come on how to do this, but the goal is to increase your ability to have thoughts, feelings, and take in experiences while still remaining in the driver’s seat of your life.

We can’t control what happens to us, and “what happens to us” includes our thoughts and feelings. We can develop strategies for how to manage them, but ultimately the thought or feeling that arises for us is as much out of our control as the actions of the person down the street.

One of the most powerful things we can learn to do to help us manage our mental health is to strengthen our ability to control where we place our attention, and to increase our ability to tolerate our thoughts and feelings. The more skilled we are at this, the better we are able to manage difficult internal thoughts and feelings when they arise, and the more control we can have over our actions and reactions.

Most of us do not have an intentional relationship with our internal world. We feel a strong emotion, or have a strong reaction and that takes over our attention. Our internal world can then distract us from our external world – making it difficult to focus on an activity, project, person, or event.

There will always be overwhelming moments in life. Most of us can’t learn to take all the power and intensity out of those moments, even with meditation. Sometimes, we will still be distracted by intensity in our internal world, or events that disturb us in our lives. However, we can dramatically reduce our susceptibility to the intensity of these experiences by increasing our ability to control where we place our attention.

With meditation we learn to develop a spotlight around whatever we’ve chosen to focus our attention on. Like a spotlight, the stronger our ability to control our attention, the more we can focus on what we’ve chosen to focus on, and the less energy and attention is given to what we’ve chosen not to pay attention to.

The specific skill that I’ve seen enable many of my clients (and others) is a particular kind of meditation where we are working on observing our thoughts, feelings, and sensations without reacting to them. This skill, like a muscle, requires practice. The good news is it can take as little as 30 seconds a day for you to dramatically increase your ability to control your attention.

Future post to cover HOW to do this.

Notes:

1`. Chelsea Handler’s book, life will be the death of me, covers her journey through therapy and how her use of mindfulness (and therapy) changed her life.

2. I want to be clear: meditation is not intended to numb you, or desensitize you from painful experiences in your life or events in your community. We are not sticking our heads in the sand and “ignoring”. When we control our attention the goal is not to “block things out” (that would be avoidance). There will be more posts to come on how to do this!

3. Jon Kabat-Zinn ‘s book “wherever you go there you are” is an excellent introduction into mindfulness and meditation

May 31, 2021March 27, 2023

Emotional Blocking

Our emotions continue to effect us even if we don’t perceive them
Even if we don’t feel or notice our feelings they can still have a major impact on how we process the world around us
Some of us believe our emotions don’t influence us, and we are ruled only by logic or reason
Some of us know we have feelings, but they slip away and escape us before we can really make sense of them
This post is for those of you who feel like your emotions are far away or hard to hold on to. There will be posts to come to help you sustainably get in touch with your inner world
To get better at noticing, feeling, and making sense of our emotions we need to learn how to turn the volume up on our feelings in a way that doesn’t overwhelm us, but has emotions stick around long enough for us to make use of them.
Emotions are complex, but they involve brain and body changes in a feedback loop. We can learn to tap into that feedback loop to help us be in better touch with our feelings
For those of us that have a hard time registering what we are feeling starting with our bodies is often the more accessible entry point.
Each feeling has combination of body sensations and brain changes that make it distinct. We can learn to pay attention to those body changes and stay present with them as a way to help us connect more to our emotional world.
Remember: if something feels like too much, return to grounding skills.

Thus far I have written a lot about feeling overwhelmed by emotion, the times when we are filled to the brim or feel like we are bursting. For many of us, however, we have the opposite relationship with our emotions, we struggle with not being able to hold on to our feelings; they slip our of reach, or just aren’t there.

At times, it’s not an intentional pushing down or away, it’s just what happens, like the feelings don’t ever really seem to bubble up. Other times it may be more intentional. Some of us have come to believe that emotions are a waste of time, or we we’ve trained ourselves “not to have them” and consider ourselves to be ruled solely by logic and reasoning.

