138. How to Survive a Panic Attack - SOLO EP

Mar 9

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Today's solo episode is all about how to cope when you are experiencing a panic attack or other forms of intense anxiety. We discuss three DBT distress tolerance skills that will help you stop a panic attack in its tracks: The STOP skill, the TIPP skill, and the ACCEPTS and IMPROVE skill. If you struggle with anxiety, this is a MUST LISTEN & I share a coping skill that is 100% effective, every single time!!

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About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

[00:00:00] Sadie: Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

[00:00:19] You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

[00:00:37] So let's dive in this week on She persisted.

[00:00:42] avoidance amplifies emotions. So whenever you feel an emotion rise, do your best to ride it out, to feel it, to be like, what thought am I having? What caused this?

[00:00:49] Just sit with it and that will long term do you so much good when it comes to processing your emotions rather than just immediately avoiding, distracting scrolling on TikTok because I've done that too. And I promise you, if you can even just sit with the emotion for a couple of minutes, it does wonders.

[00:01:03] But when you cannot sit with the emotion because you're in crisis mode, for example, you are having a panic attack. This is what you are going to do. Hello, hello, and welcome back to She Persisted. I'm so excited you're here today. If you're new here, my name is Sadie. I am a 19 year old. Actually, I might be 20 by the time you're listening to this. I forget what date this is airing, but my birthday is on the 14th, so if you're listening to this after the 14th of March, I'm 20 now.

[00:01:27] , I am a sophomore at the University of Pennsylvania studying psychology, and I started to persisted after a year and a half of intensive treatment for severe depression and anxiety. Today we're talking about anxiety, so giving you all my tips and tricks that I learned in treatment before treatment, specifically for panic attacks, because one thing I remember from my experience, and one thing I hear all the time, so the biggest thing you wanna solve, the biggest pain point normally is those panic attacks because they are so debilitating and so overwhelming. You want a fix, you want a quick fix, and I have one for you that will work every single time.

[00:01:59] So before we dive into that, we have a little story time. We don't normally do story times, but I just had to share this because it is all because of you guys, and this was insane.

[00:02:07] So to paint you a little picture, I'm sitting in my little research lab. I'm doing my Excel sheets, doing my copy and pasting. I'm a research assistant at a lab at the University of Pennsylvania. We're studying depression and anxiety, very on brand for this week's episode. And the podcast, you know what I like, stick to it, doing my little copy and pasting, doing my Excel thing.

[00:02:24] I can email my computer. I'm like, oh, that's interesting. What is it? It was a lovely listener telling me how my website was broken. He was like, , I don't think it's Link works. And I was like, I'm so sorry. Let me fix that right away. But he said, oh, by the way, like I saw in the New York Times a footnote.

[00:02:41] so I was checking out your recommended episodes to start with. Your website was broken. I was like, thank you so much for telling me. Because if you have a website or you know someone that has made their own website, you know how many links exist on your site.

[00:02:53] Like it is so challenging to make sure that all of them are correct. Of course, you do everything upfront to make sure you're copy and pasting the right links, but it's really hard to go back and find when something's off, especially if it's like in a blog post or in an embedded page. So anyone that has ever nicely told someone that their website's wrong, you are a godsend because we would.

[00:03:12] So sent the nicest message and I was like, thank you literally so much. I'll fix it up right now. And I said, wait, I'm just curious. You said New York Times, footnote did it feature, , she persisted. Like, what are you talking about? I had a little feeling, I was like, , that would be an odd detail to include if it wasn't about sheep persisted.

[00:03:29] But I was like, I'm surely not. Nothing about Jeep, persistent Army is in the New York Times. So I was like, oh, what are you talking about? Not sure what you. I get an email response. He sends me a picture. She persisted is in the Sunday edition of the New York Times. So if you got the New York Times on Sunday, February 19th, 2023 she persisted, was featured.

[00:03:50] I'm holding the newspaper. Yes, I did order it from the New York Times for $35. , if you're on page two, the columns and commentary section, you might find a column called Teenage Despair and Smartphones, and within that column you might find a footnote called Adolescent Angst, aka this podcast

[00:04:08] and I will read you what it says. . Basically it recaps recent CDC data, talking about depression and sadness in teenagers, and it says a few things to read, listen to and watch to better understand the causes and solutions for teen sadness. And right next to that is listened to, she persisted.

[00:04:27] This podcast started in 2019 by Sadie Sutton is a great resource for young people interested in learning about mental health episodes, feature interviews with psychologists and experts, and tips for managing symptoms of anxiety and depression. That's me. That's this freaking podcast in these Sunday New York Times.

[00:04:42] Guys, I am literally peeing myself. I'm freaking out.

[00:04:45] I'm holding it up in the YouTube video.

[00:04:47] . I have my newspapers. Now I have a vision. I'm gonna do cute little like coffee stop photo shoot. There's gonna be croissant, a cup of coffee. My featured footnote. There'll be photos of me holding up the footnote.

[00:04:55] I'm so freaking proud. Stay tuned for that. You heard it here on the podcast. Technically you heard it on Instagram first, but you heard it on the podcast. Maybe first. If you don't follow me on Instagram and I cannot say thank you to you guys enough for listening, for allowing.

[00:05:10] She persisted to have an audience and. That people can find it. It's literally insanely amazing and it makes me so happy that this podcast that I started as the resource I wish I would've had is hopefully the resource that some of you guys are actually utilizing when you are struggling.

[00:05:25] So, Putting that resource in action. Let's walk the talk here. We are talking anxiety and we are talking specific tips and tricks. I'm giving you all the coping skills I use and I pull from when I get anxious. First things first. You guys might have heard me say this before. Long-term and short-term anxiety are very different. The skills that you're gonna use for a panic attack or really intense anxiety are very different from the skills we're gonna wanna use long-term. I've done other episodes on long-term anxiety.

[00:05:48] I'm probably gonna do one again in the next couple of months. But these skills that I'm teaching you are only for when you're in crisis mode. So there's this thing in D B T C B T, lots of different areas of therapy and mental health called a SUD score that stands for subjective units of. Plural. There's no S at the end, though.

[00:06:06] That is a subjective rating of how distressed you are.

[00:06:09] So when you are feeling calm, normal, average day today, you're probably at like a one or two because you're experiencing no distress. If you're like the average teen who kind of just has that little simmering anxiety under the surface, you're like, I have that assignment due next week.

[00:06:23] I kind of have a lot on my plate. I'm constantly seeing all this news and information on social media. You probably do have a little bit within your baseline, so you're not quite at like monk level zero, but you are calm, there are no stressors going on. If you're a full-blown panic attack, you were at a nine. You were at a 10. You're very overwhelmed. You're extremely distressed, and so we can kind of break up when we're using these anxiety coping skills based on our level of distress. Same thing goes for anger, sadness, depression, the things that we're using. For lower levels of anxiety and depression and other emotions that last a long period of time are gonna be more emotion regulation skills.

[00:06:56] That's the module in D B T when we're in crisis mode, that's distress tolerance. The skills I'm teaching you are distress tolerance, and the reason that we only use distress tolerance skills when we are in crisis is that they will lose their effectiveness over time. The example I always give is that if.

[00:07:11] Get anxious and you watch the office, it's a great distraction. It calms you down. It works temporarily, but if you watch the office for 24 hours a day, seven days a week, it will become background noise. It will no longer impact your anxiety. It will no longer work as a self-soothing mechanism. So that is why we save our best coping skills, like distraction, specifically for when we were in crisis mode and not on a daily basis. The other reason we do that is because most of these crisis skills, Except for one, and I'll tell you when we get to that one, our avoidance, short-term avoidance can be okay because if you were to nine outta 10, you're not able to function.

[00:07:47] You're not able to implement other skills and be effective. You do need to short-term distract yourself. You need to get yourself to a better place to make a plan to long-term deal with that emotion. But if we were to distract and avoid 24 7, , all of your emotions, whether it's depression and anxiety, anger, et cetera, will amplify avoidance, amplifies our emotions.

[00:08:05] It especially amplifies anxiety. This is why one of the most effective treatments for anxiety is C B T and exposure therapy, where you slowly but surely expose yourself to the thing that's making you anxious until you overcome that. Anxiety works for social anxiety if you're flying, , heights. All of these things really effective to be treated with C B T and exposure therapy.

[00:08:25] So if there's one little caveat thing that you take away and that is front of mind is that avoidance amplifies emotions. So whenever you feel an emotion rise, do your best to ride it out, to feel it, to be like, what thought am I having? What caused this?

[00:08:37] Just sit with it and that will long term do you so much good when it comes to processing your emotions rather than just immediately avoiding, distracting scrolling on TikTok because I've done that too. And I promise you, if you can even just sit with the emotion for a couple of minutes, it does wonders.

