Webinar: Dialectical Behavioural Therapy (DBT) and Crisis Survival Skills

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00:00 Introduction

03:55 Today’s Challenge

04:44 Overview

06:43 Mindfulness

08:11 Mindfulness & Emotional Regulation: The 3-Minute Breathing Space

13:27 The Window of Tolerance

17:24 Mindfulness and the Window of Tolerance

18:03 What is Emotional Distress?

20:33 Feeling Wheel

21:24 Unhelpful (and Common) Responses to Anxiety & Stress

23:23 Coping with COVID-19 Using DBT

24:10 Four Solutions to Any Problem (DBT) Framework

27:25 Accepting Distress

29:25 Radical Acceptance

33:19 Tolerating Distress

35:22 Crisis Skills: STOP

38:58 Crisis Skills: IMPROVE the Moment

47:31 Building Resilience

48:36 ABC’s Accumulating Positive Emotions

55:45 Self-Care: PLEASE

59:47 Resources for Coping with Stress & Anxiety

00:00 Introduction

Lanie: Hello and welcome to EHN’s coping with stress and anxiety during COVID-19 webinar. My name is Lanie Schachter-Snipper, and I’m the Clinical Director of Bellwood Health Services. This webinar was developed by Elizabeth Montgomery, who is the clinical program development lead at Bellwood, and a subject matter expert in distress management and trauma. Liz has supported countless clients who have survived traumatic events by providing them with practical skills to manage emotional dysregulation, and to enhance resilience. Living through a pandemic is not something that most of us have emotionally prepared for. People thrive on predictability, and security and for many COVID-19 has created a sense of uncertainty and fear, and even chaos. It’s left many of us, even those not previously prone to mental health issues with unprecedented levels of anxiety and depression. The good news is that you’re not alone, and there is help. This webinar will touch on various skills that you can use. To help you cope during this time. Please share these ideas with your friends and loved ones. The more we all support each other in practicing good mental health habits, the more likely we are to emerge from this time with our health and wellness intact. Thank you for listening. Enjoy. 

Liz: Hello, my name is Liz Montgomery. Thank you all for taking the time out of your busy schedules to be with me today and talk a little bit about building skills to manage the stress that we’re all dealing with. Before we start this webinar, I want to just take a moment to pause and ask you to check in. One of the skills that we’re going to be talking about today is this concept of mindfulness. Mindful awareness is a very powerful skill that we can use to help get us out of this autopilot response we may find ourselves in where we are so stuck in doing and being busy, that we don’t actually recognize and realize how much stress we’re under and all that we’re dealing with. So, today, before we start, I’m going to ask you to step out of that autopilot response and check in with yourself. We’ll just take the next minute to bring your awareness into yourself and how you are feeling in this very moment. I’d like you to think about what emotions are present with you. Perhaps notice how your body feels today. Maybe places of pain or stress that are present. Maybe taking note of some thoughts. Where’s your mind at? Where are your thoughts taking you. Just check in, slow yourself down. Take a moment to be present with whatever comes up. As we go throughout the webinar today, I’d like you to continue to check in with yourself. Perhaps taking some moments throughout the presentation to notice changes, if any. Allow yourself to slow down and be present with what’s happening for you. 

03:55 Today’s Challenge

Liz: Today we are here to talk about facing the challenges that come with managing a pandemic. We are in a situation right now that probably none of us have prepared for and it’s very overwhelming, a lot of these challenges that we’re facing. I’m here to help you understand some tools that we can use to help manage the stress associated with these challenges we are facing today. As I said in the introduction, mindfulness can be an amazing strategy to help us in understanding and managing the stress that we’re facing. 

04:44 Overview

Liz: In the presentation, today, we’re going to go through a mindfulness meditation. I’m going to help you understand the concepts of emotional distress and dysregulation and how mindfulness can be a tool in managing that. We’re going to talk about what exactly it means to be in a state of anxiety and what are some solutions that we can look to and turn to, to help solve that experience of anxiety and worry and stress. Today I’ll be using the framework of dialectical behavioural therapy to help us build skills. Dialectical behavioural therapy is an evidence-based treatment designed by Marsha Linehan. It helps us to put a framework on managing emotional dysregulation and distress. It gives us tools to build a better awareness of what is happening for us in the moment and make sure that we’re matching our coping skills to help us be most effective in our lives. So, out of those solutions for solving our problems will come our crisis skills. Today I’m going to talk to you about some specific skills to manage crisis in the moment or experience of distress that feels really overwhelming, as well as ways that we can help build our resiliency to stress over time. We also provided some resources for you to access and there’ll be an opportunity for some questions at the end. So, that’s our agenda for today. Let’s get into it.

