![#24: Coping With COVID-19 [Part 1]](https://bayareadbtcc.com/wp-content/uploads/2020/03/marielle-new-podcast-graphics-1-750x470.png)
#24: Coping With COVID-19 [Part 1]
In today’s episode, Marielle and Ed explore skills to help you cope with your emotions as we collectively face a pandemic. Many of you may be feeling intense distress on a regular basis during these uncertain times. DBT offers lots of skills to help manage strong, painful emotions like fear and panic.
Different ways of thinking about your distress levels are discussed, including the Subjective Units of Distress Scale and the Window of Tolerance. Stopping regularly throughout your day to check in with your distress level and naming your emotion can be a helpful first step in helping you feel more centered.
The Distress Tolerance skill of TIPP is discussed, as is Contributing and Self-Soothing. TIPP, in particular, is helpful in calming an over-activated nervous system.
Show Highlights:
- Our nervous system is always trying to operate within a window of tolerance
- Hyperarousal: fight/flight response where you are activated to move
- Hypoarousal: freeze response where you are numbed out and bracing yourself
- Our nervous system is built to find a threat and deal with it
- The threat of COVID-19 means there is not a lot to do right now for many people, other than isolation.
- Checking into what you’re feeling, allowing it
- If you feel emotions strongly, you may be feeling things even more deeply than others during this time
- TIPP skills help change your physical response to emotional distress
- Dunking your head in a bowl of cold water can really help!
- Intense exercise to get your heart rate up so your body has to work to bring your heart rate down which is calming
- Paced Breathing: inhaling to a count of 5 and exhaling to count to 7
- The exhale activates the part of your nervous system that relaxes your body
- Paired muscle relaxation is tensing individual muscles as you breathe in and relaxing your muscles as you breathe out
- Self-soothing is about using your senses in whatever way is pleasing to you: smell, taste, hear, touch
- Contributing is helping out others in need: donations if you can, helping out others, reaching out to people
- The dialectic approach – walking the middle path between extremes, between the extremes of panic on one side and denial on the other
- Noticing if you’re being pulled toward one direction or another
- Radical acceptance that we are in a moment of great uncertainty
- Ask yourself: What am I doing right now? What do I need right now?
Links & Resources
DBT Skills Training Handouts and Worksheets, Second Edition
SUDs (Subjective Units of Distress) scale
The Skillful Podcast Episode #10: The TIPP Skill: Using Your Body to Calm Down
Ask us a Question
We’d love to hear from you! Where are you getting stuck with your skills application? Ask us a question for the chance to have it answered on the podcast. Submit your question here.
Please note that questions, and this podcast in general, are not a substitute for individual mental health treatment.
#24: Coping With COVID-19 [Part 1] Transcript
Marielle Berg
Hello and welcome to The Skillful Podcast where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center.
Marielle Berg
Welcome, Ed.
Ed Fowler
Hi Marielle.
Marielle Berg
Today, Ed and I are going to be discussing skills to help you cope through the current crisis.
Ed Fowler
Marielle and I have been talking about how much we have been using DBT skills to get through all of the ups and downs and stresses and uncertainties as the COVID 19 virus has a huge impact on our country and our world. And we thought it would be helpful for us to talk about what we’re trying, and give ideas for things that you might try to help you through this challenging time.
Marielle Berg
Yes, and as we’re recording this, I’m aware that things are changing so rapidly day to day, often, and we have listeners from all over the world who are facing different circumstances. We are recording this on Monday, March 23. And there’ll be a lag between when were recording it and when it will come out. So things might be very different by then or are largely the same, we don’t know.
Marielle Berg
But we thought it might be useful to just offer whatever wisdom we can to help people through this really difficult time. And I also want to mention that this is a time where so many of us are needing all the support we can get. And our center is available for online therapy for California residents if you’d like to reach out.