[00:08:51] But when you cannot sit with the emotion because you're in crisis mode, for example, you are having a panic attack. This is what you are going to do.

[00:08:57] I'm gonna teach you three skills, kind of three and a half, because one is distraction, but it's broken down into two parts, so basically three skills. The first one we're gonna talk about is the stop scale. We're then gonna do the tip scale, and then finally accepts and improve. These are all D B T scales. If you are new here at Dialectal Behavioral Therapy or D B T is a clinically proven treatment for anxiety depress.

[00:09:19] Eating disorders, OC D, borderline Personality Disorder. Literally so many different implications. You can read the studies on it. These are D B T skills. This is not D B T treatment, so you won't get the same results. However, most of these skills are used on populations that have become really ineffective with coping with their emotions, regulating their emotions, maintaining their stability with regard to their mental health, having healthy relationships.

[00:09:39] And so if these skills are working for those populations, they can also work for you and they'll be very effective. I also like to say that if you are living a well-functioning, balanced, effective, You're probably doing a lot of these things already.

[00:09:51] Is the first skill. The Stop skill Stop is an acronym. We love acronyms. In D B T, it stands for stop. Take a step back, observe and proceed mindfully. This one should always be front of mind for when you are experiencing an intense emotion. We first are physically stopping and mentally stopping. So say you are in a class, you're about to give a speech.

[00:10:08] You all of a sudden feel a panic attack coming on. You can't. Freeze, physically freeze and mentally freeze. It's very important because a lot of the times alongside a physical panic attack will be those mental spirals. So just pause. Don't continue down that little spiral at entertaining what the thought is, you're gonna take a moment, you're going to freeze mentally. You're going to remember, we're pausing because our emotions are urging us to act. And because the emotional intensity is so strong, the urge to act on the emotion is really strong. The urge is to avoid, the urge is to hide, to run away. To follow that train of thought.

[00:10:41] So we're gonna stop, we're gonna pause, we're gonna take a step back. You are going to take a break from the situation. You're going to let it go. You're going to decrease a little bit of the stress when you are taking a step back. Ideally, you leave the situation both physically and mentally. So if you're a panic attack about a super important conversation you're supposed to have with someone and you don't know what you're gonna say, it's stressing you out.

[00:11:02] You're gonna stop thinking about that for a little bit. If you're about to give your speech, you're gonna see if you can really quickly run to the bathroom and take a break, take a step back from the classroom, environ. You are going to take a deep breath. This is crucial. Take a couple deep breaths if you can.

[00:11:15] Really focus inhaling through the nose, exhaling through the mouth, and pausing. After you inhale. You also wanna try to make your exhales longer than your inhales. This is really, really effective for me. I like to do two counts in pause and three counts out. We're going to do everything we can here to avoid acting impulsive.

[00:11:33] with regard to what our emotions are urging us to do

[00:11:36] and how we're going to do this is we're going to observe. This is the next part of the top skills we've done. Stop. We've taken a step back. We are observing. So now we're going to figure out what is happening in this situation? What are the urges that are coming up? What are the thoughts that are coming up?

[00:11:51] How can I proceed in this situation and be effective? You wanna notice what's going on both internally and externally. Most of the time when you're feeling really overwhelmed with anxiety, it's easier to start with externally. Where were you? What was happening? What was being said? How are you feeling right now?

[00:12:06] Like, what is around you? Is it feeling hot? Are you feeling cool? What is going on? . Now you're gonna go internally. Is your heart racing? Are your muscles clenched? Are you breathing really rapidly? Are your thoughts spiraling? Are you having thoughts that things are getting a lot worse than they actually might be?

[00:12:23] What is going on? Are you having certain urges to avoid, to run away, , to engage in an unhealthy behavior? Whatever it is, take a minute, observe those. Make sure to really hone in on the thoughts, the feelings, and things that others are saying or doing. We wanna get really clear and when we're observing, we're using a little bit of mindfulness here.

[00:12:40] So we're being objective. We're saying only things that can be observed without judgment. So what are the thoughts? What are the emotions? What did people do? Again, we're not like, that was so annoying or that was so frustrating, or That's not fair. , I don't want to do this. Those are all kind of judgements and, and not objective facts.