06:43 Mindfulness

Liz: Starting with this idea of mindfulness. Some of you are probably pretty familiar with this terminology. It’s a buzzword today in the psychological world. Practice of mindful awareness can help us feel better especially when we’re struggling with difficult emotions and fluctuations in our mood, and even experiences of physical pain, the idea of mindfulness is that we are stepping out of this mode of doing the busyness that we find ourselves in and coming into a space of non-doing, or simply being. Mindfulness is about present awareness, getting out of autopilot and stepping into the present. Some important concepts that we need in order to be mindful is to remind ourselves to practice non-judgment. I don’t know about you, but I often find myself being very critical of myself and the world around me, especially nowadays. So, when we talk about mindfulness, we’re talking about practicing intentionally being non-judgmental and focusing on observing the present moment without trying to change it.

08:11 Mindfulness & Emotional Regulation: The 3-Minute Breathing Space

Liz: Mindfulness and emotional regulation go hand in hand. In order to be able to regulate our emotions, we first have to be aware of them. That’s where mindfulness comes in. Mindfulness helps us to understand how we are feeling in the moment, and then direct ourselves accordingly to best fit our emotional needs. There’s a simple mindfulness exercise that we can do to help us start to tune in to where we are in the present moment. It’s called the three-minute breathing space. The three-minute breathing space asks us to first start with focusing on the breath and then build and expand our awareness of that breath in the moment. You can use the acronym “AGE” to help cue us into this practice: first, we begin with Awareness, then we Gather our attention, and then we Expand that attention outward. 

I’m going to take you through a three-minute breathing space. Just like we did in the beginning of this workshop, I’m going to ask you to take a moment to bring your attention inward. We start by gathering awareness. If you feel comfortable, you can close your eyes, if that helps you to focus or you can direct your gaze to a single spot in the room. I’d like you to bring attention to your breath. Beginning to notice the breath in the body following each inhale and exhale, full and complete cycles of breath. Reminding yourself to take that non-judgmental stance, not trying to force or change the breath just noticing how it is for you right now. Gathering the breath now, beginning to notice how the breath moves in the body focusing in on the belly, following the inhale, noticing the belly rising and the exhale watching it fall back towards the spine. Following each breath, noticing where one breath and the next begins. Gathering breath in the belly full and complete inhale, full and complete exhale. Expanding our awareness now to notice how the breath moves from the core outward. Noticing perhaps places of tension, of stress in the body where the breath stops, reminding yourself again to not force the breath. Just watching it, noticing where it goes and noticing where it stops. Recognizing places of resistance, recognizing places of relaxation and freedom, where the breath flows. Continue to focus on that breath. Just a few more moments here expanding awareness with each cycle of breath, with each inhale and with each exhale. Before we pause our practice and come back, I’d like you to take one more deep breath, perhaps the deepest breath you’ve taken yet today. Drawing breath deep from the belly, full and complete inhale and letting it out, full and complete exhale. When you feel ready, allow yourself to return again to the room. Opening your eyes if they were closed. Completing our practice.

13:27 The Window of Tolerance

Liz: Take a few moments to reflect on that mindfulness that you just engaged in. What did you notice? About the breath, about your body? Perhaps you found it difficult to stay focused. That’s completely normal. Especially with all this going on these days, there’s a lot on our minds and it’s really hard to take that time to pause. It’s part of the power of the mindfulness practice is it allows us a space to slow down. Often times we’re so stuck in that, “go, go go,” that we’re burning ourselves out and we don’t realize it until we’re completely exhausted. Mindfulness helps us to prevent that exhaustion by pausing when we need it, to recharge. A helpful tool that we can use to help us understand when we are getting too stressed is this idea of the window of tolerance. The window of tolerance is what we can use to help us understand the space where we feel grounded, where we feel connected, where we’re able to function optimally. That’s the window of tolerance. That’s the place where we want to stay. That’s where we work our best. 

Now, oftentimes we are operating outside of our own window of tolerance. Some of you probably feel like you’re constantly out of that space, you’re not able to think and feel at the same time. So, there’s two ways that we can understand how we get out of this window of tolerance. One is in a state of hyperarousal. This is often what we associate with the experience of fight or flight. Hyperarousal is all about our anxiety response, it’s this place where we become very, very activated, we feel overwhelmed by our emotions. We feel disconnected from the present, we find ourselves reacting very impulsively. This is a place where we might experience irritation, anger, frustration, rage, panic, that’s hyperarousal. Then we have this other space called hypoarousal. Hypoarousal is our freeze response, our hypoarousal state is where we experience sadness, we feel low mood, shut down, maybe even feeling numb, disconnected. 

