Happy Monday, welcome to your mental health mini.
You have a solo today and we are talking about how to cope with a
panic attack, exactly what skills to use, how to navigate
the physical distress and then work through the mental
avoidance amplifies our emotions.
Whenever you feel an emotion rise, do your best to ride it
out, to feel it, to just sit with it and that will long term
do so much good. But when you cannot sit with the
emotion because you're in crisis mode, for example, you are
having a panic attack, this is what you are going to do.
It's the first skill, the Stop skill.
It stands for Stop. Take a step back, observe, and
proceed mindfully. We first are physically stopping
and mentally stopping. So say you are in class, you're
about to give a speech. You all of a sudden feel a panic
attack coming on. You can't breathe, freeze,
physically freeze, and mentally freeze.
You're going to remember we're pausing because our emotions are
urging us to act and because the emotional intensity is so
strong. The urge to act on the emotion
is really strong. The urge is to avoid.
The urge is to hide, to run away.
Ideally you leave the situation both physically and mentally.
If you're about to give your speech, you're going to see if
you can really quickly run to the bathroom and take a break.
You're going to take a couple deep breaths.
If you can really focus, inhaling through the nose,
exhaling through the mouth, and pausing after you inhale.
You also want to try to make your exhales longer than
inhales. We're going to do everything we
can here to avoid acting impulsively with regard to what
our emotions are urging us to do.
And how we're going to do this is we're going to observe this
is the next part of the top scales.
We've done stop. We've taken a step back.
So now we're going to figure out what's going on both internally
and externally. Most of the time when you're
feeling really overwhelmed with anxiety, it's easier to start
with externally. Where were you?
What was happening? How are you feeling right now?
Is it feeling hot? Are you feeling cool?
What is going on? Now you're going to go
internally. Is your heart racing?
Are your muscles clenched? Are you breathing really
rapidly? Are your thoughts spiraling and
having certain urges to avoid, to run away, to engage in
unhealthy behavior? Whatever it is, take a minute,
observe those. Make sure to really hone in on
the thoughts, the feelings and things that others are saying or
doing. We want to get really clear.
And when we're observing, we're using a little bit of
mindfulness here. So we're being objective.
We're saying only things that can be observed without
judgment. We're not like that was so
annoying or that was so frustrating, or that's not fair.
Those are all kind of judgments and not objective facts.
So really focus on the facts for this observing part.
And what's great about this is as you start to lay out the
facts and let go of those assumptions and judgments, some
of the anxiety does sometimes go away.
And the last part of the stop scale, you're going to proceed
mindfully. You're going to act with
awareness. You're going to consider your
thoughts, your feelings, situations, and other people's
thoughts and feelings. You're going to be as effective
as possible and balance that rational side of things and the
emotional side of things. You're going to think about what
your goal in the situation is. What is your objective?
So if you were supposed to give a talk in class, it's your
objective to get through the talk.
So your objective to ask your teacher if you could postpone,
but you're going to actually follow up and do the speech.
Are you going to try and just go after the next person who's
presenting whatever it is? Figure out what your goal is and
make sure that you are truly listening to both the rational
side of things and the emotional side of things, not just what
your emotion is urging you to do, which is likely to avoid.
Also important to ask yourself and you ask your wise mind,
which in DBT is that balance of the rational and emotional?
And we're going to decide, will this action that you'd like to
take to move forward, is it going to make things better or
worse? If you avoid the situation long
term, that's going to make it worse.
You are going to work through this, use a coping skill
effectively that will make the situation better.
We also have to address the physical, and that's where the
TIP skill comes in. TIP is an acronym in DBT that
stands for temperature, intense exercise, pace breathing, and
paired muscle relaxation. The temperature part of the TIP
scale. Ideally you have a bowl of ice.
You're going to take a deep breath in, you're going to hold
your breath, you're going to place your face in that bowl of
ice water. You are going to hold it for 30
seconds or however long you can kind of hold your breath.
You're going to take your head above the water, breathe in,
breathe out, go back under. So you are going to repeat this
until your heart rate and your breathing rate decreases.
When your body comes into contact with this cold water,
what is stimulated is your heart rate decreases and in turn your
breathing rate decreases. We know that our heart rate,
breathing rate are increased with anxiety, so it will lower
it past that threshold and it will get it back to your normal
level. The intense exercise again
targets a part of our anxieties fight or flight response, which
is that when you are overwhelmed, your heart rate,
your breathing rate increases. And when you are engaging an
intense exercise, your body does its normal process of lowering
its heart rate and lowering its breathing rate, and in turn, it
goes past that threshold that it was at for anxiety.
He's breathing very simple. You are breathing deeply into
your belly. You are slowing the pace of
inhaling and exhaling way down past what it's at with anxiety.
So DBT says 5 seconds in, seven seconds out.
But the key is that your exhale is longer than your inhale.
You're going to do that for a few minutes.
And then the last part of the tip scale is paired muscle
relaxation. So what we're going to do as
we're doing our breathing, and as you inhale, you clench the
muscle and as you exhale, you let go and you're letting go of
not only the tension that you've just caused by squeezing your
muscles, but also the tension that was there from that anxiety
and from that emotional intensity.
After you were less consumed by these physical symptoms of
anxiety, we're then able to establish a plan of how can I
cope? How can I proceed?
How can I effectively get myself out of this situation?
Having the trust in yourself that you know skills that will
work and that you can get yourself out of that stressful
situation is a game changer and it gives you a lot of help.