What to do when you're too upset to think straight

0:00Shireen Rizvi:This message comes from Capital One Commercial Bank. Access comprehensive solutions from a top commercial bank that prioritizes your needs today and goals for tomorrow. Learn more at Capital.One slash commercial. Member FDIC. Distress is inevitable. Pain is an inevitable part of life. And so much of what we do are attempts to avoid distress and pain. We drink when we're anxious or we lash out at people when we're angry. Those behaviors are the result of not knowing how to tolerate what feels intolerable in that moment, which is that emotional experience. You're listening to Life Kit. I'm Mariel Segarra.

0:50And you just heard from Shireen Rizvi. She's a professor of psychiatry and behavioral sciences at Montefiore Einstein. She co-wrote a book called Real Skills for Real Life, and it's filled with distress tolerance skills that come from dialectical behavior therapy. That's a form of therapy that helps people understand the connections between their thoughts, their behaviors, and their emotions. She says according to this framework, in moments of distress, we have these two options. We could try to change the situation that's causing us distress, but sometimes we can't just remove the problem or solve the problem.

1:27And so in those moments, we have to learn how to accept the distress and respond in a more effective way. What do you think people get wrong about coping with distress? I think first thing that people get wrong is thinking that I have to get rid of it right away. Their first impulse and instinct is to do something to make it stop. And I think the second thing that people get wrong is the idea that I need to do something to make it go away because otherwise it will last forever. And so one thing that we want people to learn is that actually whatever it is you're feeling, no matter how intense, no matter how awful it feels in this moment, it will pass.

2:14On this episode of Life Kit, research-backed skills to help you tolerate distress. And these skills can make sense in a lot of different situations. When you're stuck in traffic, when you got in a fight with your partner, when your teenager is rude to you, and when you're dealing with big life events like illness or death. Okay, so the first distress tolerance tool we're going to talk about here from the book is something called TIP. It's an acronym, T-I-P. and it actually stands for four distinct skills that you can use in moments when you're so distressed that you just can't think straight. You say in the book, these are not skills to help you solve the problem, right?

2:53Yes, exactly. And the idea is these are skills to help you go from, let's say, a 100 on a scale of 0 to 100 to an 80. And then when you're at an 80, you might be able to flip through the pages and find something else to do. Okay, so TIP is an acronym. It stands for T-I-P. T is temperature. What does that mean? Yeah, temperature is actually one of my favorite skills. This is going to sound really weird, but it's making your body think that you have just dived into extremely cold water. And the reason we do that is because there's such a thing called the mammalian dive reflex, which is a reflex that all mammals have, that when we are submerged in cold water, it increases the likelihood of survival.

3:41And the reflex does things like slows down your heart rate, slows down your respiratory rate. Those are things that we also often need when we're in high degrees of distress and are physiologically aroused. So the way that we practice this skill is to get a large kitchen bowl, fill it with very cold water with some ice cubes in it so that it's pretty cold. you take a deep breath and then you plunge your face your eyes and your temples in particular into the water while holding your breath and staying there for as long as possible for most people i have to say it is incredible in terms of how well it works for people in terms of getting that arousal to go down i should make a note as we often do that we don't recommend this for people who have a heart condition or who are taking beta blockers because the sudden decrease in heart rate could obviously be a problem for certain conditions.

4:47But if you don't have those conditions, it's definitely worth a try. And if you wear a smartwatch or something else that monitors your heart rate, you can actually look. You could do a little test to see your pre-post heart rate when you practice the temperature skill. So that's T. I is intense exercise. So are you running up the stairs really fast? You're doing anything you can to get your heart rate up quickly. I taught this in a group just last week, and we all stood up and did jumping jacks. So the idea behind that is that it's almost paradoxical, but in that moment of high agitation, high distress, you're actually revving yourself up.