As Daniel Seigel writes, there are consequences to this non-experience of emotions too, “When we block our awareness of our feelings, they continue to affect us anyway. Research has repeatedly shown that neural input from the internal world of the body and emotion influences our reasoning and our decision making. Even facial expressions we’re not aware of…directly affect how we feel and so how we perceive the world.”

In short, what Dr. Seigel writes is that even if we don’t notice our feelings are there, they are. Even though we aren’t conscious of them, they impact us, our decision making, and how we perceive what’s going on around us.

So, for these folks, we want to help you learn how to turn the volume up on emotions in a sustainable way. For that to happen, we need to help you tolerate the experience of your emotions, which have probably been whittled down because at one point they were too painful, or perhaps you came from an environment where they were not welcome.

We can help you increase your ability to notice your internal world by helping you work to be more connected to your body. Emotions are complex, but they involve brain and body changes in a type of feedback loop. We want to help you plug into that feedback loop by being more present with your body. That way we can help you work to notice and gradually hold on to the emotional signals within you.

There will be more on how to do this, but keep your eyes peeled for mindfulness and body based posts to come.

Notes:

The Daniel Siegel quote comes from his book, Mindsight. (page 125). Full Citation: Siegel, Daniel J., Mindsight : The New Science of Personal Transformation. New York: Bantam Books, 2010.
The theory of emotions (the part about emotions being a feedback loop that involve brain and body changes) is a brief summary of what is laid out on pages 87 – 88 and page 137 of Marsha Linehan’s DBT manual. Full Citation: Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
If you are eager to start working on increasing your awareness of your emotional world run yourself through the exercise of taking some core emotions (anger, sadness, fear, joy, confusion), and sit quietly. Work to pay attention to what happens in your body as you bring up a memory that includes each emotion. Each emotion has a distinct feeling experience in our bodies, and we want to become aware of how those feelings manifest in each of us. Knowing “what” they feel like and “how” it feels in our bodies, and being able to tolerate that feeling helps us become more able to identify and tolerate emotions as they come up naturally in our lives. Be sure you have mastered grounding skills before trying this, it may be overwhelming to start “turning up the volume”. If so, consider starting only with emotions that are more tolerable to feel and get to the more difficult ones once you’re comfortable there.
Wondering why on earth you’d want to feel your feelings – especially your negative ones? Read this post about how are emotions are like “traffic signals” in our inner world .

May 26, 2021March 27, 2023

How to Ground

Grounding skills are the “reset” button for our brain
Many of us avoid our feelings because they are too overwhelming for us to handle
When feelings are too much they can overload us (fill us to the brim and consume us), or numb us (leaving us with nothingness, tired, unable to focus)
When we can effectively use grounding skills we know how to bring ourselves back from those moments
Having this ability to bring ourselves back makes our emotions much less scary – because we know we can always hit “reset” if needed.
These can be done ANYTIME, including when you are around other people and they don’t ever have to know you’re doing it. They can take as little as 20-60 seconds.
For grounding skills to work it is ESSENTIAL that you 1) Engage your senses 2) Engage your whole self (which means no thinking about the thing that’s going on while doing it!) and 3) are mindful of keeping yourself and others safe
Nearly every time I introduce these to a client they roll their eyes at me and ask me if I’m kidding. I am not kidding. This really works. Try it and see for yourself.
The skill I have seen that is most effective is counting a particular classification of objects in a room (i.e. how many circular objects do you see, how many green items are in the room, how many places where you could set something down)
I consider grounding skills to be essential prerequisites for intensive psychotherapy. For us to face our painful emotions we need to have the skills (and to confidence) to come back from them.
There are thousands of grounding skills. Learn more in today’s post.

Grounding skills are essential “bail out tools” for the mind. These are the life raft, oxygen mask, parachute of the brain – essential for helping us “come back to the ground” when our internal world is more intense than we know how to handle (when we are outside our window of tolerance.

These are skills we want to keep in our back pocket at all times, and I encourage my clients to use them in low stress scenarios before relying on them in high stress scenarios so that they get used to what it feels like to “bring themselves back online”.

There are thousands of grounding skills, and you can even make them up can work as long as they meets some basic criteria: 1. Engages your senses 2. You commit yourself with ALL your attention and capacity at that moment 3. Does not have the potential to cause harm to you or others 4. is done at a time when your safety is not threatened. If your physical safety is threatened you need to get to a safe place first. Grounding can help you find emotional safety.

Despite being simple (almost laughably simple) these exercises are often powerful IF we follow the criteria listed above. I find the biggest pitfall is not following criteria 2 – it is essential that we not multi-task and think about something else, we have to bring our brain back to exercise again and again if it veers away. It will be natural for it to veer away, just keep coming back to the task. I also find it helps to keep it simple – if counting works for you (it’s my favorite), rely on counting, and keep counting different types of things in the space around you until the intensity has dissipated.

Grounding exercises work because they engage a different part of our brain AWAY from our emotional center (which is overloaded prior to grounding). These exercises also force us to come back to the present, which is often not as threatening as our internal world.
Examples of other grounding exercises in the comments, you can also search the internet for lists of these.

Notes:

Grounding Exercise: Visual. Counting a particular classification of objects in a room: How many circular objects do you see, how many green items are in the room, how many metallic items, how many places where you could set something down, how many soft items, how many hard items. The list goes on and on. This one is excellent for doing discreetly.
Grounding Exercise: Touch based: While in place, scan through your body and notice every part of your body that is touching something other than air. Notice how it all feels on your skin. Notice the pressure of where your weight is, the feeling of fabric on your skin etc. Experiment with pressing into what you are touching. Count how many different items your body is in contact with. This one is excellent for doing discreetly. This grounding skill might be challenging for someone struggling with body image concerns.
Grounding exercise: Touch, smell, sight, sound. Shower with fragrant (and different than usual) scented cleansing products. Notice the temperature difference between the water and your body. Showers can be very powerful, but this is obviously not one you can do in place.
Grounding exercise: Smell. Put on a lotion or perfume. Smell it and see if you can pick out the different scents in it. How many can you identify. This can be done discreetly, but does require keeping something scented with you which might be a barrier for some.
Grounding Exercise: Taste and touch If you have a liquid with you put it in your mouth and hold it before swallowing (be mindful of not doing something that causes pain – aka – make sure it’s not too hot!). Notice the temperature change. Notice any tastes. See if you can classify them.
Grounding exercise: Hold an ice cube. This one is awesome because it is very hard to think about anything else while you are holding an ice cube. What I don’t like about it is that it a) requires you have access to ice b) requires you move from where you are – which you may not feel motivated to do in the throes of emotion and c) leaves you wet which can be annoying and something that deters you from doing it. I like to think about this one as one to try when you’ve tried some internal ones as those aren’t working as well as you’d like
Grounding exercise: If you search the internet you’ll find this one: identify 5 things you see, 4 things you feel, 3 things you hear, 2 things you smell and 1 thing you taste. This is great because it really engages all your sense and is very powerful at bringing you back because of how much focus it requires of your brain. What I don’t like about it is that it might be hard to remember in the moment, and it might be frustrating if you can’t smell or hear anything at the moment.
All of this sound totally ridiculous? Check out why we need Distress Tolerance skills.
See more about how to gradually incorporate a skill in my post on How Change Happens.
Are you finding you need to ground often? I’d encourage you to consider one on one therapy to help.

May 26, 2021March 27, 2023

Controlling our Attention

We can’t control what happens to us. What happens to us includes events, but it also includes our thoughts and our feelings
Many of us experience inner anguish because we have trouble accepting that what we think and feel is not actually within our control.
We feel what we feel, we think what we think and the best way to insulate ourselves from tough times is work to build coping skills that help us live in harmony with our inability to have the inner world we believe (or have been told) we “should” have.
We can use meditation and mindfulness based skills to help us detach from the intensity of our thoughts and feelings. While we can’t control what happens, these skills help us increase our control over what we pay attention to.
We can use emotion regulation skills that help us to “turn down the dial” on emotions when they are intense, but not at their most powerful.
When emotions are their most intense we can use distress tolerance skills to help us get through a situation without responding to them in a way that will create a problem for us further down the road.
This account will help you learn skills in all three of these categories, and work to help you build awareness of when it makes sense to use which kind of skill.
These skills help us manage pain when it arises in a way that won’t create further suffering for us, and will help protect our relationships and get us through with as little suffering as possible.
No one manages their thoughts and feelings ideally 100% of the time. That is not possible. We are all human. The goal is to help you have the skills so that you know what to do, aren’t so lost in those moments, and can get through them with as little suffering as possible.

