Dealing with Distress: Self-care Resources
Our cognitive, affective and behavioral patterns and experiences are shaped by the relationships both past and present, and the social worlds we interact with. As a person working in the field of mental health, I pay close attention to the ways that people’s difficulties and distress are maintained and expressed in their relationships — and to how the experience of secure, supportive and empathic relationships can help people develop ways of living more stably, authentically and meaningfully. In addition to the importance of healing relationships and communities for a person’s mental health, it is also important for individuals to develop and have access to tools and strategies they can use to help themselves in moments of overwhelm.
In the following list I’ve included a combination of (predominantly) evidence-based interventions from CBT, DBT and mindfulness therapeutic modalities as well as some self-care activities and ideas. They are designed to help people get grounded in their bodies, regulate their emotions and challenge anxious beliefs that take hold in moments of increased stress and nervous system arousal.
A mindful minute
Use a stop watch to time how many breaths you can take in one minute, taking slow deep breaths. Each time you do a complete inhale and exhale, count 1. When you have done 1 minute, make a note of how many breaths you took. Next time you’re at work and you notice higher stress or anxiety, close your eyes and breathe that number of breaths, counting slowly in your head. This practice stimulates the parasympathetic nervous system which counters the effects of anxiety on our nervous system. In short, it helps calm down your body and re-connect body and mind.
Breathing in, Breathing out
On the in-breath make a mental note (saying internally) “breathing in” and on the out breath “breathing out”, this is one way to focus your attention on the here and now activity of breathing. It is particularly helpful if you find that sustaining attention on the breath is consistently interrupted by other distracting thoughts. Our minds are very good at distracting us with thoughts, analysis and judgements — explicitly labeling breaths can help to keep attention focused.
Changing your body chemistry — for times of high emotional activation (from DBT skills training handouts and worksheets, developed by Marsha Linehan).
- Change the temperature of your face with cold water — hold your breath, splash cold water on your face. Alternatively, hold an ice cube in your hands or hold a cold pack on your cheeks for 30 seconds.
- Intense exercise to calm your body down — short bursts of energy expenditure.
- Paced Breathing — breathe deeply into your belly, slowly and deliberately (e.g. five-six breaths per minute), breathe out more slowly than you breathe in and pair the inhale/exhale with muscle tensing and relaxation.
STOP skill (from DBT skills training handouts and worksheets, developeed by Marsha Linehan).
Stop — do not react, stop or freeze to ensure your feelings do not make you act impulsively
Take a step back — remove yourself from the situation, take a break, take a deep breath. Remind yourself if it’s a good idea now it’ll be a good idea tomorrow — maybe other possible reactions or solutions will present themselves to you in the meantime
Observe — move into a mindful headspace, notice what is going on inside and outside you. What is the situation, what are your thoughts and feelings? What are others saying or doing and how is it making you feel?
Proceed mindfully — act with awareness, in deciding what to do, consider the situation, others’ thoughts/feelings. Think about your goals and values. Ask your “wise-mind”: “which actions will make this situation better or worse?”
Grounding techniques
I have seen variations of this exercise that can be useful in the event of dissociation (trauma response) or panic, where your sympathetic nervous system is in a state of over-arousal and it feels as though physiological sensations have hijacked your body (and diminished your ability to be mindful).
Favorite color: think of a color, now look around the room and name out loud 5 items of that color.
Senses: name 5 objects you can see in the room, name 4 things you can feel, 3 things you can hear, 2 things you can smell and 1 good thing about yourself
Re-orienting yourself in place and time (answer these questions out loud): What is my name? Where am I? What is the date? What is the month? Year? How old am I? What season is it?
Challenging questions
In times of heightened fear and anxiety, it can be easy to fixate your mind to the point where you believe the thing you fear is true or inevitable. To limit catastrophizing and to introduce new perspectives and more rationality to your thought pattern, ask yourself these questions (it may be helpful to write down your answers if you notice your thoughts are rapid):
1. What’s the evidence for this, what’s leading me to think this?
2. Am I magnifying/exaggerating the probability of this happening
3. Is there another way of looking at this, encouraging thoughts that start with “on the other hand…”
4. So what if this happens? What would I do about this and how would I manage it? Are there resources I can bring to bear to solve this problem (switching to solution focused thinking)
Acceptance of what is/Letting it be
This helps when you notice a tendency to assign more meaning than necessary to an anxious thought (where you give it more power over you by assuming it is true). Thinking a thought does not make it true, take a step back and notice that this thought is just a thought, and in letting it be it will pass like all the other (tens of thousands of) thoughts you have in a day.
Self-compassion
When you notice you are being particularly self-critical or are overwhelmed with negative self-talk, it can be really helpful to imagine something you might say to a loved one if you caught them being hard on themselves.
- Once you imagine something positive, affirming or validating to say to someone you care about, direct it inwards and try to internalize the message for yourself
Our quest for perfection does more to harm our self-esteem than it does to build personal success and move us closer to our goals. As a human you are expected to make mistakes, messing up is part of being human! People can interpret mistake-making as evidence of their worthless-ness or hopelessness; to interrupt this automatic cognitive leap:
- Remind yourself that every day you can reasonably expect to make mistakes so when it happens you can observe with less judgement
- Practice mindfulness to help you notice and catch the negative thought loops that generally follow a mis-step; through making yourself consciously aware of those automatic negative thoughts you can allow other neutral thoughts and reactions to emerge
- Change the content of your self-talk by thinking about a mantra that rings true for you in moments where you are feeling more confident, remind yourself that this has been true in the past and will be true again. Look to favorite writers and poets for wisdom and inspiration. In FMRI studies, positive self-talk has been found to correlate with an increase in activity in the prefrontal cortex and reduced activity in the amygdala (the emotion processing center).
- Drop the practice of comparing yourself to what others are up to as a measure of your own worth.
Self-soothing if you experience overstimulation or sensory sensitivity
- Buy yourself a squishy, fluffy, tactile toy to carry around with you
- Listen to an AMSR video/audio track (cue up your favorite audio or visual “AMSR-tist”)
- Develop daily rituals that promote a sense of bodily calm e.g. journalling, coloring, bathing, walking, meditating
- Walk through a park or set aside some time to sit in a green space or community garden
- Trial a mindfulness app or access free online mindfulness resources e.g. https://www.uclahealth.org/marc/mindful-meditations
- Do some gentle stretching
- Have a book on the go, fiction can be a particularly helpful way to unplug, tap into your imagination and explore new possibilities
Write a list of go-to activities in preparation for times when you are activated so you don’t have to think of something in the moment. Be mindful of the kind of activity that might be satisfying or soothing depending on your experience of distress i.e. do you want to do something that is focused on sensations, moving your body, expressing your emotions, socializing, relaxing or challenging thoughts?
If you are in a crisis, a resource that is free and available around the clock is the King County crisis line 866–427–4747. King County 2–1–1 is a database of community resources where someone will connect you to the resource you need. Below are psychotherapist (and support group) databases that can help you search for psychotherapists by neighborhood, cost, insurance, modality, gender, diagnosis and/or clinical focus:
