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

Stressed, anxious, or angry? Distress tolerance tools — from dunking your head in a bowl of ice water to imagining yourself in a calm setting — can help. In this episode, clinical psychologist Shireen Rizvi shares dialectical behavior therapy skills from the recent book she co-authored, Real Skills for Real Life. These physical and mental exercises can help you care for yourself, so you can think more clearly, problem solve and make it through life's painful and frustrating moments. Follow us on Instagram: @nprlifekit https://www.instagram.com/nprlifekit/?hl=en Sign up for our newsletter here. https://www.npr.org/newsletter/life-kit Have an episode idea or feedback you want to share? Email us at [email protected] mailto:[email protected] Support the show and listen to it sponsor-free by signing up for Life Kit+ at plus.npr.org/lifekit http://plus.npr.org/lifekit See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

  This week on Up First, the midterms, less than 15 days away. President Trump, Vice President J.D. Vance, and former President Obama, all crisscrossing the country, rallying voters in key races from Michigan to Georgia to North Carolina. Join us every morning as we guide you through the home stretch of this election season, Up First, on the NPR app or wherever you get your podcasts.

• 0:25Speaker 01

  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.

• 0:56Marielle Segarra?

  You're listening to Life Kit. I'm Marielle Segarra. And you just heard from Shireen Rizvi. She's a professor of psychiatry and behavioral sciences at Montefiore Einstein. She co-wrote a book called Real Skills for Real Life, and it's filled with distress tolerance 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.

• 1:27Speaker 01

  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.

• 1:44Marielle Segarra?

  What do you think people get wrong about coping with distress?

• 1:48Speaker 01

  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. And 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.

• 2:23Marielle Segarra?

  On this episode of Life Kit, research-backed 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 got in 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, T-I-P. And it actually stands for four distinct skills that you can use in moments when you're so distressed that you just can't think straight. You say in the book, these are not skills to help you solve the problem, right?

• 3:02Speaker 01

  Yes, exactly. And the idea is these are skills to help you go from, let's say, 100, on a scale of 0 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.

• 3:17Marielle Segarra?

  Okay, so TIP is an acronym. It stands for T-I-P. T is temperature. What does that mean?

• 3:23Speaker 01

  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 are physiologically aroused.

• 4:05Speaker 01

  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

• 4:48Speaker 01

  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 a try. And if you wear a smartwatch or something else that monitors your heart rate, you can actually look. You could do a little test to see your pre-post heart rate when you practice the temperature skill.

• 5:11Marielle Segarra?

  So that's T. I is intense exercise. So are you running up the stairs really fast?

• 5:19Speaker 01

  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.

• 5:47Marielle Segarra?

  Interesting. Okay, P is paced breathing. What does this mean?

• 5:52Speaker 01

  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 paced breathing is to slow your breath down. And the third component of paced 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.

• 6:28Marielle Segarra?

  And then we actually have one more P, which is

• 6:31Speaker 01

  Yes.

• 6:31Marielle Segarra?

  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?

• 6:41Speaker 01

  Yes, exactly. And the idea is that if you tense your muscles as hard as you can and then relax, you actually get to a greater sense of relaxation than if you just tried 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 cue word that you associate then with the relaxation piece.

• 7:12Marielle Segarra?

  We'll have more Life Kit after the break.

• 7:21Speaker 03

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• 7:49Speaker 05

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• 8:13Speaker 06

  Hi there. I'm Brittany Luce. And not to brag, but I host a really fabulous podcast. It's called It's Been a Minute. I love making it, and I think you'll love listening to it. Over the last year, hundreds of thousands of listeners have been tuning in. And I got to say, if you haven't yet, you're missing out. Listen to the It's Been a Minute podcast from NPR today.

• 8:37Marielle Segarra?

  You have another set of skills 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 IMPROVE stands for.

• 8:50Speaker 01

  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.

• 9:31Speaker 01

  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.

• 9:49Marielle Segarra?

  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.

• 10:01Speaker 01

  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 use these skills a lot. But I actually think that I have that similar experience where I wouldn't wish cancer on anyone, and I did feel like it changed me in particular ways that I'm actually grateful for.

• 10:28Marielle Segarra?

  Yeah, I'd rather that it 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 I did chemo.

• 10:41Speaker 01

  I did not get that, so I experienced distress over not getting this magical hair that people talk about.

• 10:48Marielle Segarra?

  Oh dang, sorry.

• 10:51Speaker 01

  I have to find other meaning.

• 10:52Marielle Segarra?

  Yeah. Okay, the P stands for PRAYER.

• 10:58Speaker 01

  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.

• 11:20Marielle Segarra?

  R is RELAXATION.

• 11:22Speaker 01

  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 way. 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?

• 11:52Marielle Segarra?

  O is ONE THING IN THE MOMENT, putting your full attention into just one thing that you're doing right now.

• 11:59Speaker 01

  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 was 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.

• 12:30Marielle Segarra?

  And then V is for VACATION. It's like giving yourself a little mini 20-minute vacation.

• 12:36Speaker 01

  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 10 minutes that makes you have that sense of, I'm just taking a break? So maybe it's looking at a gossip website, or a 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.

• 13:08Marielle Segarra?

  Okay, so the last letter is E, ENCOURAGEMENT. What does this mean?

• 13:12Speaker 01

  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 a hard time with this, 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.

• 13:46Marielle Segarra?

  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.

• 13:55Speaker 01

  And making it a little bit lighter.

• 13:57Marielle Segarra?

  Yeah. We'll have more Life Kit after the break.

• 14:06Marielle Segarra?

  Stay tuned for the following announcements and messages from our sponsors.

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• 15:00Marielle Segarra?

  You also have some distress tolerance 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?

• 15:15Speaker 01

  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 kind of denying the reality that he did do that.

• 15:54Speaker 01

  So willingness is this quality of moving towards 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.

• 16:16Marielle Segarra?

  It makes me think about going back to getting cancer. People would say to me, do you ever feel like, why me? You know? And I really didn't feel that too much. Like, I wanted to turn it around to, why not me? One in something like eight 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? You know?

• 16:59Marielle Segarra?

  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, you know?

• 17:09Speaker 01

  Yeah. 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, our 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 in those moments, right? And so can we learn to be willing to accept and embrace the reality of whatever life

• 17:52Speaker 01

  gives us, all of the positives and all of the negatives?

• 17:57Marielle Segarra?

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

• 18:06Speaker 01

  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, you know, sitting or standing upright, pushing your shoulders back, and

• 18:48Speaker 01

  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 adopt what we call a HALF SMILE, where

• 19:29Speaker 01

  we very 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.

• 19:47Marielle Segarra?

  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?

• 20:04Marielle Segarra?

  Toxic positivity or something, you know, like just put a smile on your face and, and then all these horrible things that are happening are fine.

• 20:14Speaker 01

  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 that, but, but try it, practice it and report back. Let me know how it goes.

• 20:59Speaker 01

  The third piece is this whole 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 know, 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?

• 21:41Marielle Segarra?

  Yeah, these skills are not meant to solve your problems.

• 21:45Speaker 01

  Exactly.

• 21:46Marielle Segarra?

  Shireen, thank you so much for this.

• 21:48Speaker 01

  Thank you so much for having me.

• 21:52Marielle Segarra?

  All right, time for a recap. Let's go through the skills we learned. Takeaway one, tip skills. These are helpful in moments when you're so distressed that you can't think straight. T stands for temperature. Specifically, dunk your 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. P stands for paced breathing. Make sure your exhale is longer than your inhale. And P also stands for paired muscle relaxation. Squeeze a muscle, then relax it while saying a word like, relax. You can do that in a sequence from head to toe.

• 22:36Marielle Segarra?

  Takeaway 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. M stands for meaning. Not everything happens for a reason, but this happened and it does have meaning in my life. P stands for prayer. Go inward and connect with the divine. And if you don't believe in God, try praying to your wisest self. R is for relaxation. Do something that you know reliably relaxes you. Drink some tea, watch your favorite TV show from the 90s, pet your dog. O is one thing in the moment. Focus completely on one thing that you're doing right now. V is vacation.

• 23:21Marielle Segarra?

  Give yourself a 10 or 15 minute break from everything. No checking messages, no working, just vacationing. And E is for encouragement. Remind yourself, you got this and mean it, because you do. Lastly, takeaway 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.

• 24:05Marielle Segarra?

  For instance, sit with your hands in your lap, turned up toward the sky. It's a simple postural shift. Now, 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.

• 24:34Marielle Segarra?

  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 Marie Schneider. Our digital editor is Malika Gharib and our visuals editor is CJ Riechelmann. Megan Kane is our senior supervising editor and Lauren Gonzalez is our executive producer. Our production team also includes Andy Tagel and Margaret Serino. Engineering support comes from Jimmy Keely. Fact checking by Tyler Jones. I'm Maria Elcegara. Thanks for listening.