One of the things we therapists know, and we work to help our clients accept, is that coping is about learning and accepting what we can and can’t control. We can’t completely control what happens to us, our thoughts and our feelings.

Many of us have luck for sometime pushing thoughts and feelings down or away. We also can organize our lives in such a way that we can have some control over what happens in it, though that’s more often possible when we have more resources. Regardless, at best we only have some control, and we don’t have the level of control many of us wish we did.

I want to be clear: pushing feelings or thoughts down or away isn’t bad. It’s a skill. A skill that works some of the time. However, if we only rely on that particular skill for coping with our internal world we are not equipped for very difficult times, or for when a tidal wave of thoughts or feelings comes in. Further, we lose our ability to learn from our feelings if we rely too heavily on pushing them away.

So, we all need to have a broad array of coping skills. Think of them like tools in a tool belt, different skills for different scenarios.

Instead of trying to control what happens to us, our thoughts, or our feeling we can work to increase our ability to control what we pay attention to and to detach from the intensity of what we may be feeling or thinking. This can be done through meditation and mindfulness based work.

Sometimes we need to learn how to lower intense feelings, that’s called emotion regulation. We use emotion regulation skills when we feel emotions on a level where they “need some wrangling” (i.e. they aren’t dissipating on their own), but not when they are at their most powerful.

When our feelings are really intense, and emotion regulation skills don’t work we can learn to ride them out, let them peter off, distract, or soothe ourselves through distress tolerance skills. With these skills we are working on introducing new and different focal points to divert our attention for a period of time. We are not solving or changing, we are getting through and in doing so helping our brains “reset” so we can tackle the issue when our feelings are not as intense.

Notes:

This post outlines three of the fours modules in Dialectical Behavior Therapy’s skill’s training program. For more information Full Citation: Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Pushing thoughts and feelings down or away, as mentioned in the post, is a distress tolerance skill. It is a powerful tool to use when our emotions are too overwhelming for us to face, or when the scenario we are in requires we move forward rather than address our experience. For more on why we need distress tolerance skills see the argument for distress tolerance. As with ANY distress tolerance skill we want to return to the topic at hand once we are available to face it (i.e. the scenario allows it, and our internal world feels more balanced).
We use emotion regulation skills when we are still in our window of tolerance, but nearing the edges of it, or perhaps just outside of it. For information on what our window of tolerance is and what it feels like to be outside of it, see “window of tolerance”.
Another reason it is difficult to control our thoughts and feelings is outlined in the post “your brain as an association machine“.
Post covering how we can learn from our emotions is called “emotions as traffic signals” .
Unsure if your emotion is dissipating on its own, or if you need to intervene to help? See Emotions are brief.
One thing that feels important to acknowledge: While these skills can help us manage pain they are not the be all end all and it’s not as though these replace the need for therapy or support from others at times. These skills do not turn us into a one person “cope with anything and everything” machine. These skills help us manage pain when it arises in a way that won’t create further suffering for us, and will help protect our relationships and get us through with as little suffering as possible.

