What to do when you're too upset to think straight

left in the family's garage. "He told me you've no make me cry."

“Antonio Junior left home to join a protest in Seattle. A week later, he was shot and killed there.”

"I need some a ref me, just as for my son." Listen to "We Keep Us Safe" on the Embedded Podcast from NPR. Distress is inevitable pain is an inevitable part of life and so much of what we do are attempts to avoid distress and pain. We drink when we're anxious or we lash out at people when we're angry. Those behaviors are the result of not knowing how to tolerate

what feels intolerable in that moment, which is that emotional experience." You're listening to "Life Kit," I'm Mariel Segadra, and you just heard from Shureen Rizvi. She's a professor of psychiatry and behavioral sciences at Montafiore Einstein. She co-wrote a book called "Real Skills for Real Life" and it's filled with distress-tolerant skills that come from dialectical behavior therapy. That's a form of therapy that helps people understand the connections

between their thoughts, their behaviors, and their emotions. She says according to this framework, in moments of distress we have these two options. We could try to change the situation that's causing us distress, but sometimes we can't just remove the problem or solve the problem and so in those moments we have to learn how to accept the distress and respond in a more effective way.

“What do you think people get wrong about coping with distress? I think first thing that people”

get wrong is thinking that I have to get rid of it right away. Their first impulse and instinct

is to do something to make it stop. I think the second thing that people get wrong is the idea that I need to do something to make it go away because otherwise it will last forever. And so one thing that we want people to learn is that actually whatever it is you're feeling, no matter how intense, no matter how awful it feels in this moment, it will pass. On this episode of LifeKit, research back to skills to help you tolerate distress.

And these skills can make sense in a lot of different situations. When you're stuck in traffic, when you've gotten a fight with your partner, when your teenager is rude to you, and when you're

“dealing with big life events, like illness or death.”

Okay, so the first distress tolerance tool we're going to talk about here from the book is something

called tip. It's an acronym, TIP. And it actually stands for four distinct skills that you can use in moments when you're so distress that you just can't think straight. You say in the book, these are not skills to help you solve the problem, right? Yes, exactly. And the idea is these are skills to help you go from, let's say, 100 on the scale of zero to 100 to an 80. And then when you're at an 80, you might be able to flip through the pages and find something else to do. Okay, so tip is an

acronym. It stands for TIP. T is temperature. What does that mean? Yeah, temperature is actually one of my favorite skills. This is going to sound really weird. But it's making your body think that you have just dived into extremely cold water. And the reason we do that is because there's such a thing called the mammalian dive reflex, which is a reflex that all mammals have that when we are submerged in cold water, it increases the likelihood of survival. And the reflex does things like slows down your heart rate,

slows down your respiratory rate. Those are things that we also often need when we're in high degrees of distress and our physiologically aroused. So the way that we practice this skill is to get a large kitchen bowl, fill it with very cold water with some ice cubes in it so that it's pretty cold. You take a deep breath and then you plunge your face, your eyes and your temples in particular into the water while holding your breath and staying there for as long as possible. For most people,

I have to say it is incredible in terms of how well it works for people in terms of getting that

arousal to go down. I should make a note as we often do that. We don't recommend this for people who have a heart condition or who are taking beta blockers because the sudden decrease in heart rate could obviously be a problem for certain conditions. But if you don't have those conditions, it's definitely worth the try. And if you wear a smartwatch or something else that monitors your

when you practice the temperature skill. So that's tea. I is intense exercise. So

“are you running up the stairs really fast? You're doing anything you can to get your heart rate”

up quickly. I taught this in a group just last week and we all stood up and did jumping jacks. So the idea behind that is that it's almost paradoxical but in that moment of high agitation, high distress, you're actually revving yourself up and then when you stop the exercise that decrease in heart rate comes on, you feel calmer. The endorphins kick in and so on. Interesting. Okay, P is past breathing. What does this mean? When we're distressed and in high anxiety,

we tend to breathe from our chest, which is actually more hyperventilating and is the opposite of relaxing, right? It gets us more revved up. So we want to breathe from our belly area.

The second quality of past breathing is to slow your breath down and the third component of

past breathing is that you want your exhale to be longer than your inhale. So you might practice this with your belly, for example, breathing in for a count of four and then breathing out for a count of six. And then we actually have one more P, which is paired or progressive muscle relaxation. And that means like going through your body muscle group by muscle group, tensing the muscles as tight as you can and then releasing them. Yes, exactly. And the idea is that

if you tens your muscles as hard as you can and then relax, you actually get to a greater sense

of relaxation than if you just try to relax without tensing the muscle first. And then the

paired piece is to say the word relax or to say the word calm or some other Q word that you associate then with the relaxation piece. We'll have more life kit after the break. One year after Congress eliminated federal funding for public media and PR remains committed to informing the public, but a free press doesn't just happen, it's something we must protect. Without federal funding, we're relying on your support now. Please make your gift today at

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in here that go by the acronym Improve. You say in the book these skills are designed to make difficult moments better in some usually small way. Walk me through what improves the answer for.

