Shireen Rizvi is a professor of psychiatry and behavioral sciences and co-authored the book Real Skills for Real Life: A DBT Guide to Overcoming Stress, Emotions, and Relationships.
Jesse Finkelstein/Sonya Barlas/NPR
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Jesse Finkelstein/Sonya Barlas/NPR
Think about the last time you were distressed. How did you cope with it?
Have you taken out your anger on someone? drink alcohol? Pretend like it never happened?
There are healthy ways to deal with pain. “Those behaviors are the result of not knowing how to tolerate what seems unbearable,” says Shireen RizviProfessor of Psychiatry and Behavioral Sciences at Montefiore Medical Center. “In those moments, we have to learn how to acknowledge the crisis and respond more effectively.”
She explains how to do it in her book Real Skills for Real Life: A DBT Guide to Overcoming Stress, Emotions, and RelationshipsPublished earlier this year.
He and co-author Jesse Finkelstein, a clinical psychologist, use engaging diagrams and illustrations to teach implicit skills dialectical behavior therapy (DBT), a form of therapy that helps people manage difficult emotions. For example, there is a decision tree on how to use DBT skills to resolve conflict and an infographic on how to practice mindfulness.
DBT was first developed by psychologist Marsha Linehan In the 1980s for the treatment of borderline personality disorder. Since then, numerous studies have shown that “DBT skills are helpful for a variety of people with many different types of problems,” Rizvi and Finkelstein write in their book — and not just for people with complex mental health problems.
Tip: What to do when you’re so stressed that you can’t think straight
Rizvi, a board-certified DBT therapist, shares a set of techniques from her book called TIP. This acronym stands for temperature, intense exercise, rapid breathing and coupled muscle relaxation.
You can use these four different skills in moments when you’re so distressed you can’t think straight, she says. For example, if you have a big fight with your partner, or if you’re dealing with a major life event like illness or death.
TIP can quickly bring down the level of emotional intensity from extreme to moderate. “They can help you go from 100 to 80 on a scale of zero to 100,” says Rizvi. Then when you’re 80, you’ll have more clarity to do something else to help yourself.
T: Lower your temperature
how to do it: Fill a large kitchen bowl with cold water and ice, take a deep breath and submerge your face, eyes and temples in the water while holding your breath. Stay there as long as possible, says Rizvi.
Why it works: it triggers mammalian dive reflexRizvi says, which occurs when mammals are immersed in cold water. It increases your chances of survival by slowing your heart rate and respiratory rate. “These are things we (our bodies) need even when we’re in extreme distress.”
Rizvi doesn’t recommend this maneuver for people with heart disease or taking beta blockers. “A sudden drop in heart rate can obviously be a problem,” she says, “but if you don’t have those conditions, it’s worth a try.”
Me: Do some intense exercise
how to do it: Do anything that gets your heart rate up quickly, says Rizvi. Climb the stairs, do some jumping jacks or pushups. Maintain that pace for 30 seconds or more.
Why it works: The idea behind this skill is “almost contradictory,” she says. “In that moment of high arousal, you are revitalizing yourself.” Then, when you stop exercising, your heart rate drops, making you feel calmer – and your endorphins are activated.
P: Try breathing a little faster
how to do it: Make your exhale longer than the inhale, says Rizvi. Inhale for a count of four, then exhale for a count of six.
Why it works: When we’re distressed, we breathe from our chest, “which is like hyperventilating, the opposite of relaxing,” says Rizvi. Breathing faster can slow your heart rate and reduce emotional intensity.
P: Practice paired muscle relaxation
how to do it: Go through your body, muscle group by muscle group, and tense the muscles as tight as you can – then release them. Breathe in while tightening your body. Then, as you exhale, say or think of a word you associate with relaxation, such as “relax” or “calm,” as you exhale. This is the “coupled” part of the exercise, says Rizvi.
Why it works: “The idea is that if you tense your muscles as much as possible and then relax, you get a greater sensation of relaxation than if you try to relax without tensing the muscles first,” she says.
intense moments don’t last forever
Rizvi says one of the biggest things people misunderstand about distress is that they have to get rid of this feeling immediately or it will last forever.
But it is not so, she says. “One thing we want people to learn is that whatever you’re feeling, no matter how intense, no matter how terrible it feels in the moment, it will pass.”
The story was edited by Meghan Keane. The visual editor is CJ Riculan. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us LifeKit@npr.org.
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