May 18, 2021March 27, 2023

The Argument for Distress Tolerance

Often times when we feel intense negative emotion our drive will be to pull towards, so we can do something / say something / solve something to “release” the emotion
Blood actually starts flowing differently in our brains when we are in high distress – it flows away from the parts of our brain that are best at problem solving, and thinking through consequences, pros, cons, priorities, and values.
This means despite that intense desire to lean it, in those moments we actually want to lean away.
Part of coping well is knowing where that line is in ourselves, when we need to step away rather than step towards. Sometimes we can’t problem solve right away, we just have to get through.
When we are feeling our negative feelings very intensely (like an 8 or a 9 out of 10) we need a different set of strategies. In those times we need to work on distracting, calming, soothing, and diverting attention
Distress tolerance skills teach us to try and shift our attention away instead of trying to manage the problem at hand
For these skills to work we *really* need to shift our attention completely and allow ourselves to be completely engaged in something else. This helps the brain “reset”. Sometimes this means we have to shift our attention again and again until our brains cooperate.
Learn more about why we need distress tolerance skills in today’s post. Specific skills to follow another day.

One of the big gripes I hear about distress tolerance skills – skills and techniques that help you get through the moment (like focusing on your breathing, going for a walk, watching a show) – is that we’re not problem solving. These types of skills don’t actually make the situation better or address the problem at hand. They just divert your attention from whatever the problem is.

All of that is true. Those types of coping mechanisms don’t make the situation better or solve the issue at hand.

That is not their purpose.

Distress tolerance skills help YOU feel better so YOU can (eventually) effectively tackle the situation at hand. They help YOU come back “online” so that you can problem solve, think clearly about solutions, consequences, pros, cons, priorities, and values. They help YOU be in the mindset to tackle a concern with all of your facilities – which we have less access to when we are in a panic, or when we are overwhelmed with emotion.

Think about it. Have you ever quickly addressed what felt like a pressing issue at the time only to reflect later (in a less intense state of mind) to realize you could’ve handled it better? When our emotions are running high (and I mean we’re feeling them at an 8 or a 9 on a scale of 1-10) our brains don’t work the same as they do when we are calmer.*

Often, when we feel strong emotions we feel them with urgency and we believe we need to act NOW. But usually that desire to act NOW is more about making the feeling “go away” than it is a response to any true urgency from the situation at hand.

When we use distress tolerance skills we are not trying to change how we feel or the situation we are in. Instead, we are changing where we focus our attention. This gives us a break from a very intense situation so we can return to it later with our full attention and our facilities intact.

The key with distress tolerance skills is to let things settle and then return to the problem or situation at hand when the external circumstances permit and when your internal state of mind is more balanced. If we don’t return to the problem at hand we’re engaging in avoidance, and that creates a whole host of other issues in our life.

Notes:

* Blood flows differently in our brains when we are experiencing intense negative emotion. This is our brain’s way of trying to protect us when we experience a signal of “alarm” from our emotions, so that our bodies can be ready to handle what our emotions are telling us is a major issue. Your frontal lobe (a section of your brain just behind your forehead) has many functions, but one of them is to help you process the signals from your emotional world and weave those with logical decision making and discerning judgment. As Bessel Van Der Kolk describes in his book, “The Body Keeps the Score”, our frontal lobes have less blood flowing to them when we are in intense emotional states, “As long as you are not too upset, your frontal lobes can restore your balance…Neuroimaging Studies of human beings in highly emotional states reveal that intense fear, sadness, and anger, all increase the activation of subcortical brain regions involved in emotions and significantly reduce the activity in various areas in the frontal lobe” (Pages 62-63) (The Subcortical regions of the brain he refers to are the areas of the brain under the frontal lobe). Full citation for the book: Van, . K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.

Unsure how to identify if your brain may not be “online”? See post dated May 11th called The Window of Tolerance. This post covers what it can feel like when we’re in a place where we want to consider using distress tolerance skills.
Sometimes it can take practice, trial, and error to come to recognize when we’re “not really here”. It will get easier with time.
Much of what I pull from in this post regarding classification of “what” a distress tolerance skill is comes from Marsha Linehan’s Skills Training Manual for Treating Borderline Personality Disorder. Full Citation: Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.