Ed Fowler
As we’re thinking about this, episode, Marielle, I’m remembering one week ago today, when you and I were getting ready to podcast and we got the notification that San Francisco and a bunch of Bay Area counties were going to be starting the stay at home order that night. And both of us were like trying to figure out what are we doing? What are we going to do? What do we need to plan? What do we need to prepare?
Ed Fowler
And I’m struck today, that like, that moment was like such a moment of, as we’ve talked about before, high distress with all the uncertainty and trying to figure out what needs to be done, and what are we going to do. And that’s where we had this idea of like, we’re going to end up using a lot of skills, how do we help other people think about the skills that can help to deal with these types of distressing times?
Marielle Berg
Yeah, so one of the things we conceptualize in DBT is the Subjective Units of Distress. And I’ll also link to that scale in our show notes, which is basically a scale from one to 10 with one, or maybe even zero being like the most calm, peaceful self that you can be, all the way to 10, the most kind of freaked out, kind of out of your mind, super anxious self that you can be.
Marielle Berg
And I think when we were planning to do this podcast last week, and we heard just moments before our scheduled time to talk that this shutdown was happening. And my SUDs shot up to, you know, a seven or eight or above. And when we are that distress, it is almost impossible to access the prefrontal cortex of our brain, which is our more logical, kind of executive functioning portion of our brain.
Marielle Berg
And my hunch is, and you can speak to this, Ed, that you were kind of pretty elevated then too. And we decided that that was not the time to begin offering, you know, tools and advice on how to cope.
Ed Fowler
Plus it would have been a very different podcast.
Marielle Berg
Yes.
Ed Fowler
Nothing, nothing is going to help whatsoever. [Both laughing]
Marielle Berg
Yes.
Ed Fowler
So we did some skills to bring ourselves down, and then did those again and again and again over the past week. And I think for me, I’m finding that I’m getting into more of a rhythm of, kind of a whole set of skills that I’m using, over and over each day, to manage all of the stressors that are coming up around everything that’s going on that seems so uncertain and so frightening.
Marielle Berg
Yes, and we will probably do another episode on this topic. We might unfortunately have to do quite a few, we’ll see how long this lasts. And in terms of coping and skills to use, we are thinking today about focusing primarily on the Distress Tolerance skills and Mindfulness. And then we have other skills we can share, in part two of coping through the COVID 19 crisis.
Marielle Berg
But today, we thought that we should first offer the Distress Tolerance skills because when we are when our SUDs, when our distress is so high, it’s almost impossible to think clearly. And so we need things at hand that we can draw upon that will help settle our nervous system and calm us down.
Marielle Berg
And another way of thinking about, we use the Subjective Units of Distress scale. But another way of thinking about this is your Window of Tolerance. And maybe you can speak to this a little bit, Ed, because I know this is also used in trauma therapy.
Ed Fowler
Yeah, so the idea that our nervous system is always trying to operate within this window of tolerance, where we’re able to balance our emotions and our reason, our thoughtful mind. But our nervous system is built to get us into hyperarousal at times that kind of fight, flight response. Where we’re feeling like there’s a danger and we need to respond to it, and we’re really activated and want to do something, and are not able to think clearly.
Ed Fowler
Or sometimes our nervous system wants us to get into hypoarousal, or a lack of arousal, which is more the freeze response, where we’re just kind of numbed out, we are kind of bracing ourselves, we’re freezing in place as a response to extreme stress. And so when we’re at either end of that spectrum, hyperarousal, or hypoarousal, we want to get ourselves back into that window of tolerance, where our nervous system is engaged and not overwhelmed. And that we are in DBT terminology, able to access our Wise Mind. Balancing both emotion and reason, not pushing one or the other away, or holding too tightly to either emotion or reason. But just being able to hold both lightly, and respond from there.
Marielle Berg
I think it’s helpful to check in periodically throughout the day or before, or after you check the news, or maybe have a stressful conversation with someone – like what is my my level of distress right now, and am I in my window of tolerance? Because that can direct you to figure out what what actions you might need to take to help yourself in that moment.