“So I think about improve as being a set of strategies that are available to you as tools in your”

toolbox for those moments where you can't do anything about the problem right now but maybe there's a way to make it a little bit better. And so the acronym stands for seven separate skills. The first is imagery. In the moment of crisis and difficulty using visual imagery to think about something calming. Going to your happy place, bringing to mind a particular image that is soothing and relaxing to you. The M stands for meaning. And that's spending time thinking about what meaning you can draw

from the experience no matter how hard it is. So this is really hard right now and at least I'm learning that I can tolerate it. I found it helpful thinking about this after going through cancer treatment that like now I'm like I have more trust that I can handle whatever comes in my life. Mm-hmm. Yeah, I love that. And actually I didn't know that about you but I also went through cancer treatment and I think that I used these skills a lot but I actually think that I have that similar

particular ways that I'm actually grateful for. Yeah, I'd rather that I hadn't happened.

“But yeah, but since it did, you know, there is there was something that I got out of it.”

I also got like really pretty wavy hair because of it. I did chemo. I did not get that. So I experienced distress over not getting this magical hair that people talk about. Oh, dang. Sorry. I have to find other meaning. Yeah. Mm-hmm. Okay, the P stands for prayer. The P stands for prayer and here you could pray to God if that's something that you do but we also want this to be something that anyone could do no matter how religious or spiritual they are and so we also say

pray to your own self to your own inner wisdom to ask for support and guidance and to give yourself love. Our is relaxation. Yeah, it's saying in this moment that's really challenging for me

“I'm going to intentionally do something that makes me feel a little calm and actually gives me a sense of”

pleasure in some small ways. So what's my favorite coffee drink or my favorite tea that I can just sit quietly and drink? Can I take a relaxing shower or a bath? Can I take five minutes to just lay in bed and relax? Oh, is one thing in the moment. Putting your full attention into just one thing that you're doing right now. Yeah, so often when we're in high distress or we're freaking

out about something our mind is in a million different places and in order to help us feel a little

better in this one moment what we try to do is to say throw yourself completely into just one thing. For example, you're practicing relaxation by having a cup of tea just do that right and when you

“start having thoughts about what's going to come next let that go and bring your attention back.”

And then V is for vacation. It's like giving yourself a little mini 20 minute vacation. Exactly. Most of us can't afford either time-wise or financially to just take a vacation whenever we're in stress but what is something that you could do for even five minutes or ten minutes that makes you have that sense of I'm just taking a break. So maybe it's looking at a gossip website or trashy magazine or laying down on the couch and watching a 30 minute TV show. Anything that gives

you a sense of I am just taking a break and I'm doing something fun and relaxing for myself.

Okay so the last letter is E encouragement. What does this mean? It basically means learn how to

encourage yourself and be a cheerleader for yourself. Some people find this really hokey but actually most of us are really bad at this which is the skill of being able to say to yourself you can do this. Keep going and I often say for people that have hard time with this it's it's say to yourself what you would say to a friend because most of us are good at encouraging other people and not as good as encouraging ourselves. Even just saying it with that tone for me helps like

you got this of course you got this you know it's like I'm being my own friend in that moment and making it a little bit lighter. Yeah we'll have more life kit after the break. This is our glass of the American life. Do you know our show? Okay we're the way I'm going to tell you about it. We make stories that hopefully pull you into the beginning with funny moments and feelings and people in surprising situations and then you just want to find out what is going

to happen and cannot stop listening. That's right. I'm talking about stories to make you miss appointments. This American life where you get your podcasts. You also have some distressed tolerant skills that are more long term and one of them I really liked was willingness. I feel like I haven't heard this before. When does it make sense to use this skill? We have to accept really difficult challenging things in our lives but to accept it we have to have a quality of willingness

to go there as opposed to willfulness which is how we often operate. So willfulness is saying this shouldn't be this way. Why me? This shouldn't have happened. He shouldn't have done that. We are constantly having should statements. But saying he shouldn't have done that is actually

acceptance with an open mind to say I am willing to approach this instead of being willful and stubborn

and refusing to accept what is. It makes me think about going back to getting cancer. People would say to me do you ever feel like why me? I really didn't feel that too much. I wanted to turn it around to why not me. One in something like 8 women get breast cancer. So it was unexpected but maybe not that unusual and that framing actually helped me because it's like if why not me for this terrible thing then also why not me for some really exciting things that I want to do when I get

better. Why not me like finally go on that trip to Japan or why not me having kids. Why not me

“like living in a beautiful space? It's interesting because it reminds me of I think this is more”

of a Zen practice or saying where it's kind of like experience the non-headache or the non-toothache that when we have a headache or a toothache or full attention is drawn to that and we might have those kinds of thoughts. Why me? Why now? What about all the moments that we don't have a headache or a toothache? We don't say why me and those moments and so can we learn to be willing to accept and embrace the reality of whatever life gives us all of the positives and all of the negatives.