There are signs that we are moving out of our window of tolerance. Today, I’m hoping that we can use the skills in this workshop to help you understand when that is happening and to better understand what triggers you to go outside of that space of connection. It’s also helpful for us to understand our own patterns. Each of us responds differently to stress. Some of us may go into that fight or flight response. We’re in hyperarousal, anxious, angry. Some of us may shut down under the face of stress, going into hypoarousal. What’s your pattern? Think about it. How do you respond to stress? Which way do you go? Understanding your response to stress can help you make sure you’re coping more effectively by pairing the skills that match best with the state of hyperarousal and the state of hypoarousal.

17:24 Mindfulness and the Window of Tolerance

Liz: Our goal with mindfulness is to keep us in the window of tolerance as much as possible. Mindfulness gives us the skills to check in and recognize when we are going out of our window of tolerance so that we can do things to bring us back in. It helps us understand when we are in that danger zone and do things to bring us back. That’s our goal with mindfulness.

18:03 What is Emotional Distress?

So, I want to shift gears here and talk a little bit more about this experience of emotional distress. So, we have an understanding of these states of hyperarousal and hypoarousal, our fight, flight, and freeze response. Our fight, flight, and freeze response happens when we are under extreme stress. It’s our body’s biological way of surviving. This fight, flight, and freeze response gets triggered by this area in our brain called the amygdala. The amygdala is responsible for keeping us alive. It’s our body’s alarm system that says something in the environment is threatening, and we need to do something about it. It may feel like you’re in a constant state of alarm these days. There’s a lot of threats happening in the environment, and our body and our brains get overwhelmed by them. This leads to our experience of distress. 

Biologically, we are driven towards seeking out positive emotions and trying to avoid negative emotions whenever possible. So, when we are in this state of stress, when we are surrounded by negative emotions and experiences, the brain doesn’t like it, and it does everything it can to help us survive and get away from those negative emotional states. That’s why we may find ourselves going into avoidance behaviors when we’re really stressed. We’re going to talk a little bit more about some unhelpful avoidance strategies that we may engage in. Part of where mindfulness comes in here in helping us manage our distress is that it allows us an opportunity to actually address and acknowledge the emotions that were experiencing, instead of fighting them or avoiding them. One thing we know is that avoidance is not a long-term solution to our problems and the more we avoid the issues that are causing us stress, the more distress they bring us. Avoidance doesn’t help us solve our problems. So, we need to look at other strategies to help us understand and deal with the emotions that we’re experiencing and the stressors that are causing them. 

20:33 Feeling Wheel

Liz: Oftentimes, it’s hard to put words or labels to how we’re feeling. The feeling wheel that you see in front of you is a tool that you can use to help put a label on your experiences. This is all part of that practice of mindfulness, helping us to understand what we’re experiencing in the moment and understanding the nuances of the emotions that we are feeling. Sometimes we don’t register and recognize emotions until they’re so intense that we are completely overwhelmed. With mindfulness, we try and look at those early signs that we’re moving out of our window of tolerance and placing labels on those emotions to help us better understand them. 

21:24 Unhelpful (and Common) Responses to Anxiety & Stress

Liz: So, let’s talk a little bit about avoidance. When life presents us difficult situations, this triggers negative emotional responses. People find it difficult to tolerate the discomfort that comes with these negative emotions. Think about that for yourself. Perhaps there’s some emotions that you find it really difficult to tolerate. Some feelings that you avoid, that you want to escape from. We all have emotions that we don’t like that feel uncomfortable. We all probably engage in some unhelpful escape mechanisms to help us deal with those experiences of discomfort. Some ideas that we may be responding in unhelpful ways to stress would be experiencing changes in our sleep patterns, changes in our eating. You might notice that you have changes in your thoughts, maybe difficulty concentrating, intrusive thoughts and worries. Maybe you’re experiencing increased frustration and irritation. Perhaps noticing lower energy levels. Maybe your substance use has increased, an extra glass of wine at the end of the day. Sometimes we find we may be avoiding and responding to stress by isolating, disconnecting from positive relationships. Take a moment and think about some of your common responses to stress. Do you engage in any of these unhelpful responses listed above? 

23:23 Coping with COVID-19 Using DBT

Liz: We all deal with stress in different ways and we’re all trying to survive while doing the best we can, and we can all learn to do better. That’s a key concept in dialectical behavioural therapy. We assume that we are all doing our best, and we can always do more. So, although we may find ourselves engaging in these unhelpful escape routes to deal with our stress, it’s important not to judge ourselves for that. We’re just trying our best. Hopefully today you can learn some tools to help you to do better.

24:10 Four Solutions to Any Problem (DBT) Framework

Liz: Dialectical behavioural therapy provides us with a context to understand our experience of emotional distress and explore options for coping effectively with life stressors. Marsha Linehan, the founder of DBT, she proposes that there’s four solutions to any problem that we can face in our lives. The solutions here act as a checklist for helping us navigate overwhelming circumstances and manage the uncertainty of the time. 

