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Happy Monday, welcome to your 
mental health mini. 

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You have a solo today and we are
talking about how to cope with a

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panic attack, exactly what 
skills to use, how to navigate 

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the physical distress and then 
work through the mental 

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avoidance amplifies our 
emotions. 

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Whenever you feel an emotion 
rise, do your best to ride it 

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out, to feel it, to just sit 
with it and that will long term 

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do so much good. 
But when you cannot sit with the

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emotion because you're in crisis
mode, for example, you are 

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having a panic attack, this is 
what you are going to do. 

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It's the first skill, the Stop 
skill. 

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It stands for Stop. 
Take a step back, observe, and 

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proceed mindfully. 
We first are physically stopping

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and mentally stopping. 
So say you are in class, you're 

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about to give a speech. 
You all of a sudden feel a panic

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attack coming on. 
You can't breathe, freeze, 

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physically freeze, and mentally 
freeze. 

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You're going to remember we're 
pausing because our emotions are

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urging us to act and because the
emotional intensity is so 

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strong. 
The urge to act on the emotion 

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is really strong. 
The urge is to avoid. 

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The urge is to hide, to run 
away. 

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Ideally you leave the situation 
both physically and mentally. 

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If you're about to give your 
speech, you're going to see if 

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you can really quickly run to 
the bathroom and take a break. 

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You're going to take a couple 
deep breaths. 

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If you can really focus, 
inhaling through the nose, 

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exhaling through the mouth, and 
pausing after you inhale. 

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You also want to try to make 
your exhales longer than 

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inhales. 
We're going to do everything we 

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can here to avoid acting 
impulsively with regard to what 

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our emotions are urging us to 
do. 

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And how we're going to do this 
is we're going to observe this 

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is the next part of the top 
scales. 

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We've done stop. 
We've taken a step back. 

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So now we're going to figure out
what's going on both internally 

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and externally. 
Most of the time when you're 

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feeling really overwhelmed with 
anxiety, it's easier to start 

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with externally. 
Where were you? 

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What was happening? 
How are you feeling right now? 

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Is it feeling hot? 
Are you feeling cool? 

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What is going on? 
Now you're going to go 

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internally. 
Is your heart racing? 

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Are your muscles clenched? 
Are you breathing really 

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rapidly? 
Are your thoughts spiraling and 

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having certain urges to avoid, 
to run away, to engage in 

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unhealthy behavior? 
Whatever it is, take a minute, 

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observe those. 
Make sure to really hone in on 

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the thoughts, the feelings and 
things that others are saying or

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doing. 
We want to get really clear. 

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And when we're observing, we're 
using a little bit of 

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mindfulness here. 
So we're being objective. 

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We're saying only things that 
can be observed without 

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judgment. 
We're not like that was so 

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annoying or that was so 
frustrating, or that's not fair.

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Those are all kind of judgments 
and not objective facts. 

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So really focus on the facts for
this observing part. 

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And what's great about this is 
as you start to lay out the 

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facts and let go of those 
assumptions and judgments, some 

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of the anxiety does sometimes go
away. 

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And the last part of the stop 
scale, you're going to proceed 

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mindfully. 
You're going to act with 

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awareness. 
You're going to consider your 

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thoughts, your feelings, 
situations, and other people's 

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thoughts and feelings. 
You're going to be as effective 

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as possible and balance that 
rational side of things and the 

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emotional side of things. 
You're going to think about what

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your goal in the situation is. 
What is your objective? 

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So if you were supposed to give 
a talk in class, it's your 

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objective to get through the 
talk. 

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So your objective to ask your 
teacher if you could postpone, 

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but you're going to actually 
follow up and do the speech. 

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Are you going to try and just go
after the next person who's 

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presenting whatever it is? 
Figure out what your goal is and

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make sure that you are truly 
listening to both the rational 

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side of things and the emotional
side of things, not just what 

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your emotion is urging you to 
do, which is likely to avoid. 

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Also important to ask yourself 
and you ask your wise mind, 

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which in DBT is that balance of 
the rational and emotional? 

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And we're going to decide, will 
this action that you'd like to 

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take to move forward, is it 
going to make things better or 

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worse? 
If you avoid the situation long 

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term, that's going to make it 
worse. 

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You are going to work through 
this, use a coping skill 

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effectively that will make the 
situation better. 

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We also have to address the 
physical, and that's where the 

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TIP skill comes in. 
TIP is an acronym in DBT that 

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stands for temperature, intense 
exercise, pace breathing, and 

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paired muscle relaxation. 
The temperature part of the TIP 

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scale. 
Ideally you have a bowl of ice. 

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You're going to take a deep 
breath in, you're going to hold 

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your breath, you're going to 
place your face in that bowl of 

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ice water. 
You are going to hold it for 30 

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seconds or however long you can 
kind of hold your breath. 

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You're going to take your head 
above the water, breathe in, 

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breathe out, go back under. 
So you are going to repeat this 

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until your heart rate and your 
breathing rate decreases. 

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When your body comes into 
contact with this cold water, 

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what is stimulated is your heart
rate decreases and in turn your 

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breathing rate decreases. 
We know that our heart rate, 

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breathing rate are increased 
with anxiety, so it will lower 

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it past that threshold and it 
will get it back to your normal 

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level. 
The intense exercise again 

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targets a part of our anxieties 
fight or flight response, which 

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is that when you are 
overwhelmed, your heart rate, 

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your breathing rate increases. 
And when you are engaging an 

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intense exercise, your body does
its normal process of lowering 

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its heart rate and lowering its 
breathing rate, and in turn, it 

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goes past that threshold that it
was at for anxiety. 

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He's breathing very simple. 
You are breathing deeply into 

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your belly. 
You are slowing the pace of 

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inhaling and exhaling way down 
past what it's at with anxiety. 

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So DBT says 5 seconds in, seven 
seconds out. 

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But the key is that your exhale 
is longer than your inhale. 

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You're going to do that for a 
few minutes. 

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And then the last part of the 
tip scale is paired muscle 

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relaxation. 
So what we're going to do as 

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we're doing our breathing, and 
as you inhale, you clench the 

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muscle and as you exhale, you 
let go and you're letting go of 

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not only the tension that you've
just caused by squeezing your 

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muscles, but also the tension 
that was there from that anxiety

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and from that emotional 
intensity. 

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After you were less consumed by 
these physical symptoms of 

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anxiety, we're then able to 
establish a plan of how can I 

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cope? 
How can I proceed? 

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How can I effectively get myself
out of this situation? 

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Having the trust in yourself 
that you know skills that will 

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work and that you can get 
yourself out of that stressful 

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situation is a game changer and 
it gives you a lot of help.