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TIP SKILLS FOR MANAGING EXTREME AROUSAL (DISTRESS TOLERANCE

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megan gewitz

on 12 June 2017

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Transcript of TIP SKILLS FOR MANAGING EXTREME AROUSAL (DISTRESS TOLERANCE

When TIP skills are useful
The first TIP skill is tipping the Temperature of your face with cold water or cold packs on the face, while holding your breath.
This induces the human dive reflex, which in turn sets off the parasympathetic system and reduces physiological and emotional arousal very quickly.
Tipping Facial Temperature with Cold Water
The dive reflex is the tendency in humans (and other mammals) for the heart to slow down to below resting heart rate when the person is immersed in very cold water without oxygen.
This effect is due to increased activation of the parasympathetic nervous system, which is the body's physiological system for decreasing arousal
States of emotional overarousal occur when the sympathetic nervous system becomes overactive and the parasympathetic nervous system is underactive
Research Point:
Procedures:
Splashing cold water on your eyes and cheeks may even be sufficient.
To make it work even better, stand, bend over, and hold your breath.
Splash cold water on the face
What are TIP skills?
Use a bowl of cold water
Bend over, hold your breath, and put your face (up to your temples) in a bowl of cold water for between 30 and 60 seconds, or until you start to become uncomfortable. This is usually sufficient to induce the dive reflex.
The colder the water and the longer the immersion, the better it works. However, do not have the water too cold. Water below 50oF may cause facial pain during immersion.
You are caught in emotion mind and can’t get out.
You are in a crisis—that is, a high urge to engage in destructive behavior hits and you can’t distract yourself.
An important demand needs to be met, and you are too overwhelmed to think of what to do.
You are not processing information effectively.
You are emotionally overwhelmed.
Other skills are not feasible to do, or are not helpful even if you are not in a crisis.
You are at your skills breakdown point.
There are four TIP skills:
Tipping the Temperature of your face with cold water
Intense aerobic exercise,
Paced breathing, and Paired muscle relaxation. (Note that there are two P skills, though there is only one P in TIP.)
Each skill has the effect of rapidly changing your biological response patterns, and thereby causing a reduction in your emotional arousal.
TIP skills change your body chemistry to reduce high emotional arousal and feelings of being overwhelmed.
TIP skills work very fast, within seconds to minutes, to bring down emotional arousal.
TIP skills are as effective as dysfunctional behaviors (drinking, using drugs, eating, self-harm) at reducing painful emotions, but without the short- and long-term negative results.
TIP skills work like fast-acting medications, but without the cost of medications or the side-effects that some medications cause.
TIP skills are easy to use and don’t require a lot of thinking.
Some TIP skills (paced breathing, some parts of paired muscle relaxation) can be used in public without others’ knowing that you are using the skills.
Why use TIP skills?
The TIP skills are designed to activate the human body’s physiological nervous system for decreasing arousal.
The nervous system consists of two parts: a “sympathetic nervous system” and a “para- sympathetic nervous system.” These two systems work in opposite directions.
The sympathetic system activates the fight-or-flight syndrome and increases arousal.
The parasympathetic system increases emotion regulation, which is associated with decreases in emotional arousal.
All of the TIP skills regulate emotions by increasing activity of the parasympathetic nervous system and decreasing activity of the sympathetic nervous system.
How the TIP skills work
Sit in a chair, and hold the ice pack or zip-lock bag (wrapped in a cloth to keep from being too cold) or cold compress over the eyes and upper cheeks.
Wet the side touching your face.
Standing, bending over, and holding your breath at the same time appears to increase the effect.
Use an Ice Pack, a Zip-Lock Bag of Ice with Water, or a Cold Wet Compress
TIP SKILLS FOR MANAGING EXTREME AROUSAL (DISTRESS TOLERANCE HANDOUTS 6–6C)
When to use cold water
In addition to times of high emotional arousal, cold water or cold packs can be helpful in the following situations:
Inability to sleep due to ruminating or “background” anxiety
Dissociation, including dissociation during therapy or skills training sessions
Heart problems.