Our first option whenever possible, whenever we have the chance is to problem solve. We problem solve by changing what we can control in the situation. Option one asks us to consider how can we solve the problem of the virus COVID-19 being here right now. Can we do anything? We can keep practicing ways to limit the spread of the virus and to be smart about how we proceed in the weeks to come. But there’s a lot about this situation that’s not within our control that we can’t actually directly problem solve. That’s when we move to option number two. 

How can we change how we feel about the problem? How do we change the way we’re feeling about all this happening around COVID-19? This option references the fact that we can focus on ways to use skills of emotional regulation to manage our experience of stress and worry. Our worry can become more tolerable when we are mindful of what is reasonable to worry about and what is not. Some things we need to worry about that are within our control to help us solve the problem. Other things that are outside of our control, we need to let go of because worrying about them is causing more stress. It’s not helping. That brings us to option number three. 

How can we tolerate and accept the problem? Option three invites us to focus on acceptance as a way to get through the day. This option is especially helpful when other options aren’t working. We can’t problem solve, and we can’t change the way we’re feeling about the problem. Option three asks us to accept the reality that we’re dealing with. This is a global pandemic, and we still need to continue to do things to get through the day. 

Our final option, which is always an option, is to stay miserable and possibly make things worse. We always have the option to not use helpful coping skills, and to choose to stay stuck. This is an important reminder that we can always choose. We always have a choice of how we cope. We can’t always control the situation, but we can choose what we do with it. 

27:25 Accepting Distress

Liz: I’d like to move us now into thinking about skills. The first place to start is with acceptance. How do we accept our distress? The concept of radical acceptance asks us to stop fighting reality and to start accepting what is. It’s when we step out of that fight that we can allow ourselves to regenerate. When we are in constant battle with our reality, we are stuck. We can’t change the situation of COVID-19. We need to accept what’s happening right now and work on changing what we can in our own environment and in ourselves. So, what do we need to accept? We need to accept the facts about the past and present. Even if we don’t like them. This is really important. Just because you’re accepting doesn’t mean you’re approving. Acceptance isn’t approval. Doesn’t mean you have to like what’s happening. It means that we have to accept it. If we don’t accept what’s happening. We can’t actually create change. You have to accept what is before we can change. We also need to accept that there’s realistic limitations on the future for everyone and life can still be worth living, even though we’re experiencing stress and pain. So how do we do it? 

29:25 Radical Acceptance

Liz: Acceptance can feel really difficult in the moment, but there’s some steps that we can take to help us get there. 

The first step is awareness. In order to accept reality, we have to notice when we’re fighting it. Observe when you experience emotions, of anger, of irritation, of frustration, anxiety, pay attention. That’s mindfulness. Notice when you are fighting reality, what triggers you into these emotions. 

Next, we need to acknowledge. Remind yourself that unpleasant reality cannot be changed, and that there are causes for the situation that we’re in right now that are not within your control. This is how things are right now. Acknowledge that life can still be worth living, even where there is struggle and pain. Next, we have to bring space for allowing. 

Allow the current situation to be present with you. Accept it with your complete body, mind and spirit. Use accepting self-talk to help bring you into a place of openness. Engage in behaviors that you would do if you did accept the facts of this crisis in your life right now. Act as if you are in a place of acceptance. We can act our way into changing our thinking. Next is attending. 

Notice your body sensations and emotions. As you think about acceptance. Instead of fighting and avoiding the emotions that come up, allow space for disappointment, for sadness, for anger. Accept that these negative emotions are present. Practice tolerating the discomfort by applying some self-compassion in the moment. Be kind to yourself. Remind yourself that these emotions are normal. Everybody is feeling distress and you’re human just like them. 

Step five, action. We need to be proactive in our coping. Just because we’re practicing acceptance doesn’t mean we are stepping away from being active in our life. Identify events and things that may seem unacceptable to you. Think about the situations that you might have difficulty coping with in the future and rehearse how you could work on accepting them. Use visualization, imagine it’s possible for you to accept. The more you practice acceptance ahead of time, the less distress you’ll experience should these events occur. This is the idea of mental rehearsal. Athletes use this strategy all the time in preparing for competition for highly stressful situations. They rehearse executing the skill before they get into the situation. They both do it with their bodies during practice, but also mentally, they reinforce those pathways through visualization. If we can imagine ourselves coping successfully, the odds of us doing it in the moment are much greater. So, rehearse, practice accepting, practice coping effectively. That way when you need it, you’ll be able to do it.

