DBT Group: Week Eight – Part II – Coping Ahead

Module: Emotion Regulation

This is the second of three parts for Week Eight. Covering the ABC Skills, (B) Building Mastery, and (C) Coping Ahead.
This post covers (C) Coping Ahead.
The first one, (A) Accumulating Positive Emotions: Short Term (click here for post) and Long Term (click here for post). The second one (B) Building Mastery, click here.
And the third post will be the P.L.E.A.S.E. Skills (Treating PhysicaL illness, Balanced Eating, Avoid Mood-Altering Substances, Balanced Sleep, and Get Exercise.

I think each of these skills deserves its own post in order to more fully explore how important these skills are towards managing our emotions, helping us to reduce vulnerability, and towards living a more fulfilled, positive life.

Homework Take-Up:
Handout:
Emotion Regulation Handout 19 – Build Mastery and Cope Ahead
Worksheet:
Emotion Regulation Worksheet 12 – Build Mastery and Cope Ahead

Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
(A) – Accumulating Positive Emotions
– Short Term
– Long Term
(B) – Building Mastery and a sense of competence
(C) – Coping Ahead to better manage emotional situations
(P.L.E.A.S.E. – Treating PhysicaL Illness, Avoid Mood-Altering Substances, Balanced Eating, Balanced Sleep, Get Exercise) – Taking care of your health and well-being physically deserves as much attention as taking care of your mental health and well-being

Starting with:
Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
Third Box (Overview): (C) Coping Ahead
Moving to:
Emotion Regulation Handout 16 – Build Mastery and Cope Ahead

This piece is important because we often find ourselves in highly emotional situations and we get overwhelmed, and we either don’t know how to handle it, or we turn to our tried and true ways of coping. Which is usually negative, destructive ways.

Doing what we can to cope ahead gives us space and time to breathe, and find a more effective way to cope and handle the situation.

Obviously, there is no way for us to see the future and know exactly what situation will come our way and exactly what emotion we’ll respond with.

Coping ahead isn’t about trying to guess the future. It’s about knowing ourselves, and the typical ways in which we have been triggered in the past. It’s about recognizing and recalling certain situations that have led us to feeling hopeless or helpless, or what has led us to our destructive coping mechanisms.

There are patterns to our behaviours and reactions, that we can use to our advantage. We can use the patterns from our past to try and cope ahead for when we encounter the same situation again at a later date. It is by no means foolproof, and what may work one time may not work for another time, but there are times when it can help us, and when it does, it can feel like a lifesaver.

For example: For a long time I was having panic attacks whenever I was in a store. It didn’t matter which store, or whether it was day or night, or if it was busy or quiet (although busier stores did make it worse), and it didn’t matter if I was shopping alone or with someone, I would have a panic attack.

Inevitably, within 15 minutes of being in the store, sometimes less, I would suddenly feel a rush of panic through my body. And I always knew what it meant. The moment it hit me. My heart would race, my hands would get cold, I would hold my breath, and I would feel lightheaded. I was certain I would pass out. I would have to stop in my tracks, wherever I was, and either place a hand on a shelf or a rack or a post, something that would give me a sense of grounding. Something that would help me to feel more stable, and less like the world was tilted.

I would suddenly have tunnel vision, and I would need to focus on something fixed ahead of me. It didn’t matter what it was, a product on a shelf, a tile on the floor, as long as it didn’t move I would zone in on it. Between holding my breath, holding a shelf (or post, or rack), and focusing on one spot before me I felt that this would ground me. I believed that as long as I wasn’t moving, and what I focused on wasn’t moving, then I was stable, and I was safe. I believed this would make the panic subside and I would feel okay. It was almost like staying still meant that nothing bad could happen.

Unfortunately, this was not true. In fact, just the opposite would happen. From holding my breath, I would exacerbate the feeling of lightheadedness, and my urge to run and hide grew stronger by the second. Because I was too afraid to move it wouldn’t be long before it would inevitably turn into a full blown panic attack. I feel like I am going to die, and somehow I need to inch my way out of the store to safety, which would mean a quiet corner or some quiet, secluded spot where I could gather my thoughts and calm down. I would often leave the store without purchasing anything. And it would take me longer than normal to get home as well because I would still feel a sense of tunnel vision.