Ed Fowler
And this is where, for me the over the past week or really weeks, but this week, in particular, I have been noticing very regularly, especially like if I see any kind of news stuff that my stress level starts to go up. And I think one of the things I’m really recognizing is that our nervous systems are built to find threats and prepare ourselves to deal with them. But so much around the COVID 19 virus and everything that’s happening around it are threats that we can’t do much about right now, there’s not a lot to do in the moment, other than for instance, stay home.
Ed Fowler
And so our nervous system is engaged, we’re looking for something to do. I read news, I see oh my gosh, something’s happening, I want to do something. And there’s nothing to do right now, and I’m like kind of on, and noticing that I need to catch myself. And it’s most helpful when I’m able to say hold on, I’m getting really stressed out right now I need to bring this back down and turn towards in particular Distress Tolerance and Mindfulness skills to get back into the present moment. And out of all of the terrifying scenarios that my mind is automatically creating as a way to protect me, but not in a way that’s going to be immediately actionable and helpful for me.
Marielle Berg
Yeah, and I’m thinking just to normalize, and hopefully folks already know this, but I think it’s worth saying, that fear is, you know, appropriate, is really natural in a situation like this when there’s so much that’s unknown. And fear often wants to motivate us to take some action, some kind of protective action. And as you said, there, usually at least right now, there isn’t much to do other than to socially distance and stay home and stay as isolated as possible. And so that can leave a lot of energy coursing through your system with without a lot of outlets for it to be released.
Ed Fowler
And we’re not having the same social interactions that we typically have. And so we’re left with some of the stuff without the same outlets where if we’re coming into contact with people on a more regular basis, we might be able to talk about stuff, or or at least take our mind off things with other people and we’re having to access that kind of social support in a very different way.
Ed Fowler
That’s why I think that the first step for us all, is to just notice what’s happening. To mindfully be aware of: where am I at, what’s going on right now, what do I need in this moment o strike more balance?
Marielle Berg
Yes.
Marielle Berg
And even that pause can be helpful. And if you can name your emotion, even just putting a name to what you’re feeling like, oh, this is fear. Or noticing the different kind of levels of fear. Okay, this is – I’m having anxiety, maybe that’s a lower level fear, or, oh, I feel some panic in my body, whatever it might be. Maybe I feel some anger or irritation at the way this crisis is being handled by our government, or governments around the world. Just naming and noticing that in and of itself can have a calming effect.
Marielle Berg
And I think so often, folks don’t give themselves permission to stop for a moment and check in like, what am I feeling? What’s actually going on with me? And I think there can be a fear, like, if I really tap into my fear, it’s gonna overtake me.
Ed Fowler
Right.
Marielle Berg
And so we have skills that will certainly help with that. But the converse usually happens, if you can allow some of those feelings to be there, instead of trying pushing, instead of trying to push them away. Often we have more capacity to manage those painful emotions, than we really realize.
Ed Fowler
And the curiosity, having a stance of curiosity about what we’re experiencing, inherently brings in our Reasonable Mind when we’re talking about the DBT framework of states of mind. You know, noticing that we all have a Reasonable Mind that’s fact based, and Emotion Mind driven by our emotions, and we’re trying to balance those in a Wise Mind dichotomy, that’s not the word, trying to balance those with a Wise Mind perspective.
Ed Fowler
And so being curious about what emotion am I feeling? Can I name it? What are the physical sensations I’m experiencing that go along with that emotion?Inherently, that brings in our Reasonable Mind. And that will strike a balance if the emotion is pretty strong. And fear, in particular, can be a really powerful emotion. So just that moment of curiosity can be in and of itself a valuable skill that can get us closer to our balance.