33:19 Tolerating Distress

Liz: Now I’d like to move us into talking about tolerating distress. This is option three. We talked about accepting the problem now we’ve got to work on tolerating the problem. Tolerating distress is all about finding the balance between accepting emotional distress and taking action to improve it. Managing stress over the long term is difficult. We need to learn how to ride the waves of our distress, so that we don’t end up doing things that make it worse. In moments of extreme emotional and mental crisis, we may actually need to shift our focus away from accepting and work on decreasing our distress. Our actual experiences of emotions, both positive and negative, are actually quite brief. We often engage in biased interpretations of our emotions that contribute to an increased intensity and longevity of distress. In the affective forecasting literature, it suggests that we tend to think negative emotions will last a long time and that positive emotions won’t last long enough. If we remain in a state of high stress for too long, this makes us vulnerable to engaging in unhelpful coping mechanisms, which could potentially make the situation worse. The skills in this section are designed to help us ride the waves of our emotional distress and avoid doing things that make us feel worse. So, remember, emotions don’t last long. We want to work on finding the balance between accepting emotional distress and taking action to improve it and we can use practical skills to help us avoid making situations worse. 

35:22 Crisis Skills: STOP

Liz: Here’s some strategies. Our first skill here is called the “STOP” strategy. The stop skill is used to slow down our reactions in the moment and provide us with an opportunity to gain perspective on the situation that’s causing the distress. Stop is meant to get us out of autopilot. The stop skill can help us stay in control and avoid acting impulsively. The steps to stop are simple. 

Step one: stop. Literally pause whatever you’re doing and don’t react. Maybe visualize a stop sign in front of you, count to five. Imagine a red light flashing in front of your face. Don’t let your emotions get the best of you. Freeze in the moment. 

Next, we need to take a deep breath, now take another. Allow yourself to step back from the situation. Bring your body back online. Our fight or flight response may have just got triggered. You’re in a state of crisis. Your amygdala, your alarm system is telling you, you need to do something. Our breath is a way to cue our physiology to get our brain back online by breathing deeply in the belly. We take ourselves out of that fight or flight response and bring ourselves back into the present moment. The breath is very powerful. It’s one of our strongest physiological tools to manage distress. We should use it more often. 

Once you’ve taken a deep breath, now we observe. I like to call this taking a helicopter view. Imagine yourself looking down at the current situation causing you stress. Observe what others are saying and doing. Look at yourself, what are you saying and doing? What is your body saying and doing? Make sure you’re seeing the whole picture for what is happening in the moment. Remember, when we’re under stress, our perception gets distorted. We may be in a state of tunnel vision, you’re only seeing one thing, not the whole picture. “STOP” asks us to take that step back and look at what is happening and then we can proceed mindfully. 

Think about your goals and the outcome you’re hoping to achieve. Make sure you’re considering all the factors in the situation. Think about your own thoughts and feelings as well as those of others. Proceed with caution, making sure you’re choosing the most effective action in the moment. We are going to be effective when we think about our goals. Oftentimes what leads us into impulsive decision making, or avoidance behaviors is when we lose sight of what we’re trying to achieve. Remind yourself, what do I want to get out of this situation? What do I need? How do I want the other person to feel? Then act accordingly.

38:58 Crisis Skills: IMPROVE the Moment

Liz: Our next crisis skill is an acronym, “IMPROVE.” During times when you find that you do not have control over unpleasant events, you will need distress tolerance skills to make it through the situation without engaging in unhealthy behaviors. Remember, intense emotions do not last forever. So, we can use our DBT skill of IMPROVE to tolerate emotions until the intensity of that feeling subsides. It’s about getting to the other side of the distress without making things worse. So, this strategy can be used anytime you need to tolerate a situation that you can’t change. Let’s go through the acronym. 

The “I” stands for “imagery.” Imagine yourself dealing successfully with the problem and feeling accomplished when the situation is over. Picture yourself in a common positive place, someplace where you can manage frustration with ease. If you believe you will be successful in managing the stress, you are more likely to get that outcome. It’s when we begin to doubt ourselves, that we plant those seeds in our brain that then change our perspective. Then we’ll lose confidence in our abilities. So, believe in yourself, imagine that you can cope. 

Meaning: try to find meaning in the current challenge. Ask yourself some of the following questions to help get perspective. What can I learn from this experience? What can I learn about myself, that could help me in the future? What if something good happens because of this? Are there possibilities? We know that finding meaning in the most difficult of circumstances helps us to build resilience and maintain a sense of purpose in our struggle. We can find meaning in the struggle that will help us to ride that wave of distress. 

Prayer or practice: prayer can come in any form that works for you. The idea of prayer from a dialectical behavioural perspective is that we can use a connection with a higher power, including God or the universe to help us tolerate a situation. We can surrender our problems and ask for help in managing that situation that we are in. For some of you who may not associate or connect with this concept of prayer, another word that we can use here is practice. Practice means focusing in on an activity that brings you a sense of mastery or accomplishment. It’s about building up our self-esteem and ability to feel capable and competent in the moment. This goes back to the idea of imagining ourselves being successful, if we can do things that help us to feel more confident and competent, we will feel more capable of dealing with the stress that we’re experiencing. 