[00:12:58] So really focus on the facts for this observing part. And what's great about this is as you start to lay out the facts and let go of those assumptions and judgments some of the anxiety does sometimes go away. Not always, but sometimes. And the last part of the stop skill is you're gonna proceed mindfully.

[00:13:14] You're going to act with awareness. You are going to consider your thoughts, your feelings, the situations, and other people's thoughts and feelings. So you're gonna be as effective as possible and balance that rational side of things and the emotional side of things. You're going to think about what your goal in the situation is.

[00:13:29] What is your objective? So if you are supposed to give a talk in class, it's your objective to get through the talk. It's your objective to ask your teacher if you can postpone, but you're going to actually follow up and do the speech. Are you gonna try and just go after the next person who's presenting whatever it is, figure out what your goal is and make sure that you are truly listening to both the rational side of things and the emotional side of things, not just what your emotion is urging you to do, which is likely to.

[00:13:54] It's also important to ask yourself and you ask your wise mind, which in D B T, is that balance of the rational and the emotional, and we're going to decide, will this action that you'd like to take to move forward, is it gonna make things better or worse? If you avoid the situation long term, that's gonna make it worse. If you are going to work through this, use a coping skill effectively that will make the situation better.

[00:14:16] You were building mastery over your anxiety and you're equipping yourself with your skills long. So if you have never developed any coping skills for anxiety at this point, you're like, okay, that's great. I'm going to proceed mindfully, but I don't know how to cope with my anxiety or make it feel better.

[00:14:30] So I'm like proceeding mindfully back into the situation with no skills. I got you. These are skills, but we have to pause first. That stop skills absolutely essential. Or we're never able to implement the skills because we just keep having anxiety and a panic attack.

[00:14:43] So one of the most overwhelming parts of panic attacks that people repeatedly say they feel like they're dying. They feel like they can't breathe. Their heart's racing, they think they're having a heart attack. It's those physical symptoms. It's the physiological symptoms of distress when you're having a panic attack, your body is in fight or flight mode, so it's actually responding as though there is like a line coming at you and chasing you and your body thinks that a real threat exists and it needs to get out of the situation.

[00:15:08] There are a lot of things that your body is doing to try and prepare itself for survival. If you're sweating, the reason that your body's sweating is because if something was chasing you and tried to grab onto you, you'd become more slippery. It'd be more challenging for that thing to grab onto you.

[00:15:23] There's other things like your heart's increasing, your breathing rate's increasing. You need more oxygen, you need more blood flow to be able to run away and be able to keep up that pace. That's why you're breathing more rapidly. there are other smaller things like your digestive system is put on pause for a moment.

[00:15:36] Your body is not worried about digesting your food. It's worried about survival. That's why we sometimes get stomach aches alongside panic attacks. All of those are examples of how your body is physically responding to that anxiety. And so if we want to address this panic attack in full, we can't just address the mental.

[00:15:52] We also have to address the physical, and that's where the tip scale comes in. TIP is an acronym in D B T that stands for temperature and tense, exercised pace breathing and impaired muscle relaxation. This is one of my favorite skills. This should be DBTs claim to fame. I wish everyone knew this. They heard it and were like, oh, that's D B T.

[00:16:10] I know that because this is the biggest game changer when it comes to anxiety. The skill, the tea part, the temperature part will work a hundred percent of the time. I did an interview recently where I was talking about the skill I was teaching and she was like, this is great if it works for you. And I was like, no, no, no.

[00:16:25] This will work for everyone 100% of the time. And that's because it's not a mental thought process. It's not something that you are. Trying to see if you are actually able to distract yourself from what you're thinking. It's a physiological response that 100% of the time will help get rid of that physiological arousal associated with anxiety.

[00:16:44] So the temperature part of the tip scale. Ideally you have a bowl of ice. I will, after I explain this, give some substitutions that you can do if you're at school or work, or you're not able to have access to a bowl of ice. But ideally, you use a bowl of ice. So if you're at home, if you're at a friend's house, if you can get a bowl of ice, you want a bowl of ice, because this will be most effective.

[00:17:05] When I was at residential, they always had metal bowl device, like mixing bowls. They constantly had ice. Washcloths were always on hand because they were using this scale all the time. Whenever people got distressed, if you were in a therapy session, you were getting overwhelmed. Oh, and can the ice bucket, it's tip scale time.