Some of this is changing or thoughts but then there's also changing or posture. Tell me about that.

“So often when we are feeling willful we would likely find that our body is tense in some way.”

Perhaps our shoulders are up, our jaw is clenched and so there are ways that we could focus on changing our body and by doing that we can actually send signals back to our brain that oh this is not so terrible. So for example having what we say is a willing posture which is kind of often opening up your chest sitting or standing upright pushing your shoulders back and adopting willing hands is a phrase that we use where if you're sitting you sit with your hands

face up in your lap and it's such a subtle and small thing but if you notice what happens if you're

“sitting and you just place your hands gently on your lap palms up it's almost like a signal to”

your brain to yourself to the world I am open meaning I am accepting of what's happening and the other thing that we do with our body is a doctor what we call a half-smile where we vary gently and sometimes very subtly turn up the corners of our mouth ever so slightly to adopt that more serene facial expression actually communicates back to your brain that things are okay. I imagine that this advice would be very helpful for some people and then it'll really annoy

others who are like yeah but I'm dealing with something really difficult or like this isn't going to solve my problem or it almost feels like you know toxic positivity or something you know like just put your smile on your face and and then all these horrible things that are happening are fine yeah all things that I hear on a daily basis when I teach these skills so a couple of different things that I say in response so one is increasing the number of tools that you have in your

toolbox so I want you to have all of the tools as many as you can possibly have and that doesn't mean that you're going to use all of them but you have them all and they're available to you.

The second thing is that this is all an experiment gather data try it you have you have these thoughts

that this isn't going to work or it's just going to lead to some other terrible outcome just notice

idea that we are trying to give people skills to manage distress as we've been talking about but

“also skills to solve problems so if you're in this horrible relationship that you feel like you can't”

get out of how do you use the distress tolerance skills in moments when you need them to help you cope with a really difficult moment but at the same time how are we going to either change this relationship or get you out of this relationship in a way that's more sustainable and also will lead to overall greater peace and happiness and less negativity. Yeah these skills are not meant to solve your problems. Exactly. Sure and thank you so much for this. Thank you so much for having me.

All right time for a recap let's go through the skills we learned take away one tip skills these are

helpful in moments when you're so distressed that you can't think straight. T stands for temperature specifically don't cure face in a bowl of cold water with ice to trigger your mammalian

“dive reflex which will bring down your heart rate and get you breathing slower. I stands for intense”

exercise do some jumping jacks run up the stairs. Peace stands for past breathing make sure your exhale is longer than your inhale and he also stands for paired muscle relaxation squeeze a muscle then relax it while saying a word like relax you can do that in the sequence from head to toe. Take away two we have the improved skills these are designed to make difficult moments better in some small way. I stands for imagery think of a scene that calms you down and stands for meaning

not everything happens for a reason but this happened and it does have meaning in my life. Peace stands for prayer go inward and connect with the divine and if you don't believe in God try praying to your wisest self ours for relaxation do something that you know reliably relaxes you drink some tea watch your favorite TV show from the 90s put your dog. O is one thing in the moment focus completely on one thing that you're doing right now. V is vacation give yourself a 10 or 15

minute break from everything now checking messages no working just vacationing and E is for encouragement remind yourself you got this and mean it cause you do lastly take away three try the skill of willingness which is useful when you're dealing with a longer term situation that's causing you distress and you find yourself denying reality trying to control everything or focusing on what should have happened instead. Yeah you're right they shouldn't have done that and this shouldn't

have happened to you but it did accepting that can be a helpful distress tolerance tool one way to indicate willingness to your brain is to adopt a willing posture for instance sit with your hands in your lap turn to up toward the sky it's a simple postural shift and I want to be really clear these tools are not meant to solve your problems they're options for how to get through

difficult moments we can't always change the situations or conditions causing us pain but even when we

can we still need tools to take care of our bodies and help us keep our heads on straight while we problem solve and change the world all right that's our show before we go we'd love your help would you please rate and review life kit in your podcast app tell us a favorite tip you've learned or which episodes you like the most this episode of life kit was produced by Sylvie Douglas and Claire Murray Schneider our digital editor is Malica Greb and her visuals editor is C. J. Rekelon

Megan Caine is our senior supervising editor and Lauren Gonzalez is our executive producer our production team also includes Andy Tegel and Margaret Serena and generic support comes from Jimmy Keely fact checking by Tyler Jones and Mary El Sagarra thanks for listening on consider this NPR's afternoon news podcast we cover everything for politics to the economy to the world but every story starts with a question and NPR we stand for your right to be

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