If you or someone you love is having thoughts of ending their life, I encourage you to contact the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to 741-741 to chat with the Crisis Text Line.
Disclaimer: I am not a certified mental health professional. My advice is based solely on my experience as a psychiatric patient and my research/personal interest in mental health. Please consult a doctor or therapist for qualified treatment if you suffer from mental illness.
Before I started DBT, one of my greatest challenges was distress tolerance — in other words, how I deal with difficult emotions. My threshold for withstanding negative emotions was very low, because I didn’t have the coping skills I needed to thrive in adversity. Instead, I resorted to self-destructive behaviors that were bad for me and bad for my depression.
Now, I’ve learned so many distress tolerance skills to help me cope with negative emotions — and I wanted to share them with those of you who may also be struggling to withstand emotional pain. Which is exactly what I plan to do in this blog post, by the way!
Stick around ’til the end, and I’ll tell you how to download my FREE printable coping cards. The printable comes with eight cards the size of an index card featuring distress tolerance skills. They fit perfectly in a wallet, purse, backpack or pocket, so you will no longer have to struggle to remember your therapy skills on-the-go. And therapists: feel free to use these coping cards in your clinical practice, if you so choose!
Skill #1: Distracting From & Challenging Your Thoughts
Our negative thoughts are the driving forces behind our negative emotions, according to the principles of Cognitive-Behavioral Therapy, or CBT for short. Thus, interrupting and challenging negative thoughts can effectively put an end to negative emotions. Here are a few techniques I’ve learned for getting the hang of this.
I learned STOPP in my Dialectical-Behavior Therapy (DBT) Intensive Outpatient Program (IOP). STOPP is an acronym (something we love in DBT!) that helps you remember how to interrupt your negative thoughts. Here’s how it works:
Stop! Literally, think or say the word “Stop” to yourself.
Take a deep breath. Place a hand on your belly to ensure you’re breathing deeply.
Observe your thought. What is it trying to tell you?
Pull back. Ask yourself if this thought is realistic. What evidence do you have for/against the thought?
Proceed mindfully. Determine what the best, most effective course of action is to take — and take it!
STOPP can not only help you interrupt and challenge negative thoughts, but it can also help you react more calmly and patiently when dealing with overwhelming emotions like anger or guilt — especially if you need to respond mindfully to someone else, like a partner or a friend you might be arguing with.
Examining the Evidence
Examining the evidence is another core principle of CBT. It can also be described as “checking the facts” on your thoughts, to see if your anxious or distressed thoughts still make sense once they run the test of logic. To perform this skill, you need to do three simple things: catch your negative thought, examine your negative thought and reframe your negative thought.
First, catch the negative thought running through your mind. Hold onto it. What does it say?
Second, examine your negative thought by asking yourself the following questions (they can be difficult to remember, which is why I created a coping card to help!):
- What evidence do you have for/against the thought?
- Are you guilty of distorted thinking?
- What would you say to a friend in the same situation?
- How is this thought helpful/harmful to you?
- Is there another way of looking at the situation?
Once you’ve weighed the evidence and done a cost/benefit analysis of whether holding onto this negative thought is really serving you in any way, you can try the third and final step: reframing your negative thought. Given the facts you found in step two, how can you rephrase your thought in a more realistic and balanced way? Try your best to remember this version of your thought next time you catch the negative thought!
Another DBT acronym, ACCEPTS helps us when we’re in a moment of distress and don’t feel up to challenging our negative thoughts. Instead, it serves to distract us from those thoughts so we can escape the negative emotions we attach to them, enough to view the situation from a distance.
ACCEPTS stands for:
Activities. Distract yourself with hobbies and/or chores.
Contributing. What can you do to help others in your life?
Comparisons. Think of those less fortunate than yourself and summon your gratitude.
Emotions. Create a contrasting emotion to the one you’re feeling by using books, movies or music to alter your mood.
Pushing away. Can you leave the situation that’s stressing you out, whether mentally or physically?
Thoughts. Use your thoughts to distract yourself, whether that’s counting or doing a puzzle.
Sensations. Break yourself out of your negativity with a hot/cold shower or drink, hot water bottle or cold ice cube in your hand.
I’ve made a coping card to help you remember these steps, so you don’t have to worry about recalling what ACCEPTS stands for on the go! Just remember that it’s a skill you can use to distract yourself from negative thoughts.
Step #2: Coming Down From a Crisis
Whether it’s suicidal thoughts, a panic attack or an emotionally stressful life event, a crisis can really throw you for a loop if you’re not prepared to deal with it. These simple skills are specially designed to help you cope with those big moments where you’re too overwhelmed to remember complicated techniques.
Grounding techniques are the perfect way to get back down to earth during a moment of anxiety or panic. They consist of quick, easy exercises that don’t take much effort to remember (though just in case, I’ve still created a coping card on grounding for you to carry on-the-go!). Try the following grounding techniques to help you calm down in a crisis:
5-4-3-2-1. This is kind of a fun way to wind down from a moment where you feel overwhelmed! Rely on your five senses for this coping skill. In your head, name five things you can see, four things you can hear, three things you can touch, two things you can smell and one thing you can taste. By the time you’re finished, you should feel cooler and more collected.
4-7-8 Breathing. Deep breathing is a powerful way to send a message to your body that it’s time to calm down. Try this breathing technique next time you’re in panic mode. Breathe in for four, hold for seven and exhale for eight “Mississippis,” and feel the sense of ease spread through your entire body.