5:29And then when you stop the exercise, that decrease in heart rate comes on. You feel calmer. the endorphins kick in and so on. Interesting. Okay, P is paced breathing. What does this mean? When we're distressed and in high anxiety, we tend to breathe from our chest, which is actually more hyperventilating and is the opposite of relaxing, right? It gets us more revved up. So we want to breathe from our belly area. The second quality of paced breathing is to slow your breath down. And the third component of paced breathing is that you want your exhale to be longer than your inhale. So you might practice this with your belly, for example, breathing in for a count of four and then breathing out for a count of six.

6:19And then we actually have one more P, which is paired or progressive muscle relaxation. And that means like going through your body muscle group by muscle group, tensing the muscles as tight as you can and then releasing them? Yes, exactly. And the idea is that if you tense your muscles as hard as you can and then relax, you actually get to a greater sense of relaxation than if you just tried to relax without tensing the muscle first. And then the paired piece is to say the word relax or to say the word calm or some other cue word that you associate then with the relaxation piece. We'll have more Life Kit after the break.

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7:51Shireen Rizvi:See AHS.com slash contracts for coverage details, including service fees, limitations, and exclusions. Support for this podcast and the following message come from Strawberry.me. Be honest. Are you happy with your job? Are you stuck in a job you've outgrown or never wanted in the first place? Are your reasons for staying really just excuses for not leaving? Let a career coach from Strawberry.me help you get unstuck. Discover the benefits of having a dedicated career coach in your corner and get 50 % off your first coaching session at strawberry.me slash NPR. This message comes from Audible. Manifestos are a call to action, an artful scream.

8:34Shireen Rizvi:They capture people's anger and try to do something with it. Dan Taberski's Manifesto is a podcast that attempts to take the manifesto back from mass shooters and nihilists and return it to its rightful place with regular folks with just the right amount of crazy. Listen to Dan Taberski's Manifesto wherever you get your podcasts or binge the entire series right now only with Audible. You have another set of skills in here that go by the acronym improve. you say in the book these skills are designed to make difficult moments better in some usually small way walk me through what improve stands for so i think about improve as being a set of strategies that are available to you as tools in your toolbox for those moments where you can't do anything about the problem right now but maybe there's a way to make it a little bit better and And so the acronym stands for seven separate skills.

9:34The first is imagery. In the moment of crisis and difficulty, using visual imagery to think about something calming, going to your happy place, bringing to mind a particular image that is soothing and relaxing to you. The M stands for meaning. And that's spending time thinking about what meaning you can draw from the experience no matter how hard it is. So this is really hard right now. And at least I'm learning that I can tolerate it. I found it helpful thinking about this after going through cancer treatment that like now I'm like I have more trust that I can handle whatever comes in my life.

10:23Yeah, I love that. And actually, I didn't know that about you, but I also went through cancer treatment. And I think that I use these skills a lot, but I actually think that I have that similar experience where I wouldn't wish cancer on anyone. And I did feel like it changed me in particular ways that I'm actually grateful for. Yeah, I'd rather that it hadn't happened. Yes. Yeah. But since it did, you know, there was something that I got out of it. I also got like really pretty wavy hair because I did chemo. I did not get that. So I experienced distress over not getting this magical hair that people talk about.

11:10Oh, dang. Sorry. I have to find other meaning. Okay, the P stands for prayer. The P stands for prayer, and here you could pray to God if that's something that you do, but we also want this to be something that anyone could do no matter how religious or spiritual they are. And so we also say pray to your own self, to your own inner wisdom, to ask for support and guidance and to give yourself love. R is relaxation. relaxation? Yeah, it's saying in this moment, that's really challenging for me, I'm going to intentionally do something that makes me feel a little calm and actually gives me a sense of pleasure in some small way.

11:58So what's my favorite coffee drink or my favorite tea that I can just sit quietly and drink? Can I take a relaxing shower or a bath? Can I take five minutes to just lay in bed and relax. O is one thing in the moment, putting your full attention into just one thing that you're doing right now. Yeah, so often when we're in high distress or we're freaking out about something, our mind is in a million different places. And in order to help us feel a little better in this one moment, what we try to do is to say, throw yourself completely into just one thing. For example, you're practicing relaxation by having a cup of tea.