May 11, 2021March 27, 2023

The Window of Tolerance

We all have a sweet spot in our ability to cope, manage, process, think, feel, and communicate.
When we are in that sweet spot (also called the window of tolerance) we generally feel calm, able to take on what comes, and able to think and feel at the same time.
When we are outside of that spot we can feel very intense anxiety, rage, or feelings so big we can’t even really identify them – they just fill us to the brim
We may be more likely to ruminate (i.e. not be able to stop thinking about something), become hyper focused on the topic at hand, or lash out our feelings at others.
We may also feel a tremendous degree of urgency to “fix” whatever has pushed us outside of our window.
We can also fall outside of that window in the other direction, to a place of more emptiness, depression, numbness, or avoidance
When we’re on that side of the window we may get sleepy or have a hard time paying attention
Parts of our ability to function are “offline” when we are pushed to either side of this window of tolerance
For us to be successful in our relationships, at work, and in managing our mental health it is essential that we recognize this window exists, and that we respond to it constructively
More to come in a future post about how to widen your window of tolerance, but the first step is recognizing it exists and to identify how it manifests in you.
We can all work to widen our windows of tolerance through therapy, meditation (more on this to come) and learning (and using) coping skills. One of the reasons your therapist can be effective in treatment is because they (likely) have done some work widening their own window to be able to tolerate what their clients bring to treatment.

In the DBT world we would say we know we’re in our window when our “rational” (i.e. thinking or logical) mind and our emotional mind are accessible. As Daniel Siegal says, “If an experience pushes us outside our window…we may fall into rigidity [depression, cut offs, numbness, avoidance] or into chaos [agitation, anxiety, rage, emotions that feel so big we can’t even identify them they just consume us with intensity]”.

He explains, “We [each] have multiple windows of tolerance. And for each of us those windows are different, often specific to certain topics or emotional states. I may have a high tolerance for sadness, continuing to function fairly well even when I or those around me are in deep distress. But even a lesser degree of sadness…may cause you to fall apart. In contrast anger may be relatively intolerable for me…but for you, anger may not be such a big deal”.

Acceptance of the fact that this window exists, and there are limits in our ability to function based on our presence (or not) in it are crucial to success in managing your mental health, relationships, feelings, and thoughts. We are more likely to be pushed out of our window of tolerance at times when our safety is threatened; we are hungry, in pain, or tired. Some of us may be more inclined to fall to the rigid side (with less emotion) and others may be more inclined to the chaos side (with more emotion).

Daniel goes on to say, “Within our window of tolerance we remain receptive” (this means able to integrate information from our bodies, thinking selves, and feeling selves), “outside of it we become reactive” (this means we’re highly emotionally charged and less able to thoughtfully think through and respond to something with our full capacity to consider consequences, values, and priorities).

Many of us have spent a good chunk of our lives outside our personal windows without awareness that we CAN get to that middle ground place. When we are outside our window of tolerance it is not the time to make important decisions, or have important conversations. It is instead a time to work on coping and “coming back online” so we are out of the reactive place and back that receptive place.

Notes:

This posts combines a mix of the “wise mind” skill from Dialectical Behavioral Therapy, developed by Marsha Linehan with information from Daniel Siegal’s book, Mindsight (pages 137-138). Full Citation: Siegel, Daniel J., Mindsight : The New Science of Personal Transformation. New York: Bantam Books, 2010.
It’s not always obvious when we’re outside our window of tolerance. For some of us it just is our sense of “normal” or “how we’re supposed to feel”. If you often feel the way I’ve described suspect you may regularly be outside of your personal window.
We can learn to recognize when we’re outside our window and we can develop coping and grounding skills to bring us back within our window so we can function and manage well. Those coping skills to follow in another post, try to work on knowing when you’re in and outside of your personal windows based on the cues I described. If you have a partner – heads up – they may have a sense of when this occurs for you better than you do!