Marielle Berg
Yes, and, um, as you’re talking, I’m thinking about another challenge to this particular time. Because often when we’re talking about these skills with our clients, and in group, it’s more about individual suffering. What’s going on in that particular person’s life that they’re struggling with. And I have noticed this, certainly from myself, when I’ve, you know, turn to family and friends or my significant other for and wanting help, to help soothe my fear. And some of the emotions that I’m managing is that almost everyone around me, that’s figuratively around me, no one is actually really around me, except for very few people, but that I can contact are feeling very similar things, sometimes even more intensely.
Marielle Berg
And I think that that can lead that can lead many of us feeling under resourced. Because of the places you go to get like a perspective or someone else who’s calmer to kind of help you be more settled and more grounded, if those folks aren’t grounded, and so often, so many of us right now aren’t grounded, it’s extra challenging.
Ed Fowler
I think another way to validate our experiences right now is that in DBT, in particular, we talk a lot about people who feel emotions more strongly than others. That are on the spectrum of emotional experience, many of us feel things even more profoundly and physically than other people.
Ed Fowler
Well, now is a time where we may be feeling things more deeply. I know that for me, I’ve had a couple of times where I was like, oh, my god, this is terrible. And other people are like, no, here’s what’s happening now, here’s what’s going to happen in the future, this is what we’re going to do, checking the facts using one of the DBT skills really quickly. And my experience is different.
Ed Fowler
Because even though like I have so much more emotional balance than I’ve ever had, I still feel things pretty strongly. And so to be able to validate for ourselves, our emotional experience is whatever it is. We’re feeling things strongly? That is what it is. If we’re not and we’re finding ourselves may be more numb? It is what it is. We’re all going to have different experiences at different times. So being able to just say, this is where I’m at right now. What do I need in this moment, rather than getting into any judgment of ourselves or others?
Marielle Berg
One thing that I’ve been hearing is some folks really minimizing the way they’re struggling. Feeling like oh, I don’t have it that bad. I’m not homeless, out on the streets. I still have my job, I have health insurance. And so many folks are aware that there’s many in our world, in our community, who don’t have those resources.
Marielle Berg
And pandemics hit the most vulnerable the hardest. And we’re aware of that, and I think there can be a minimizing. Like, I shouldn’t feel bad, I shouldn’t feel so fearful, I shouldn’t be so overwhelmed, because I am essentially safe in this moment. And, you know, I was thinking that if, if that kind of minimizing, and essentially invalidating ourselves created a just world, like we’d already have a just world.
Ed Fowler
Right.
Marielle Berg
Like, that doesn’t actually change anything.
Ed Fowler
Right.
Ed Fowler
And my experience over the past week is that the people who are for instance, working in healthcare settings in hospitals, the people who have already lost their jobs, are actually coping already, whereas the people who are anticipating the possibility of things that could happen are having a harder time.
Ed Fowler
And I think that this is one of the realities is that when we end up in difficult circumstances, we tend to find ways to cope, anticipating something is actually harder, and requires more effort to pull ourselves back into like, okay, what do I do today, rather than getting into the worries of anticipation? And that’s where I think that really having that non judgmental approach and saying, I am where I am, what do I need today? Because that’s really the only thing that we can do anything about, is me, and what do I need? Sometimes that includes contributing to others. And sometimes it includes just doing something to take care of ourselves.
Marielle Berg
And so let’s let’s talk more specifically about some of these skills that can be so helpful. And I think we should start with some of the TIPP skills, because those are our 911 for when we are like way outside that window of tolerance or distress is at a you know, a 10. And we can’t think clearly,
Ed Fowler
A reminder that the acronym TIPP stands for a set of skills that help change our physical response to stress as a way to then change the emotional response. So the acronym stands for Temperature, particularly tipping the temperature around your face, Intense exercise, Paced breathing, and then the second P, Paired muscle relaxation that goes with the paced breathing.