“R” is for “relaxation.” Remember, during stressful situations, our fight and flight instinct gets triggered, which can make it really, really difficult to relax and stay focused. We need to bring ourselves out of that state of hyperarousal and engage in relaxing activities that will allow our body to calm down. When our body calms down, so will our minds. So, think about activities that you can do that help bring you a sense of relaxation and practice them very intentionally. Some things that you could try would be listening to calming music, maybe deep breathing, yoga, a hot bath. Maybe taking a relaxing walk. Practice relaxation regularly to help us stay within our window of tolerance. 

One thing in the moment: this is a really important concept that connects back to our idea of mindfulness that we discussed in the very beginning. Part of what we need to do to tolerate our distress is to make sure that we’re not adding more stress to the present moment. The only thing we need to survive is the moment that we are in. So, make sure you’re doing one thing at a time. This helps reduce the intensity of your feelings and provides you with some time to let your brain settle down. Practice focusing on the present moment instead of getting stuck in fears about the future, or painful things from the past. We don’t need to add any more onto our plates. Let’s just focus on what’s happening right now, stay in the moment, by finding one thing to do, and focus your entire self on that task. Some of you may be pretty good multitaskers. The reality is our brain isn’t actually designed to be multitasking. What ends up happening is we typically become serial taskers, we start a task, and then we start another and another and another and none of the tasks get really completed to the best of our ability, or maybe not even completed at all. So, we need to focus on doing one thing in the moment to help minimize our stress, and also to help us build a sense of accomplishment to actually complete and finish a task to the best of our ability. Then we can move on.

“V” is for “vacation.” When you have the urge to escape a negative situation, allow yourself to take a short break, to recuperate. Although we can’t take a real vacation during this crisis, you can take a vacation in your mind. This is where imagery can be really powerful. Imagine yourself somewhere else. Take 5 or 10 minutes. Imagine you’re lying on a warm sunny beach somewhere, or maybe taking a walk in a redwood forest. A mini vacation can help you gain some perspective and allow you a chance to recharge so that you can better tolerate your circumstances. 

Encouragement: we need to give ourselves some positive, affirming messages. There’s so much negativity and stress going on in the world around us, so much negative messaging. We need to give ourselves a pep talk to help us get through the crisis. Use words of encouragement. Remind yourself, I’ve got this. This too shall pass. I’ve managed difficult situations in the past and I can do it again. Tell yourself you’re strong, you are capable. We want to make sure we are practicing encouragement regularly and with intention, find some affirmations, some key words that you can believe and buy into and repeat them. 

47:31 Building Resilience

Liz: So, we’ve talked about option three. How to tolerate a crisis, how to accept a crisis. Now I’d like to talk a little bit about how do we build resilience in the face of this crisis. Self-care is critical in managing stress. We need to do things to help us recharge and keep our energy tanks full. Every day we’re getting drained mentally, emotionally, and physically. It’s essential that we take care of ourselves, so that we can help ourselves cope effectively and be in that window of tolerance. Engaging in activities that provide us a source of comfort can bring a sense of calm during times of stress. In turn, participating in activities that activate positive emotions can help us restore energy when we’re feeling drained.

48:36 ABC’s Accumulating Positive Emotions

Liz: In DBT, we have two skills that help remind us about how to be effective in taking care of ourselves. We have the “ABC’s” and we have our “PLEASE” skills. Let’s start with ABC’s. As you might have noticed, in DBT, we love our acronyms. “ABC” stands for Accumulating positive emotions, Building mastery, and Coping ahead. The ABC’s help us reduce vulnerability to emotional distress. 

The first step in doing that is accumulating positive emotion so increasing our engagement in activities that lead to positive emotions. This will allow us to build emotional reserves so that we can face difficult life situations. Engaging in daily positive experiences help us to build a shield against distress and allows us to minimize the emotional impact of negative life circumstances. Some things that we can help do to launch ourselves into more positive activities is to remind yourself to avoid avoiding. Prioritize positives in your schedule. Challenge urges to multitask and focus your attention on the positives in the moment. If we engage in a positive activity, but we’re not present. It has no effect. We actually have to focus in on what we’re doing and make sure you’re taking time to engage in activities that you enjoy every single day. Especially during these times of stress, we need to place more attention on positives. There’s high energy activities that we can do to help us accumulate positive emotions, exercising, calling friends, watching a favorite movie, reading a book. These are things we can do when we are feeling like we have the energy to really engage in things that may take a little bit more out of us. Also, during times when we’re maybe feeling low, maybe we’re in that state of hypoarousal where we’re feeling numb, we’re feeling down, feeling tired. During those times, we really need to use our positive activations, we need to engage in those positive activities. But it can feel really difficult to do it because we don’t have the energy. So, that’s where we can turn to these low energy options, things that we could do to boost our experience of positive emotions, to cue our experience of feel-good neurochemicals like dopamine and serotonin without having to exert a lot of energy: listening to some music, lighting a candle, doing some slow breathing, cuddling up with your pet in a warm blanket. Wherever you are in your emotional state, whether you’re in a place where you have energy, or where you’re feeling drained, we can find a positive activity to fit. 