Using cold water to induce the dive reflex can reduce heart rate very rapidly. Individuals with any heart disorder, a heart rate below their normal baseline due to medications, other medical problems, anorexia nervosa, or bulimia nervosa should only use this procedure with permission of their medical providers.
Short-lived effects. The physical effects of the cold water are actually very short-lived. Thus it is easy for the out-of-control emotion to return if participants are not careful. Once extreme arousal is reduced, it can then be important to practice a different set of skills appropriate for the problem at hand.
Cautions
Example: You are very angry, and you use ice water or a cold pack to reduce the intensity of the emotion. If you then start thinking about all the things that set off the anger in the first place, anger is very likely to be set off again. The same is true of any other emotion.
Example: You use cold water or a cold pack to interrupt anxiety ruminations that are keeping you awake. It is important to go back to bed and focus on something other than anxiety- inducing thoughts, such as paced breathing [see below] or thoughts of pleasant events.
A strong urge to engage in a problem behavior hits, and you use ice water or a cold pack to reduce the urge. Your arousal and urges come down. A little later, you go back to thinking about the problem behavior, and the urge resurfaces. It is thus important to engage in a different activity (problem solving or distracting) immediately after using the ice.
Practice Exercise:
Let's practice an ice dive
Please rate your level of emotional arousal before and right after futting cold water on your upper faces, covering your eyes and upper cheekbones.
Bed over the bowl, hold your breath and put your face in water for up to 30 seconds or use zip lock bags with ice and water
Let's discuss your experience
Intense Exercise
The second TIP skill is to engage in Intense aerobic exercise of any kind for at least 20 minutes.
Why intense exercise?
Research Point: Intense exercise (of any kind) for 20-30 minutes or so can have a rapid effect on mood, decreasing negative mood and ruminative thoughts and increasing positive affect after exercising
State anxiety decreases significantly if you get your heart rate to 70% of the maximum for your age.
Increases in positive emotions are associated with getting your heart rate up to 55–70% of maximum heart rate for your age, but the increases are maintained for a significantly longer time following exercise when you get your heart rate to 70% intensity.
Look up ‘calculating heart rate training zones’ on your search engine. Or go to www. chabotcollege.edu/faculty/kgrace/FitnessCenter/TargetZones.htm for how to estimate maximum recommended heart rate for your age.
A major characteristic of emotions is that they organize the body for action.
Anger organizes the body to attack or defend, fear organizes the body to run, and so on.
When the body is highly aroused, it can be difficult to inhibit emotional action even if the action is dysfunctional. Intense exercise, in these situations, can re-regulate the body to a less emotional state.
When to use exercise:
Use exercise when you are agitated, when you are angry, when ruminating just won’t stop, when you need to bring up your mood and willingness in the morning, and at any other time it has been useful for you in the past.
Example: At the end of your work day, you find out that a report you thought was due in a week is actually due tomorrow. If you don’t get the report done, you’ll have big problems at work. You feel so overwhelmed by this unexpected demand that you don’t know where to start to get things done. You can take a short break, go for a run to decrease the strong negative emotions, and then return and do what is needed to finish the report by its deadline.
Paced Breathing
The third TIP skill is Paced breathing.
This refers to slowing down the pace of inhaling and exhaling (to an average of five to six breath cycles per minute) and breathing deeply from the abdomen.
Breathing out should be slower than breathing in (e.g., 4 seconds in and 8 seconds out).
Generally, the heart beats faster during in-breaths and slows down during out-breaths. This change in heart rate is influenced by sympathetic nervous system activation upon breathing in and parasympathetic nervous system activation upon breathing out.
Paced breathing can itself cause changes in sympathetic and parasympathetic activity. In a way similar to the dive reflex, slowing breathing to approximately five or six breaths per minute (i.e. to one complete breath cycle lasting 10–12 seconds) is effective at reducing emotional arousal by activating the parasympathetic nervous system.