Marielle Berg
And so the first one, the T is for temperature. So we’ve talked about this skill, and I’ll link to that also in the show notes if you want to hear a whole episode on TIPP, but the you know, these skills are are the things that you want to reach for when you are in panic mode. And so the T for temperature is essentially dunking your head in a bowl of cold water. We’ll talk a little bit more about how exactly you do that. But that’s a skill. That’s a skill.
Ed Fowler
Yes. And again, me and Marielle in our episode, both of us talked about how the first time we heard it, we both had the common response, which is that sounds ridiculous. And yet it works so well.
Marielle Berg
It does. It’s pretty, it’s pretty amazing. So there’s different ways to do this. Before even talking about how to do it, let’s just talk a little bit about why it works. So it settles your nervous system. It’s called the dive response. I don’t know if we have any divers listening. But our heart rate slows our whole system physiologically slows down when we can dunk our head in cold water.
Marielle Berg
So ideally, you’re able to fill up a sink or a bowl of water and maybe put some ice in it, you don’t want to make it too cold that it’s going to burn your skin or be harmful in any way. But you want it to be pretty cold and you hold your breath obviously, and dunk, you dunk your head and up to about your temples. And for about 30 seconds or as long as you can hold your breath, and for so many people this works like magic. It’s pretty quick and your nervous system can calm down.
Marielle Berg
So often we realize we teach this skill to folks and like okay if you’re at work and people are like I don’t, can’t get a bowl of cold water at work and we’re like okay ice You can even take like a can of you know, soda and hold it against your face. But many many people, if not most people, are home so it this will probably be easier to access. But you can also take an ice pack from your freezer or fill up a baggie with ice and hold that against your face, maybe with a barrier like some paper towel or a dish cloth, so you don’t you know irritate your your skin and you can hold it over your eyes and your temples and hold your breath and have a similar effect.
Ed Fowler
My go-to for this is like a bag of peas in the freezer, a bag of corn because it’s already pre packaged and ready to go and, and can really, because what we want is to get the cold around our eye sockets. That’s what stimulates that dive response.
Ed Fowler
So anything that’s going to get cold around your eye sockets, and pretending like you’re diving and doing that, will basically stop the move of stress up the SUDs scale, and start to reverse it. One of the things that I hear from people a lot is oh, I tried that, and it didn’t work. Because my SUDs went from a nine to an eight. Well, it worked.
Ed Fowler
None of these skills are going to get you from a nine to a three. What you want is just to stop the distress from going up, and maybe start to move it in the other direction. And almost always, we need to follow it up with other skills as well. But this, in particular, the ice dive, is a way to just stop that distress in its tracks.
Marielle Berg
As you’re listening to it, if you have a similar response to what Ed and I had, when we first learned about this skill is feeling incredulous, feeling like that’s not going to work. I want to bring in another skill, which we won’t talk about today. But we we talk about it in our groups, which is the skill of Willingness. We’re just wanting to invite listeners to try it, when you’re highly distressed and being willing to see if it has a positive impact.
Ed Fowler
So then the I in the TIPP skill stands for intense exercise. So doing some sort of intense exercise just for a couple of minutes to get your heart rate up so that your body has to work to bring your heart rate back down, which is inherently calming. So by doing jumping jacks, or running up and down stairs, or or doing push ups or sit ups, or anything that you can do for just a couple of minutes to get your heart rate up, will give your body a chance to then work to bring it back down and again, stops the distress from going up. Stops it in its tracks.
Ed Fowler
And also with both the ice dive and intense exercise, they’re really effective ways to stop racing thoughts. So if your thoughts are really going and worries are really going, both of these are very physical things that will just stop you from thinking for a minute and give you a reset.
Marielle Berg
I know this past week, I mean, it’s not it’s not quite the intense exercise, but it’s along the same vein, you know, I have scrubbed my bathroom in ways that I have never scrubbed it. Because I just needed to move some of that energy out and calm myself down and focus on something that felt within my control for a little bit.
Ed Fowler
And so with with this one, it’s you just want to do it for a couple of minutes. And oftentimes, you may have to repeat it, or follow up with another skill to keep the stress level going back down. But it can be really effective.