12:44Just do that, right? And when you start having thoughts about what's going to come next, let that go and bring your attention back. And then V is for vacation. It's like giving yourself a little mini 20-minute vacation. Exactly. Most of us can't afford either time-wise or financially to just take a vacation whenever we're in stress. But what is something that you could do for even five minutes or 10 minutes that makes you have that sense of I'm just taking a break? So maybe it's looking at a gossip website or a trashy magazine or laying down on the couch and watching a 30-minute TV show. Anything that gives you a sense of I am just taking a break and I'm doing something fun and relaxing for myself.

13:30Okay, so the last letter is E encouragement. What does this mean? It basically means learn how to encourage yourself and be a cheerleader for yourself. Some people find this really hokey, but actually most of us are really bad at this, which is the skill of being able to say to yourself, you can do this, keep going. And I often say for people that have a hard time with this, it's say to yourself what you would say to a friend because most of us are good at encouraging other people and not as good as encouraging ourselves. Even just saying it with that tone for me helps like, you got this. Of course you got this.

14:13You know, it's like I'm being my own friend in that moment. And making it a little bit lighter. Yeah. We'll have more Life Kit after the break.

14:28This message comes from American Home Shield. It's not a matter of if an appliance or system, like your HVAC, will break, but when. Without a home warranty, these repairs or replacements can cost thousands. But with an AHS home warranty, they will fix covered breakdowns, helping protect your wallet. Get 20 % off all plans at ahs.com slash npr and see promo details. See ahs.com slash contracts for coverage details, including service fees, limitations, and exclusions. You also have some distress tolerance skills that are more long-term. And one of them I really liked was willingness. I feel like I haven't heard this before.

15:11When does it make sense to use this skill? We have to accept really difficult, challenging things in our lives. but to accept it we have to have a quality of willingness to go there as opposed to willfulness which is how we often operate so willfulness is saying this shouldn't be this way why me this shouldn't have happened he shouldn't have done that we are constantly having should statements But saying he shouldn't have done that is actually kind of denying the reality that he did do that. So willingness is this quality of moving towards acceptance with an open mind to say, I am willing to approach this instead of being willful and stubborn and refusing to accept what is.

16:16It makes me think about going back to getting cancer. People would say to me, do you ever feel like why me? And I really didn't feel that too much. I wanted to turn it around to why not me? One in something like eight women get breast cancer. So it was unexpected, but maybe not that unusual. And that framing actually helped me because it's like, if why not me for this terrible thing, then also why not me for some really exciting things that I want to do when I get better? You know, why not me like finally go on that trip to Japan or why not me having kids? Why not me like living in a beautiful space, you know?

17:09Yeah. It's interesting because it reminds me of, I think this is more of a Zen practice or saying where it's kind of like experience the non-headache or the non-toothache. That when we have a headache or a toothache, our full attention is drawn to that. And we might have those kinds of thoughts. Why me? Why now? Now, what about all the moments that we don't have a headache or a toothache? We don't say, why me in those moments, right? And so can we learn to be willing to accept and embrace the reality of whatever life gives us, all of the positives and all of the negatives? Some of this is changing your thoughts, but then there's also changing your posture.

18:05Tell me about that. And so often when we are feeling willful, we would likely find that our body is tense in some way. Perhaps our shoulders are up, our jaw is clenched. And so there are ways that we could focus on changing our body. And by doing that, we can actually send signals back to our brain that, oh, this is not so terrible. So, for example, having what we say is a willing posture, which is kind of often opening up your chest, you know, sitting or standing upright, pushing your shoulders back and adopting willing hands is a phrase that we use where if you're sitting, you sit with your hands face up in your lap.