April 20, 2021March 27, 2023

Understanding “Know your Limits”

“Know your limits”, you’ve been told. But what does that mean?
We are often given this advice without any direction as to how to do this, and many of us are operating outside of our limits without awareness
Signs you might be outside your limits: Irritability, anger, resentment towards others, a desire for someone to rescue you from having to acknowledge a limit you may may not want to be a limit.
Sometimes it’s more like a shutting down where we retreat away. Sometimes you may find yourself avoiding.
Many of us hit limits faster when we are tired, hungry, in pain, or scared for our safety (including both immediate threatening dangers, and more subtle /ongoing / systemic dangers, like feeling unable to provide for our families or feeling unsafe in our communities).
We don’t always get to determine our behavior based on where our limits are, but it’s always helpful to know when you’ve hit a limit so you can take steps to take care of yourself and pause (when possible) important decisions and activities
If you read this post and find that you are in this type of place a lot of the time / most of the time consider getting professional help, you may be struggling with anxiety or depression.

“Know your limits.” An easy piece of advice to give, and often a hard piece of advice to enact, especially if you haven’t had role models who knew and respected their limits, and who taught you how to do the same.

If you are someone who has a hard time with recognizing and respecting your limits (and you may not know this is you until you read further) it may help to consider that they may not be where you want them to be, or believe they “should” be.

Sometimes accepting our limits requires making sacrifices.

We can work towards developing awareness of our personal cues that we’ve passed our limits. It can look at feel different for everyone, so this will have to be a personal journey for each person to identify their particular signs. Here are some tips to help you get started on working towards learning where your limits are.

For many of us we get irritable or “snap”. We might say things we regret or start thinking repeated thoughts that are hard to stop (called ruminating), about how upset we are with ourselves or other people.

For others of us we shut down, fall asleep, zone out, or numb out.

Sometimes we look for someone to rescue us so that we don’t have to acknowledge a limit that we wish were not a limit, “maybe she’ll break up with me so I don’t have to”, “maybe I’ll just get fired so it could be over”, “If only he cleaned all this up then I could take a break”.

Sometimes it looks like tunnel vision where it becomes hard for us to problem solve or see the big picture. We can get fixated on one particular perspective or solution when we’re in this mindset.

If you feel the way I’ve described more often than not this is a cue that you may be depressed or anxious. I’d encourage you to seek out professional help.

We don’t always get to determine our behavior based on our limits, but we can work towards recognizing when we’re “not really here” so that we can hold off on important tasks or decisions, take breaks, ask for help, or at a minimum work on taking a few deep breaths and coaching ourselves through a difficult time.

—
Notes:

Helpful questions to ask: “Is my behavior and thinking in line with how I genuinely feel, my values, and my priorities?” Do I feel like my emotions are out of control?”
This post has connections to other posts I’ve written, specifically: we hit our limits more easily if our shoulds outweigh our wants, we can look out for increasing internalizing or externalizing when we’ve hit a limit, and we want to offer ourselves compassion as we work towards the process of learning what our limits are and learning how to accept and honor them.
Realizing you’ve hit a limit and aren’t sure what to say to others if you need a moment or to return to an important topic? How about “I need a minute”, “I’m not feeling well, I’m going to need to bow out”, “Can we circle back to this? I’m having trouble thinking through this right now”, “ok, I’m putting myself in a time out, I’ll be back in a bit”.
This is not about perfection. No one can be perfectly “available” at all times, but the idea here is to work towards building that awareness of when we really don’t have it in us to be mostly there in a way that aligns with our values, our priorities, and with capacity to manage our feelings.

April 15, 2021March 27, 2023

How Change Happens

Long Term Change happens gradually
We are all capable of making quick changes, but more often than not we want to make sustainable changes and that is a different (and much slower) process.
We often give up or think of ourselves as a failure / lazy when we encounter a situation where we fall into old patterns rather than use the new ones we are trying to work towards.
This happens because we’ve tried to use the new skill without really getting the hang of it first.
When we want to change a behavior or pattern we need to start working on making changes in low stress situations and work on increasing the complexity only when we are able to do the new thing consistently in the low stress situation.
Unfortunately, we can feel defeated because those high stress / more complex / difficult situations will still arise before we’ve been able to make the changes necessary to handle them in the new way.
Those moments are not failures. They just arose before we were ready.
The key is to stick to the gradual plan rather than give up. You will get there eventually.