Marielle Berg
And then the next part of the TIPP skill is one of the we there’s two P’s, there’s paired muscle relaxation and paced breathing. I think I’ll talk about the paced breathing first.
Marielle Berg
And so it’s a slowing down of your breathing. So it’s with paced breathing, you are inhaling to a count of five, and exhaling to a count of seven. You can also adjust that as you need to for your body. You can inhale to a counter for an exhale to a count of six. The important thing is that you are slowing down your breath. And you are elongating your exhalation because that really invites your body to settle. And when you’re taking those inhalations, you might want to put a hands on your stomach and maybe one even on your chest as well because you want to be doing diaphragmatic breathing. So breathing into your belly and really feeling it expand and fill with air, rather than doing that kind of shallow chest breathing.
Marielle Berg
So making sure when you do those deep inhalations to a count of four or five that you are breathing all the way into your belly, and then fully and completely exhaling again to a count of six or seven, whatever works for your system. And if you keep your hands on your belly, when you’re when you do this, you might feel it deflate and that can be really helpful, to physically feel the air kind of coming out. And doing this several times till you feel yourself relax. So maybe taking 10 minutes where you’re breathing into a count of four and slowly exhaling to a count of six.
Ed Fowler
The key is to extend that exhale, which activates our parasympathetic nervous system, as opposed to inhaling, which activates our sympathetic nervous system. Parasympathetic nervous system helps us relax more, whereas our sympathetic nervous system gets us more active. So extending the exhale is inherently relaxing to our body. I have been doing this one the most, this is the skill I’ve practiced the most over the past week or two.
Ed Fowler
Because anytime I notice myself starting to get stressed, I just started to do a few paced breathing breaths. And because I practice it so much, it immediately starts to have an impact. When I started using paced breathing, I had to do it more for longer periods. So for two minutes, three minutes, five minutes, in order to get that relaxation.
Ed Fowler
One of the disadvantages of paced breathing, as opposed to the temperature or intense exercise is that if we have racing thoughts, our thoughts are really going, paced breathing tends to be a little harder to do, because it doesn’t turn off the thoughts as easily as the other ones do. And that’s where adding paired muscle relaxation can be really helpful. So when you’re breathing in, you’re tensing muscles, either all the muscles in your body or specific muscles. And as you’re breathing out, you’re relaxing, so that you’re enhancing the tension and relaxation that goes with the paced breathing. And it gives your mind a little bit more to focus on, if I’m going to tense my fists and relax my fists. And really exaggerating that relaxation in order to get the maximum benefit of feeling a physical relaxation response.
Marielle Berg
And again, we will provide a link to Marsha Linehan’s DBT Skills Trainings and Handouts book, which if you don’t have and you really want to dive into these skills and practice them is super useful to refer to.
Ed Fowler
What I have been finding for myself, and as I’m talking to others, is that TIP is a really helpful way to kind of stop the stress from going up the SUDs scale. Oftentimes, we need more than that. It’s not enough by itself to actually bring this stress down, which is where there’s a whole other set of skills in Distress Tolerance, that can be a good follow up to TIPP. The skills for doing something active to bring stress down. So Distraction, Self Soothing, and our acronym for IMPROVE the Moment, which are all things that can be helpful to take our mind off of whatever we may be thinking about, worrying about, and put our mind on something else in order to let our body reduce that stress.
Marielle Berg
And some of the skills that I’ve been relying on in particular during this time period are the Self Soothing skills. So those involve using your senses in whatever way is pleasing to you. So that’s smelling a candle that you really like or inhaling the scent of coffee. Or if you have flowers nearby where you can do that. So what you smell. What you taste. Having, you know, a, maybe a small bite of something really delicious or lemon candy. What you hear. I’ve been using soothing music, or really just fun kind of pop music. I’ve also been watching some musicals. So that is hitting a bunch of different Distress Tolerance skills, there’s s|Self Soothing, and that really pleasurable to hear the music and watch the dancing. And it’s also a great form of Distraction.