Research Point
Practice Exercise:
Let's practice paced breathing
Rate your emotional arousal before and after this exercise
Watch the clock and count the seconds you inhale and the seconds you exhale
Work while counting to get a comfortable slow breathing rate, where the count in longer breathing out than breathing in, such as 5 seconds in and 7 seconds out
What numbers in and out did you choose? Let's discuss your experience
Paired Muscle Relaxation
Paired muscle relaxation, the fourth TIP skill, is the pairing of muscles relaxing with breathing out.
Paired muscle relaxation is a variation on progressive muscle relaxation, which is widely used across many behavioral therapies for anxiety disorders.
The strategy is to tense muscle groups, noticing the sensation of tension while breathing in, and then relax them by letting go of the tension, noticing the sensations as the muscle tension gradually goes down. The goal is to increase awareness of both tension and relaxation.
The emphasis on noticing muscle sensations is similar to a mindfulness procedure focusing on body sensations (i.e., mindfulness of sensations).
As a crisis survival skill, paired muscle relaxation teaches participants to notice tension and then relax muscles, and while doing so to pair relaxation with exhaling while saying the word “relax.”
Tensing and then relaxing muscle groups cause your muscles to become more relaxed than they were in the beginning, and more relaxed than you can ordinarily achieve by trying to relax without first tensing.
Pairing letting go of tension with saying the word ‘Relax’ in your mind while exhaling condi- tions your body to let go of tension and relax in the future when you say ‘Relax’ in your mind while exhaling.
Tense each muscle group for 5–10 seconds and then let go for 5–10 seconds.
1. Hands and wrists: Make fists with both hands and pull fists up on the wrists.
2. Lower and upper arms: Make sts and bend both arms up to touch your shoulders.
3. Shoulders: Pull both shoulders up to your ears.
4. Forehead: Pull eyebrows close together, wrinkling forehead.
5. Eyes: Shut eyes tightly.
6. Nose and upper cheeks: Scrunch up nose; bring upper lips and cheeks up toward eyes.
7. Lips and lower face: Press lips together; bring edges of lips back toward ears.
8. Tongue and mouth: Teeth together; tongue pushing on upper mouth.
9. Neck: Push head back into chair, oor, or bed, or push chin down to chest.
10. Chest: Take deep breath and hold it.
11. Back: Arch back, bringing shoulder blades together.
12. Stomach: Hold stomach in tightly.
13. Buttocks: Squeeze buttocks together.
14. Upper legs and thighs: Legs out; tense thighs.
15. Calves: Legs out; point toes down.
16. Ankles: Legs out; point toes together, heels out, toes curled under.
Brief paired muscle relaxation can also be used in a crisis or when you have very, very little time.
You can inhale while briefly tensing sets of muscles that can be tensed without being obvious to others—such as your stomach, buttocks, and chest—and then, when exhaling, relaxing them with the internal word ‘Relax.’
Practice Exercise- You Tube progressive muscle relaxation
HOMEWORK
1. DISTRESS TOLERANCE
WORKSHEET #4: CHANGING BODY CHEMISTRY WITH TIP SKILLS
2. DISTRESS TOLERANCE WORKSHEET 4B; EFFECTIVE RETHINKING AND PACED RELAXATION
Effective Rethinking and Paired Relaxation
The combination of effective rethinking with paired relaxation is a method of using both cognitive restructuring and progressive muscle relaxation to bring down arousal rapidly in moments of high stress.
1. Identify a situation (a prompting event) that is often related to distressing emotions, and in which you want to work on reducing your emotional reactions.
2. Ask yourself "What must I be telling myself for this situation to be so upsetting?" For example, if taking difficult exams is a really stressful event for you, youmight be telling yourself during the exam things like "I am going to fail this", "If I fail, I might as well quit because I will never go anywhere in life", "If I fail, people will know it and think I am no good," or "If I fail, it will mean that I am either a lazy good-for-nothing or am stupid."
3.Now rethink the situation in such a way as to counteract the thoughts and interpretations that cause you so much stress. As you rethink the situation, write down as many effective thoughts as you can to replace each of the stressful thoughts.
4. Prepare yourself for the next time the stressful event or one like it occurs. To do this, combine rehearsal of your effective thoughts with paired relaxation. To do this, as you breathe in, imagine the stressful event is happening to you. Be sure to imagine you are in the stressful scene, not watching it as on television. Before breathing out, say to yourself (in a convincing tone) an effective self-statement followed by “SO RELAX,” as you breathe out while intentionally relaxing all your muscles.
5. “Practice, practice, practice.”
6. When the stressful situation occurs, practice your effective rethinking and paired relaxing.
Practice Exercise
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