[00:17:21] If you would see people, they called it a fishbowl. It was this one room in the unit where there was windows. You could see inside someone was having a bad time. You're like, okay. They're in there at the ice bucket. They're doing the tip scale, like this scale is pulled from all the. In a residential setting, in a mental hospital, not just any mental hospital, the number one mental hospital in the United States, a Harvard Medical School affiliated hospital, the number one adolescent dialectal behavioral therapy program in the world.

[00:17:44] So they know what they're doing. This skill works is what they're implementing. It's what you should be too, When we're doing the tip scale, we have our bucket of ice water. You're going to take a deep breath in. You're gonna hold your breath, you're gonna place your face in that bowl of ice water. You are going to hold it for 30 seconds or however long you can kind of hold your breath.

[00:18:03] You're going to take your head above the water. Breathe in, breathe out, go back under. You're gonna repeat this until you feel your heart rate and your breathing rate decrease. The note on the official D B T worksheet is to keep your water above 50 degrees . I don't know, you don't wanna freeze your face, but that is noted.

[00:18:20] I don't know why they say that, but I gave the disclaimer that they do. So you are going to repeat this until your heart rate and your breathing rate decreases and you're like, okay, why is that going to work? And let me tell you the temperature part of the tip scale

[00:18:34] target, something called your mammalian diving reflex.

[00:18:37] This is something that all mammals do, especially humans when they come into contact with water. This is why we're doing cold water. So your body's like, not room temperature. I don't notice the difference, but your body's like, wow, I'm submerge in water. And just like your body has gone into fight or flight mode and is having these physiological things that it's been wired to do for hundreds of years.

[00:18:55] When your body comes into contact with this cold water, it will also start. Those processes that have been evolving for hundreds of years, this protective mechanism works by activating your vagus nerve and your cutaneous receptor, which is above your eyes. Your vagus nerve runs below your eyes.

[00:19:10] What is stimulated as your heart rate decreases and in turn your breathing rate decreases. This is done to conserve oxygen because when you're underwater, you can't breathe. Your body needs to conserve as much oxygen as to increase its chances of survival.

[00:19:24] So much of what our body does is just to try and survive, and we are not in a world anymore where that's necessary. On a day-to-day basis, we are giving a speech. You don't need your fight or flight mechanism. If you are doing nice little ice dive, you probably don't need your mammalian diving reflex, but we're going to use it to our advantage.

[00:19:41] So through your mammalian diving reflex through your vagus nerve, your heart rate and your breathing rate decrease, we know that our heart rate nerve breathing rate increase with anxiety, so it will lower it past that threshold and it will get it back to your normal level. After you are less consumed by these physical symptoms of anxiety, we're then able to establish a plan of how can I cope?

[00:20:00] How can I proceed? How can I effectively get myself out of this situation? That is the tip scale. It's amazing. It will work a hundred percent of the time. Again, this is your body's biological response. Unless you don't have like a vagus nerve or a mammalian diving reflex for some reason, you probably should see a doctor, but this will work.

[00:20:18] And the other options that you can do here, if you were on the go, Is a Ziploc bag, ice water. You could also do one of those cold packs that you pop and put in a first aid kit. I used to keep those in my backpack. There are a lot of options here. You could try and do cold water with like a paper towel, but the best case scenario is always that bowl of ice water.

[00:20:35] You would get the best results that way.

[00:20:36] I used to do this at residential. I used to do it at home still. Just whenever I have friends or family members that are getting really upset, they cannot function. They're like so overwhelmed, like crying, sobbing, that kind of thing. We bring out the ice wolf of water. They probably don't wanna do it.

[00:20:49] At first. They're like, are you kidding me? I don't wanna do this. You make them do it. You don't force barely. Come on, like this will work again. Your body hasn't a mammalian. Diving reflexes will help with your emotional intensity. They do it, they feel better. They can breathe through things, they can talk through things.

[00:21:03] Life. That's the temperature part the temperature component is to calm down fast, to calm down very quickly, the intense exercise. The next part of the tip scale is to calm down. When your body is overwhelmed by emotion, pace breathing is to pace your breathing by slowing it down and paired muscle relaxation is to calm down by pairing muscle relaxation with breathing out.

[00:21:23] So to give a little bit more detail there.

[00:21:25] The intense exercise portion again targets a part of our anxieties, fight or flight response, which is that when you are overwhelmed, your heart rate, your breathing rate increases, and when you are engaging in intense exercise, whether it's a sprint, jump, squats, burpees, , the examples that they give are running, , playing basketball, lifting weights, like ideally something that is really challenging, from a cardio perspective your body can't maintain that level of output. Like you know that if you're bad at running like me, you run for a little bit. Your body's like, please stop. I can't do this. You stop your heart rate, your breathing rate, decrease.