The “B” and the “C,” building mastery and coping ahead. How do we do it? Building mastery is about learning new skills that provide you with a sense of accomplishment and confidence. Engaging in activities that bring you a feeling of proficiency. This feeling will help alleviate negative emotions in the moment, as well as give you a healthy distraction to manage times of anxiety, depression and restlessness. So, we need to be intentional, plan to do one thing each day, that’s going to give you a sense of accomplishment. Focus on doing something difficult but possible. We need to feel challenged. But we want to make sure the challenge isn’t too great. Where we’ll end up feeling disappointed or unable to reach our goal. We can gradually work over time in increasing the difficulty of the task. Plan for success. Focus on accomplishing the task at hand and imagine yourself doing it well. Don’t think about how difficult it’s going to be. Think about how you will make it happen. 

Coping ahead: coping ahead is all about preparing yourself for events and situations that you know are going to be difficult. This isn’t particularly important now, as there are so many challenges, we will face in adapting to the new normal of life during and after COVID-19. We need to help prepare ourselves. So, we start by identifying challenges. Think about what’s going to be difficult and identify how you could cope most effectively with that situation. Again, the idea of mental rehearsal. We may not be able to predict everything that’s going to happen, but we can make reasonable guesses about the challenges that are going to come our way and then we can practice coping effectively with these challenges. Imagine yourself in the situation and rehearse coping effectively. Think about it, what could you do to cope? What will you say? And how will you say it? How will you troubleshoot new problems that may come up? Think of options A, B, and C and plan for all of them. This will also help us in managing our experience of worry and anxiety about the future. We experience worry, as a way to help us feel prepared because it triggers our thoughts into thinking about how we can plan to manage the threats and the stress. What often gets us stuck is that our worry turns into rumination. We begin thinking about the future and then we get lost in those thoughts and thinking about all the things that could go wrong and what might happen. When we find ourselves getting stuck in that worry and that ruminating, this is where coping ahead can be extremely helpful. Yes, we need to recognize and think about possible problems, but we also need to think about solving them. So, instead of just focusing on all the things that might happen, also focus in on what you’re going to do about them. 

55:45 Self-Care: PLEASE

Liz: Let’s move on to the “PLEASE.” One thing we can all do to help prevent the spread of the virus is to take care of ourselves physically. We know this, that when we can take care of our body, we’ll have the energy and resources needed to take care of our mental health as well. The foundational behaviors outlined in PLEASE, are proven to be highly effective in managing our physical and mental wellbeing. The “PL” stands for treat physical illness. I know that one’s a bit of a stretch. So, take care of your body and that way you can take care of your mind. When you’re sick, this impairs your ability to perform, and you can’t do your best, and that impacts our emotions negatively. 

So, make sure you’re doing what you can to help take care of your body, that can include things like balanced eating. Give your body the energy it needs to manage the stress at hand. This is more important than ever right now because you’re under extreme stress. Your body is getting drained, whether you’re aware of it or not and we need to use food as fuel to help energize our bodies and our brains. Limit caffeine. Try and be mindful of the high-sugar foods that you’re eating because these things can also lead to us crashing and that crash will have an emotional impact and make it difficult to come back from. Avoid mood altering substances. Make sure you’re taking medications as prescribed, using alcohol in moderation. Staying off drugs that will dysregulate your moods. 

Balance your sleep. Sleep is essential to our functioning. We’re biologically driven to need sleep because this is where our body restores itself. So, be mindful of the amount of sleep that you need in order to function at your best. It may be that you need more sleep right now than usual and that’s because your body is going through a lot and your brain is going through a lot. We need that consistent sleep schedule to help give us the energy we need to complete daily tasks and regulate our moods. You may notice when you’re feeling sleep deprived, your sensitivity to the environment increases, we’ve become more emotionally volatile and more impulsive. In order to help prevent us from experiencing more distress, we can do things to be proactive and preventative. Having a regular sleep routine is part of that. 

Last piece of the puzzle is exercise. Exercise triggers the release of feel-good neurotransmitters including dopamine and serotonin, endorphins. Exercise decreases our experience of anxiety and depression in the moment, as well as builds our resilience to these negative emotions in the long run. Exercise can be used in the moment where we’re feeling extreme anxiety to help deactivate our fight or flight responses. It also can be used to build a shield of feel-good neurotransmitters in our brain, to help us get through the difficult situations that we may face. 