This became quite debilitating for me because it was so indiscriminate for when it would happen, or if it would happen at all, and how intense it would be. I never knew what store I could go into a be okay, and which stores would set me off. I was relegated to try and get what I needed as fast as I could, or I ended up not going out at all. The idea of going out started to become a terrifying thought, and eventually I would start to feel the panic attack just at the thought of going out. It took a fair amount of time, and progressive exposure with my psychiatrist, that I was finally able to reduce the panic attacks I had in stores. Now I feel a lot more confident going out. I still sometimes have panic attacks but I also have ways to cope with it now too.

This is where the coping ahead comes in.

I would like to say that I am able to breathe or visualize my way through going out and having a panic attack but unfortunately I often need more than just mind control to help me through. I need to find other ways to cope ahead. What I use to help me is a distress tolerance kit I put together for myself. Those of you who have been to BPD support groups, or DBT support groups, will be familiar with the distress tolerance tools. They are usually baskets or buckets that include ice packs, toys like slinkys or squeeze balls, rocks, or blocks, scented hand lotions, puzzle toys, and even Play-Doh. It’s a wide variety of textures and distractions. These toys and tools are used to help reduce anxiety when it starts to feel overwhelming. They can either distract, soothe, or otherwise reduce the feeling of anxiety.

What you may take from the basket or bucket is entirely up to you and whatever can help you reduce your anxiety. It could be the ice pack that works to distract you as you focus on the cold, and when used at the right time can even shock your system into stopping a panic attack from happening in the first place. Or you may want to fidget with the slinky or a rubik’s cube, or a squishy ball, sometimes it takes a few tries with different textures or toys to learn what helps you calm down, or feel less anxious.

Knowing what works for me, I built my own distress tolerance kit. I hit a dollar store and got a small pouch and filled it with a few toys, like a slinky and a puzzle block, and a rubik’s cube, and I carry my distress tolerance pouch with me in my backpack so it’s there whenever I start to feel anxious. Ice packs and walking are the most effective ways for me to ease a panic attack but having an ice pack handy, or cold water to splash on my face, or going for a walk, are not always options I can use. Like when I’m on the bus or subway. So I have my little distress kit I can turn to. I’ll admit that sometimes it doesn’t help, and I end up having a panic attack, but it helps more than it doesn’t.

This is one strategy I use to cope ahead.

Another way that use to cope ahead is when I know I’m going to be in a situation that has previously triggered me, for example, sometimes when I’m with my brother, and he gets angry at something, I know that there is a possibility that will trigger me. It doesn’t always happen, and when he gets angry, it doesn’t even have to be directed at me, but I know that if it happens, it will trigger me into an emotional state of fear. It’s happened to me enough in the past that I know what signs to look for in my brother, as well as in myself.

By going through the situation in my mind, and considering how I will most likely respond, I can plan ahead to either minimize my response, cope with whatever does come up, or maybe even avoid the emotional response altogether.

First, I need to imagine the situation in as much detail as I can, and what my most likely response will be. I need to consider of there might be obstacles or factors that may interfere with being able to use my skills. For example, if we are out when his anger triggers me, I’ll most likely respond differently than if we were at my place or his. If we are out then I can walk away and let him cool down, or I can go home. If he’s at my place, I can leave the room, but it might be harder to really remove myself from the situation.

I’ll need to adapt or adjust as the situation calls for it, depending on where I am, and how I get triggered, and how intense the triggering becomes for me.

For example, if I’m already feeling vulnerable because of my own mood, and there are some vulnerability factors, like I didn’t sleep well, or I’m not feeling well, I will most likely respond with much more sensitivity than if I didn’t have the vulnerability factors or other obstacles preventing me from being as skillful as I could be.

By imagining how I might respond I can also think ahead of other ways I can cope. I can prepare myself however I need to so that I can handle the situation and minimize how much I am affected. I can plan what I could maybe say to him, let him know that his anger is affecting me, or I could try to say or do something that reduces his anger, although the focus should be on myself and reducing my heightened emotional state. Another way I could handle if I am feeling fear because of his anger is to just walk away, and completely remove myself from the situation. This would give him an opportunity to cool down but it also allows me to ease my own heightened emotional state.

Finding ways to cope ahead for situations that we have been in before, and most likely will be in again, can be a lot of trial and error in finding what works. I highly suggest thinking of as many way as possible to cope ahead with a situation you may be triggered by because it’s hard to say what will work when, and having as many options as possible allows for a much better chance to have some control over the situation and your emotions.

This is the chance to use our past to our advantage. By being familiar with what triggers us, we can prepare for what may happen, and reduce our emotional responses, and actually stand a chance of dealing with the situation and moving past it.

Good luck!

Bye for now!

Skills, Handouts, and Worksheets from DBT Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

 

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