Body Scanning. A quick meditation you can carry on-the-go, try a body scan next time you’re feeling anxious or overwhelmed. Start at the tip of your head and carefully scan your body down to your toes. What sensations can you feel? Notice where you are holding tension, and see if you can send some ease to those parts of your body by breathing deeply. Ahh, isn’t that better?
Ready for another DBT acronym? TIP offers four easy-to-remember skills that are perfect to whip up when you can no longer tolerate your level of distress. If you think you can’t stand your uncomfortable emotions a moment longer, try one of these four things instead:
- Temperature. Plunge your face into a bowl of ice water (above 50 degrees) for 30 seconds, take a cold shower or simply splash water on your face. This act calms your fight-or-flight instincts to help you feel more calm, mentally and physically.
- Intense physical activity. Jogging in place, doing as many push-ups or sit-ups as you can, vigorous jumping jacks — heck, even dancing to your favorite song! Whatever you can do to get your heart rate pumping will get some of that excess energy out and help you feel less restless.
- Paced breathing. Breathing along to a paced count will help you force your nervous system to slow down. Try the 4-7-8 breathing exercise above, or another one called four-square breathing (click here to read how to do it).
- Paired muscle relaxation. Relax your physical body while slowing down your brain by pairing deep breathing with muscle relaxation. On an inhale, tense all the muscles in your body. As you exhale, think the word “Relax” and release your tensed muscles. Feel a sense of ease spread through your entire body.
When coming off a crisis, speaking to your inner child and doing something comforting can help you feel more safe and secure. After the high of those intense emotions has passed, turn to these self-soothing techniques using your five senses to try and calm down:
Smell. Light a candle, diffuse essential oils, take a bath, use scented lotion, visit the perfume aisle and spritz them all.
Taste. Savor a chocolate truffle, go to your favorite cafe and order a coffee or tea, chew a piece of flavorful gum.
Hearing. Play music to match your mood (or the opposite of your mood), play your favorite movie in the background, listen to a podcast by your favorite celebrity.
Sight. Watch comedy videos on YouTube (I recommend Guy Who Just Bought a Boat), color an adult coloring book with bright markers or pencils, do your makeup (or someone else’s).
Touch. Get a hug from a friend or lover, wrap up in a fuzzy blanket or robe, take a hot bubble bath, schedule a massage.
As someone who’s especially fond of scent and the power it has over our mood, I love using essential oils and the principles of aromatherapy to both prevent and cope with negative emotions. It’s a great way to self-soothe if you’re someone who’s influenced by the power of smell!
Interested in getting started with aromatherapy? You can get a starter kit of essential oils on Amazon or at your local health foods’ store (my local CVS even sells some now) for fairly cheap. Try diffusing them throughout your home or mixing them with coconut oil to apply topically to your skin. (Do some research first, though, to figure out which oils are safe for topical use.)
If you’re still interested in learning more, I’ll also drop some of my favorite scents and their aromatherapy uses below, so you can fill your brain with everything it needs to know to start using the power of scent to self-soothe! (And yes, there’s a coping card for aromatherapy, too.)
- Lavender: stress relief, relaxation,, anti-anxiety.
- Lemon: energizing, awakening, mood-lifting.
- Peppermint: cooling, clearing sinuses.
- Frankincense: grounding, anti-anxiety.
- Orange: focus, energizing, mood-lifting, productivity.
- Eucalyptus: clearing sinuses, headache relief, anti-anxiety.
Step #3: Preventing Crises Before They Begin
Coping is important, but crisis prevention is also an important step to have in your mental health toolkit — and it starts with reducing your emotional vulnerabilities so you’ll be more prepared to defend yourself against negative thoughts and emotions that lead to self-destructive behaviors.
I’ve got one last DBT acronym for you today — and the acronym is PLEASE! PLEASE stands for some of the emotional vulnerabilities that predispose us to emotional distress. Regulating these aspects of your life can also help you regulate your emotions, preventing crises and making them easier to cope with when they arise.
PLEASE stands for:
Physical iLlness. Treat physical illness first to improve mood and reduce vulnerability.
Eat a balanced diet. Eating a balanced, healthy diet helps you be your happiest self, mentally and physically. Click here to check out my tips on gentle nutrition!
Avoid mood-altering drugs. Illicit drugs, alcohol and marijuana can all make us more vulnerable to emotional distress. Use them sparingly (or not at all).
Sleep for 6-8 hours each night. Ever get weepy or emotional when you don’t get enough sleep? Chronic sleep deprivation is real — as in, a real threat to your mental health!
Exercise regularly. However you can stay moving will keep your body active, and your mind happy and healthy. As Lena Dunham once said, “It’s not about the booty, it’s about the brain!”
Free Coping Cards
You’ve made it to the end of this post — congratulations! To help you remember everything you’ve learned, I’ve created free (and adorable) coping cards to help you on your journey. Here are the directions:
- Follow the link below to download and print all eight coping cards (preferably in color). DO NOT print double-sided!
- Cut around the edges of the coping cards, keeping the top and bottom attached.
- Put some glue on the blank side of the paper using a glue-stick and fold the coping cards, so the floral pattern is on one side and the pink background with coping strategies on the other.
- Let the glue dry, then stick in your wallet, purse, backpack or pocket to enjoy!