Marielle Berg
You can also think about touch. So that might be soft blankets, or putting clean sheets on the bed or lotions or whatever might be soothing to you, if you have someone close by who can give you a foot massage or giving one to yourself. And I think often when we teach these skills in groups, there can be a pushback from folks saying like it’s indulgent, or it’s not going to help. And so if you take like a bubble bath with something that smells lovely, and you light some candles and listen to some, you know, calming music, it’s not going to change your life, certainly, but it is going to calm you down.
Marielle Berg
And I think we’re really needing as many tools to calm ourselves down in this time period as possible. And experiment with what works for you. So right now Self Soothing is really calling to me who knows next week, it might be a different set of skills.
Marielle Berg
Another thing that I’ve been finding really helpful during this time where I can feel very helpless is the skill of Contributing, which is part of our Wise Mind ACCEPTS acronym for Distress Tolerance skills. And trying to find ways where I feel like I can be contributing to the greater good makes me feel like I have some agency, some say, during a time that things can feel really overwhelming and I can feel powerless.
Marielle Berg
Contributing is essentially contributing to others in whatever way you can. So that’s making donations to various organizations and charities that call to you during this time. Sometimes I think about it simply as if you’re walking down the street, if you are able and allowed to do that, and not on official lockdown right now here in the San Francisco Bay area, we are shelter in place, as of today. So you can go outside and take walks, as long as you stay six feet apart from people, but just smiling at people. Which is something you know, in many urban areas, I know I don’t do very often smiling at strangers. But I’m noticing a lot of people are returning that smile. And that is a small way of contributing.
Ed Fowler
And again, like reaching out to people is a good way to both contribute, as well as to provide ourselves some distraction and our own support. So I’m hearing a lot of people talking about reaching out to people as a way to stay connected, to reduce some of the isolation that can come from this time. And also to feel like I’m doing something for someone else, I’m checking in on how they’re doing, I’m giving other people an opportunity to have some contact. So that can be a helpful way of contributing.
Ed Fowler
So those skills around TIPP and some of those other more active Distress Tolerance skills can be really helpful when we notice that our stress level is already high, and we want to bring it down. We’re going to need a lot of that.
Ed Fowler
With distress tolerance in DBT, we also have a whole other set of skills around accepting reality as it is as a way to bring distress down. And so those skills have also been helpful to me this week. I’m finding that I have to practice the more active skills like TIPP or Distraction, Self Soothing, IMPROVE, in order to then have the Wise Mind ability to access the more acceptance oriented ones.
Ed Fowler
And one of the ways that I’ve been thinking about this, and conceptualizing it that’s been helpful to me, is using the dialectical approach and DBT. And the concept of Walking a Middle Path between extremes as my starting point. So noticing that I am very consciously trying to walk a middle path between the extremes of panic on one side, and denial on the other. So during this time, we can easily find ourselves being pulled towards panic, or pulled towards denial. There’s no problem, it’s no big deal, it’s all going to be fine, don’t worry.
Ed Fowler
Neither extreme is going to give us everything that we need. Each extreme has its pitfalls, so consciously trying to walk a middle path between the two, where I’m not denying, and I’m also not panicking. And noticing if I’m being pulled in one direction, or the other. Am I being pulled a little bit more towards panic in this moment? Am I being pulled towards denial where it’s like, it doesn’t matter, I can go out and do whatever I want, it’s not a big deal, and then kind of pulling back in the other direction? So that dialectical approach of trying to seek that balance is, for me a really helpful starting place as a framework for everything I’m trying to do to manage all of the emotions of this time.