59:47 Resources for Coping with Stress & Anxiety

Liz: What I’d like to encourage you all to do is to take the skills that we’ve talked about today and create a personal action plan. Think about the coping skills that fit best for your life that you can see yourself using and think about a way to use them to maintain your wellness. Think about the warning signs that you’re not coping well. Going back to what we talked about in the very beginning of understanding our emotional escape routes, what are signs that I may be moving out of my window of tolerance, changes in my sleep, my eating, my emotions, my thinking, my physical state. Identify what coping skills you could use when you notice that you’re not taking care of yourself. I hope today has brought you some information that you can use moving forward to manage the stress of the world we are currently living in. An important reminder to be kind to yourself and show compassion. We’re all trying our best. I’d like to end today with asking you to check in with yourself one last time. What do you notice about the body? About where you are emotionally? Perhaps where your thoughts have gone, where they have shifted to. Taking another moment to pause and just be present with yourself as you are. 

Thank you for taking the time today out of your busy life to listen to me. I really appreciate your time and attention. This final page of the presentation is a list of resources for coping with stress and anxiety. Please feel free to access any of these resources. They’re all free and available to you. Best wishes.

Coping with Stress & Anxiety

  1. Dialectical Behavior Therapy Clinic at Rutgers University (DBT-RU): https://www.youtube.com/playlist?list=PLVlLbxLe1Eo51f-BqC3u48AyikKun3mcT
  2. MindShift CBT by Anxiety Canada: https://www.anxietycanada.com/resources/mindshift-cbt/
  3. Antidepressant Skills Workbook: https://psychhealthandsafety.org/asw
  4. Intolerance of Uncertainty Information: https://www.heretohelp.bc.ca/infosheet/how-to-tolerate-uncertainty
  5. Accepting Uncertainty Module by the Centre for Clinical Interventions:
    https://www.cci.health.wa.gov.au/~/media/CCI/Consumer%20Modules/What%20Me%20Worry/What%20Me%20Worry%20-%2009%20-%20Accepting%20Uncertainty.pdf
  6. Coronavirus Anxiety: Coping with Stress, Fear, and Uncertainty: https://www.helpguide.org/articles/anxiety/coronavirus-anxiety.htm
  7. Anxiety Canada: https://www.anxietycanada.com/articles/what-to-do-if-you-are-anxious-or-worried-about-coronavirus-covid-19/
  8. American Psychological Association: https://www.apa.org/helpcenter/pandemics
  9. Mental health Commission of Canada: https://theworkingmind.ca/sites/default/files/twm_self-care-resilience-guide.pdf
  10. Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Mindfulness

  1. https://www.mindful.org/free-mindfulness-resources-for-calm-during-covid-outbreak/
  2. https://www.mindful.org/covid-anxiety-is-also-contagious-heres-how-to-calm-down-america/
  3. https://www.mindful.org/mindfulness-meditation-anxiety/
  4. https://www.tarabrach.com/mindfulness-daily/
  5. https://www.mindfulnessstudies.com/meditations/
  6. https://www.uclahealth.org/marc/body.cfm?id=22&iirf_redirect=1
  7. https://www.youtube.com/watch?v=ihO02wUzgkc
  8. https://medschool.ucsd.edu/som/fmph/research/mindfulness/pages/default.aspx
  9. https://www.loyola.edu/department/counseling-center/students/relaxation

Wellness

  1. Yoga with Adriene – free yoga video: https://www.youtube.com/user/yogawithadriene 
  2. YMCA 360 On- Demand: https://ymca360.org/
  3. Cosmic Kids Yoga and Mindfulness – YouTube channel: https://www.youtube.com/user/CosmicKidsYoga/featured

Wellness App Suggestions

  1. Stop, Breathe, Think (also on YouTube)
  2. Calm
  3. Breathe
  4. Insight Timer
  5. Mindshift
  6. Headspace

Crisis & Distress Hotlines

  1. Toronto Distress Centre: 416-408-4357
  2. Gerstein Centre: 416-929-5200
  3. Toronto Seniors Helpline: 1-877-621-2077
  4. Kids Help Phone: 1-800-668-6868, Text CONNECT to 686868
  5. Anishnawbe HEALTH: 416-360-0486
  6. Mental Health Crisis Management Service: 416-891-8606
  7. Assaulted Women’s Helpline: 416-863-0511
  8. Good2Talk (post-secondary student mental health helpline): 1-866-925-5454
  9. York Support Services (North York): 1-855-310-2673
  10. Youthdale’s Crisis Support Team: 416-363-9990

More EHN Canada Webinars

You can watch more of our past webinars on our Youtube.

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