This is the 2nd part of the blog on managing distressing emotions. Much of it is drawn from my new book, ‘The Flourishing Woman A mental health and wellbeing guide’ by Cate Howell, to be published in September/October 2023 (exciting!).
Tolerating Emotional Distress
When emotions are very uncomfortable, we need skills to tolerate or manage the distress. Sometimes we use behaviours to cope that are unhelpful, such as drinking alcohol or eating to excess, withdrawing from others or other potentially self-harming behaviours.
Dialectical Behaviour Therapy (DBT)
Developed by psychiatrist Dr Marsha Linehan, the word ‘dialectical’ refers to acceptance of self, at the same time as recognizing the need for change. This enables us to accept we are doing our best while also aiming for changes in our behaviours and how we manage emotions. DBT acknowledges that we often want a better life, and that we need many skills to achieve this.
DBT is particularly useful if there is a struggle with strong emotions or a tendency to react more intensely to a situation than others. However, many of the ideas and skills from this therapy are valuable for all of us in managing life’s challenges and distressing emotions. It has also been found to be effective with a range of mental health issues, including depression, borderline personality disorder, eating disorders, substance-related issues and post-traumatic stress disorder.
DBT and the mind!
This approach suggests that we have:
- the ‘emotion mind’, which acts when feelings are in the driver’s seat and controlling our thoughts and actions (e.g. acting impulsively)
- the ‘reasonable mind’, which focuses on logic and ignores feelings
- the ‘wise mind’, which balances both, recognizing and respecting feelings, but reacting in a reasonable, logical way (1).
We might recognize these parts of our mind if we think about how we have responded to different experiences in life. An example would be a situation where we have been criticized. Our ‘emotion mind’ might have responded with anger or disappointment, whereas our ‘reasonable mind’ might have recalled events that triggered the criticism. The ‘wise mind’ steps back to observe the situation and our thoughts and feelings, so that we can respond in a considered way.
This therapy incorporates many useful skills. Mindfulness skills form the foundation for the approach, and mindfulness meditations and breathing are encouraged. Mindful observation of emotions and behaviours is utilized in many of the skills and helps to activate our wise mind.
In relation to tolerating distress and regulating or soothing emotions, this therapy adopts the idea that the more we struggle with and try to avoid distress, the worse it often becomes. At times we cannot change situations that trigger distress, and we need to work on being willing to experience a situation as it is in the moment and without judgment.
The term ‘radical acceptance’ is sometimes used and refers to practising acceptance even if our feelings are painful, knowing that the situation or the feelings are not how we want things to be. We hold the feelings mindfully (like holding a baby), without expectations of change. However, sometimes the unexpected or change does follow, especially when we utilize our skills (2).
Self-care and regular routines are seen as part of regulating emotions, as eating well, avoiding harmful substances, getting regular exercise and getting enough sleep all help.
HALT is a great acronym that stands for Hungry, Angry, Lonely and Tired. This is when we are more vulnerable to distress and unhelpful behaviours, and it acts as a reminder to address these factors. We also need to plan for triggers for problem behaviours and have strategies ready to go, such as using our self-soothing skills or more helpful self-talk (3).
DBT links emotions to healthy and unhealthy behaviours. It also adopts these ideas:
- Doing something that will create an opposite emotion (if anxious, we can relax by listening to calming music; if sad, we can have a laugh watching a comedy).
- Pushing negative thoughts away (writing them on a piece of paper, then crumpling up the paper and throwing it away) or focusing on a pleasant memory instead.
DBT says every emotion triggers an ‘action urge’. When we are anxious, the urge is to avoid. When we are sad, we stop doing things and withdraw. When there is shame, the urge is to defend ourselves or hide, and when we are angry the urge is to fight (4). The problem is that these urges can cause more problems.
One strategy to deal with action urges is to take the opposite action! This involves choosing an urge to work on, and think about, our voice, posture, words and actions we use when acting on the urge. Then we identify the opposite action (i.e. how to change our voice, posture, words and actions to carry this out), and commit to the opposite action in situations that trigger the urge. Examples include:
- When anxious, approach what is feared and do what you have been avoiding, stand tall and speak quietly.
- When sad, be more active, get involved, stand straight and speak in a strong voice.
DBT also suggests:
- Using problem-solving skills in relation to emotions and perhaps the results of action urges.
- Looking at our thoughts, feelings and actions at each stage of the event and considering what we could have done differently, such as using coping skills.
And finally, it teaches interpersonal skills such as listening to and validating others, dealing with conflict, recognizing our rights and boundaries in a relationship, and developing assertiveness skills. Social media skills may also be addressed, such as not saying anything negative and not reacting to negative comments.
Once the approach is understood, and the skills taught, the final step is much practice and then practice some more!
Hopefully many of the strategies and skills shared in the two parts of this blog will be helpful. You can find out more in ‘The Flourishing Woman’ when published, or you may like to look at Dr Marsha Linehan’s various youtube clips. Also, Matthew McKay’s books on Dialectical Behaviour Therapy are excellent (handbook and diary).
Extract from Howell, C. (to be published October, 2023). The Flourishing Woman A mental health guide, Exisle, NSW.
- McKay, M. and Wood, J. 2011, The Dialectical Behaviour Therapy Diary: Monitoring your emotional regulation day by day, New Harbinger Publications, Oakland.
- Pederson, P. 2020, ‘DBT skills-building card deck for clients and therapists’, PESI Publishing and Media.
- Pederson, P. 2020.
- Vivyan, C. 2009, ‘Unhelpful thinking habits’, retrieved from www. getselfhelp.co.uk/docs/UnhelpulthinkingHabits with Alternavites.pdf.
- McKay, M. and Wood, J. 2011.