Marielle Berg
As you’re talking about those two extremes of panic and denial, I’m thinking about how this is so been my experience with compulsively consuming the news over the last couple of weeks. That I’ll read something that’s all about panic, and this is the end of the world in so many different ways, financial collapse, in addition to tremendous loss of life. And then other things I’ll read, that, not as many, but that are not so much denial, but are more like maybe this won’t be so bad. And then so I find myself sort of ping ponging between the two. And the way I’m thinking about this middle path for myself, is that it’s a place of, of not knowing, because we don’t we really don’t know. And that’s so uncomfortable.
Ed Fowler
And so that’s, you know, being able to notice, am I being pulled in one direction or another, or another, that’s not helpful to me? And trying to balance that, and also trying to be conscientious of our concept of Radical Acceptance of this is what it is. And right now, so much of it is, I don’t know what’s going to happen. I don’t know where this is headed for sure, right?
Ed Fowler
I’m in, we are all, in a moment of so much uncertainty. So being able to just notice, okay, I don’t know, and then do whatever I need to do to manage that. So sometimes that unknowing, it’s hard to accept and I need more active Distress Tolerance skills. Other times for me, I’m finding myself using a lot of Mindfulness skills to just stay in the current moment,to not think about what’s going to happen tomorrow or next week or next month or next year. But to really just be here right now. What am I doing right now? What do I need right now? I’m pulling my awareness just to what I’m doing in this moment, as a way to turn off that pull towards worry, or just, you know, like, don’t worry about it, no big deal.
Marielle Berg
And we didn’t even get to our Mindfulness skills. And we touched on them a little bit. But I feel like we could also do maybe a whole episode on that, because I’m also finding them super helpful. And they are the one thing that we can really pull on to bring us into the exact moment we’re in. And for the large majority of us, at least, where we are locally, right now, we are safe. That of course can change. And that is part of the the fear that comes up, and likely will change.
Marielle Berg
But if you’re safe right now, then really being in that moment.
Ed Fowler
Right.
Marielle Berg
Because freaking out about what’s going to happen, unless it’s actually effective, and that we take preparations, like Shelter in Place is usually not very effective. It leads folks to stockpile, toilet paper, and all sorts of other things, which I understand.
Ed Fowler
Right.
Marielle Berg
People do that, even though it’s not particularly effective and not good for, for the community, because then people don’t have resources they need, but it’s, it’s a panic driven.
Ed Fowler
Right.
Ed Fowler
And for me, just recognizing that, I’m going to panic sometimes. That our minds are built to say, this is a huge threat in so many ways, and I need to prepare, I think the difficulty is, for the most part, there’s not a lot to do in the moment.
Marielle Berg
Yeah.
Ed Fowler
And my mind pulls towards, it’s going to be fine, don’t worry about it, which I need sometimes. Sometimes I need to just say, you know what, I think this is all going to turn out okay, and give myself a break. But if I do that too much, and then end up not taking the shelter at home seriously, than I am putting myself and others at risk. And so trying to strike that balance, mindfulness is a really helpful way to be like, I’m not thinking about anything else, except what I’m doing right now. You know, just observing what’s happening within me and around me, noticing my environment, noticing what I’m experiencing, and just getting myself kind of grounded in this one particular moment, turning off all the thoughts about the past or the future.
Marielle Berg
And so there’s so much more that we could talk about, and we will be back and recording more episodes to help support people through this time. But in closing, I’m wishing all our listeners well, and we’d love to hear from you. You can email us with questions and we can’t promise we’ll get to all the questions on on air, but we’re here and we want to try to address people’s concerns and help people feel less alone during this time.
Ed Fowler
And if people are finding DBT skills that they’re using that are helpful to them, feel free to email us and so that we can share those ideas, and also use those ideas ourselves. Because this is a moment where there’s so much going on that we are all going to need whatever we can do to help ourselves get through this, in order to then also help each other.
Marielle Berg
Thanks for listening to today’s episode. To learn more, or if you’re in the Bay Area and want to get started with therapy, you can find us online at bayareadbtcc.com. That’s bayareadbtcc.com.