19:00and it's it's such a subtle and small thing but if you notice what happens if you're sitting and you just place your hands gently on your lap palms up it's almost like a signal to your brain to yourself to the world i am open meaning i am accepting of what's happening and the other thing that we do with our body is adopt what we call a half smile, where we very gently and sometimes very subtly turn up the corners of our mouth ever so slightly to adopt that more serene facial expression actually communicates back to your brain that things are okay. I imagine that this advice would be very helpful for some people, and then it'll really annoy others who are like, yeah, but I'm dealing with something really difficult or like this isn't going to solve my problem or it almost feels like, you know, toxic positivity or something, you know, like just put a smile on your face and then all these horrible things that are happening are fine.

20:14Yeah, all things that I hear on a daily basis when I teach these skills. So a couple of different things that I say in response. So one is increasing the number of tools that you have in your toolbox. So I want you to have all of the tools, as many as you can possibly have. And that doesn't mean that you're going to use all of them, but you have them all and they're available to you. The second thing is that this is all an experiment. Gather data. Try it. You have these thoughts that this isn't going to work, or it's just going to lead to some other terrible outcome. Just notice that, but try it, practice it, and report back.

20:58Let me know how it goes. The third piece is this whole idea that we are trying to give people skills to manage distress, as we've been talking about, but also skills to solve problems. So if you're in this horrible relationship that you feel like you can't get out of? How do you use the distress tolerance skills in moments when you need them to help you cope with a really difficult moment? But at the same time, how are we going to either change this relationship or get you out of this relationship in a way that's more sustainable and also will lead to overall greater peace and happiness and less negativity?

21:42Yeah, these skills are not meant to solve your problems. Exactly. Shereen, thank you so much for this. Thank you so much for having me. All right, time for a recap. Let's go through the skills we learned. Takeaway one, tip skills. These are helpful in moments when you're so distressed that you can't think straight. T stands for temperature. Specifically, dunk your face in a bowl of cold water with ice to trigger your mammalian dive reflex, which will bring down your heart rate and get you breathing slower. I stands for intense exercise. Do some jumping jacks. Run up the stairs. P stands for paced breathing.

22:22Make sure your exhale is longer than your inhale. And P also stands for paired muscle relaxation. Squeeze a muscle, then relax it while saying a word like relax. You can do that in a sequence from head to toe. Takeaway two, we have the improve skills. These are designed to make difficult moments better in some small way. I stands for imagery. Think of a scene that calms you down. M stands for meaning. Not everything happens for a reason, but this happened and it does have meaning in my life. P stands for prayer. Go inward and connect with the divine. And if you don't believe in God, try praying to your wisest self.

23:04R is for relaxation. Do something that you know reliably relaxes you. drink some tea watch your favorite tv show from the 90s pet your dog o is one thing in the moment focus completely on one thing that you're doing right now v is vacation give yourself a 10 or 15 minute break from everything no checking messages no working just vacationing and e is for encouragement remind yourself you got this and mean it because you do lastly takeaway three try the skill of willingness, which is useful when you're dealing with a longer-term situation that's causing you distress and you find yourself denying reality, trying to control everything, or focusing on what should have happened instead.

23:50Yeah, you're right. They shouldn't have done that and this shouldn't have happened to you, but it did. Accepting that can be a helpful distress tolerance tool. One way to indicate willingness to your brain is to adopt a willing posture. For instance, sit with your hands in your lap, turned up toward the sky. It's a simple postural shift. Now I want to be really clear. These tools are not meant to solve your problems. They're options for how to get through difficult moments. We can't always change the situations or conditions causing us pain. But even when we can, we still need tools to take care of our bodies and help us keep our heads on straight while we problem solve and change the world.

24:34All right, that's our show. Before we go, we'd love your help. Would you please rate and review LifeKit in your podcast app? Tell us a favorite tip you've learned or which episodes you like the most. This episode of LifeKit was produced by Sylvie Douglas and Claire Marie Schneider. Our digital editor is Malika Garib and our visuals editor is CJ Ricalon. Megan Cain is our senior supervising editor and Lauren Gonzalez is our executive producer. Our production team also includes Andy Tegel and Margaret Serino. Engineering support comes from Jimmy Keeley. Fact-checking by Tyler Jones. I'm Mariel Cigarra.

25:10Thanks for listening.

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