[00:21:56] Same thing when you are having really intense physical response to anxiety. You then do a couple of sprints. Your body does its normal process of lowering its heart rate and lowering its breathing rate, and in turn it goes past that threshold that it was at for anxiety. The physical symptom.

[00:22:12] Start to fade away. You can come up with a better plan to cope. Pace breathing, very simple. We all know how to breathe. You are breathing deeply into your belly. You are slowing the pace of inhaling and exhaling way down past what it's at with anxiety. So D B T says five seconds in, seven seconds out again, I said two counts in, three counts out.

[00:22:32] I count kind of slowly. I like that. Pause in the middle, but the key is that your exhale is longer than your inhale. We are going to do that for a few minutes. It's great if you can visualize yourself breathing in and out. Maybe you're using box breathing.

[00:22:46] Maybe you are really aware of how your body's responding to the breath, as your stomach and ribcage are moving. With each breath being really mindful and bring yourself back to the present moment.

[00:22:56] And then the last part of the tip scale is paired muscle relaxation. So again, like we mentioned, our body has a lot of physical responses to anxiety. One of that is tense muscles. Your body is getting ready to run away to do everything it can to physically fight for its survival. And so we want to let go of some of that tension and also the breathing rate and heart rate.

[00:23:15] So what we're going to do is as we're doing our breathing, As we inhale, we're going to clench our muscles further. You can do this one at a time, like you can do your leg, you can move all the way up, or you can do this all at once. It's much more like a meditative, calming experience. They do this before bed.

[00:23:30] When I go from like my toes to my head. . And as you inhale, you cle the muscle and as you exhale, you let go, and you're letting go of not only the tension that you've just caused by squeezing your muscles, but also the tension that was there from that anxiety and from that emotional intensity. And again, you're lowering your heart rate, you're lowering your breathing rate, decreasing those physiological symptoms of distress.

[00:23:51] So that is the tip skill. That is how you get rid of emotional intensity quickly, and then we move into our next step, which if it's a panic attack, is likely going to be distraction, especially if your panic attack is related to something mentally, like you have a speech to give, you're stressed out about an interaction or an argument.

[00:24:09] It's something mental that you keep ruminating about. Distraction will be very key to get your mind off of that long enough to find a long-term to dealing with that

[00:24:19] And having a true plan in place to problem solve, whatever that stressor is.

[00:24:24] So for distracting. We are using the accept scale, so it's an acronym that stands for activities contributing comparisons, different emotions, pushing away thoughts and other sensations. Again, these D B T acronyms are not perfect, but they are helpful for remembering a skill when you're in crisis mode and when you're not mentally at your best.

[00:24:45] The activities part of the accept scale is pretty straightforward. You are doing an activity that distracts you from your source of anxiety. The examples they give is watch tv, clean a room, find an event to go to, go on a walk, exercise, write emails, go on social media, build something.

[00:25:01] Listen to music, call a friend. Eat a favorite food. Puzzle, like so many examples, I would recommend making a list of these in your notes app or screenshotting one of the Pinterest lists of a hundred coping scales. You never wanna be in a position where you're like, I need to distract myself. What the heck do I do?

[00:25:16] Give yourself three things to pull from. You're in crisis mode. You know that you watch the office, you listen to music and you drink tea. Those are your three activities. We don't wanna leave these up to ourselves in crisis moments. We want to plan ahead. We wanna do the preventative work, and we wanna set ourselves up for success.

[00:25:32] So that's activity is contributing. You are shifting your emotion by supporting someone else in helping someone else, and not by talking them through your emotion, but maybe you are going to do volunteer work. You're helping a friend with something. You're surprising someone. You're sending a thoughtful text, you're giving something away.

[00:25:49] You're doing something nice for someone, and the reason that this works is that it's invoking a different emotion from that anxiety, so you're having a different emotional response and we can't really feel too emotion super intensely at once. So if you surprise someone and drop in, say hi, catch up with them, it's gonna be difficult to be extremely anxious.

[00:26:07] and also feel good about supporting someone else at the same time. So hopefully the intensity of supporting another person you're contributing will be a higher intensity, and if not, you can pull from one of these other distractions. The second C is for comparisons. So what you're doing is you are putting your current emotional intensity in perspective so you can compare how you're feeling now to a time when you felt different.