When you learned how to drive, did you start on the highway? Probably not. You probably started in a parking lot, got your bearings, and gradually made your way to side streets, main streets, and eventually you got on the highway.

Often, when we try to change, whether it’s building a new habit or trying a new coping skill, we come into it with unrealistically high expectations of ourselves or others for how quickly that learning and growth process should be. Then, we can’t keep up with the activity or properly implement the skill and despite our interest or desire to change we lose hope, can start to feel like a failure, or we label ourselves (or others) as lazy or incapable.

This is because more often than not we start on “the highway” rather than in “the parking lot” with something new. The time to start working on learning how to take deep breaths to soothe your nerves is not when you’re at your wits end. It’s when you feel a little off.

The time to work on being more vulnerable with your partner is not when you’re feeling intense negative feelings, it’s when you feel pretty safe and comfortable with them and yourself.

The time to start working on taking a step back and pausing rather than saying something you might regret is when you’re a little irritated not fuming with anger.

Eventually, with time and practice you can work your way up to more complex situations. The goal is to get to those situations, but to be effective in them we can’t start with them or get to them before we’re ready.

The trouble for many people is that those difficult situations will continue to arise while you are working on building this new way of doing things. This can leave someone feeling like a failure because they fall into old patterns. But, the way to really make change is to accept that you will get to those more complex situations eventually and the way to get there is with lots of practice in simple(r) situations. See comments for more.

We must work our way up to situations with increasing complexity and intensity and we must do it gradually, otherwise we are not setting ourselves up for success or permanent change.

Notes:

A “complex” situation may not seem “complex” at first. It may seem really simple, like “we were just trying to figure out who was going to load to the dishwasher” but what makes it complex is your mood, what your day was like before, how prepared you were for the conversation, what this relationship is like more generally, and how you felt about how the other person was reacting to what you were saying. How able we are to do new things is also diminished if we are hungry, tired, or in pain. Trust yourself. If it felt intense, it probably was.
In this account I am going to offer you A LOT of suggested coping mechanisms, ways to think, and ways to potentially change how you approach yourself, others, and the world. You may, at times feel overwhelmed, or like you can’t keep it with you. THIS IS NORMAL AND HEALTHY. The only way to really integrate changes is to expose yourself again and again, stick with it, keep trying, and taking things bit by bit and chunk by chunk.
When I do skills based work with clients, and I cover the materials I am sharing in this account, I tell folks to expect it to take two years for life to really be different and for these skills to feel seamless. Now, that doesn’t mean two years to see changes; progress and change can start right away – that means two years of learning, talking, revisiting, applying the skills, and then covering them all again and again until they become second nature (though they will probably always require some degree of intentionality). Two years may sound like a lot, but that’s with me teaching 50-100 skills. So if you’re only working on a handful of things it will and can go faster.
Example: If you are trying to work on not saying something in anger that you might regret start working on it when you’re annoyed, irritated or angry (but at like a 1 or 2 out of 10). Anything beyond that, you want to just let go, tell yourself you’ll get there eventually, and stay working on those less intense situations. Once you can do that consistently, then try upping the scale to a 3 or 4 – or perhaps a situation where the outcome isn’t terribly important to you (like if you got overcharged for gas and you’re angry you may be more likely to challenge yourself to take a breather before speaking than if your family member who regularly drives you nuts says something irritating…again). Keep working up to increasingly important relationships (the more important the relationship the higher stress the situation may be), increasingly important topics (like getting a raise is going to more important than returning a 3 dollar item), increasingly difficult scenarios (like it’s going to be harder to keep your cool when you’re starving and tired then when you’re well fed and rested), and relationships with decreasing safety (like if you often feel judged by someone they are going to be harder to be vulnerable with than someone who you feel is accepting, supportive, and forgiving).
You don’t have to have it all mapped out at first, that would be way too complicated. Just work towards looking for opportunities that feel accessible, keep trying, and work to reflect on what may have made a situation where you didn’t succeed stressful so you can be thoughtful about how to approach it again.