[00:26:29] You can think about how you are feeling to how others are feeling.

[00:26:33] You can watch a reality show, which I know people joke about, but it can be really effective if you're like, I'm having the worst day ever. And you watch a really funny reality TV show where people are getting in all these like silly arguments and all this drama and you be like, you know what? I am doing okay.

[00:26:47] I did not just have a beverage thrown in my face. life is good. It can be really effective to compare those emotions and put things in perspective. I will say that for me, comparisons tends to not be one that I pull from because I have never found it extremely motivating or validating or effective to be like someone else has it way worse than me.

[00:27:04] You really just gotta change your emotion right now. It's not an approach that typically works for some people. It really does. For me it hasn't, so I'll pull from a different skill that works better. The E is for different emotions, so you are invoking a different emotion by reading an emotional book.

[00:27:19] Maybe you're watching an emotional TV show, listening to a song that invokes a particular emotion. The great thing about this is you can show, watch a funny show. Watch an S N L skit. Listen to a funny podcast. Call a friend that makes you laugh. You are again invoking a different emotion that will have a stronger intensity than the anxiety will With the pee, we are pushing away, so we are pushing the situation away for a while.

[00:27:43] We are taking a mental break, so we are leaving the situation mentally. We are blocking thoughts and images related to it from our mind.

[00:27:50] We are avoiding the problem for a moment. Short term. And we're setting that boundary mentally so that we can recharge and then revisit it.

[00:27:57] The tea is thoughts. So here you can do things like counting. You can do box breathing, you can count colors, you can look at things around the room. Five things you can touch, four things you can hear three things you can smell two things you can. Taste, I'm forgetting a sense. This is terrible. , but you get the point.

[00:28:14] The other options that they give are to repeat words in a song, and your brain really focus on overriding those other thoughts that you're having. You can do a puzzle, you can watch a TV show or read. You're doing, again, something to mentally stimulate yourself in a different way. From the anxiety, we are replacing the emotion.

[00:28:30] We are replacing the thoughts, we are replacing the physical sensations. We are, we have power over these emotions. We just have to be really effective and know how to. S and accepts is sensation. So you are focusing on physical sensations that again, are distracting from either the emotional intensity, physical intensity, or the thoughts happening.

[00:28:49] So maybe you're squeezing a rubber ball, you're listening to very loud music. I love this one. You are holding ice in your hand or in your mouth. That's a great one. If you're not gonna do an ice type, you still want that impact of that sensation that's really jarring and like, wow, okay. I'm focusing on something outside of my head right now.

[00:29:04] You can go out in the rain or the snow depending on what your weather is like. Or you could take a hot shower. I love a shower or a bath after I've had anxiety. It can be so effective. Again, it gets you outta your head, really switches out the physical sensation and forces you to think about something else.

[00:29:18] So now the improved skill is about improving the moment. So now we have paused. We have taken a step back from the situation. We've gotten rid of the physical part of the anxiety. We have mentally figured out how to distract ourselves for a longer period of time so we can fully get out of that emotional intensity.

[00:29:35] Now, we're going to improve the moment before we come full circle and like long-term due with that anxiety stressor, which we're not talking about in today's episode because today we're just talking about getting through the crisis mode. This will be the final step in this crisis mode survival kit. So with improving the moment, you are using imagery, meaning prayer, relaxation, one thing in the moment, vacation and encouragement.

[00:29:56] These are things that will help you feel better in the moment and feel a little bit more hope and generally more positive about the situation. So with imagery, you could be imagining relaxing scenes. You could imagine everything working out well. You can mentally think about something that's very calming and a preferred reality to what's going on.

[00:30:15] You can mentally imagine emotions draining out of you, like water from a pipe. You can remember a different moment where you felt happier or in a better mood. So you were using imagery to again, shift the situation and put a, a positive spin on it and kind of let go of those more negative aspects with meaning.

[00:30:33] This can be really effective. , More I find with long-term anxiety, but you can use it in the moment as well. So you were finding purpose and meaning in whatever the painful situation is. You're focusing on positive aspects, you're repeating the positive aspects over and over again, and you're remembering to listen to your values.

[00:30:50] So for me, sometimes if I'm getting in an argument and I'm really overwhelmed, I'm feeling anxiety. I am. Do you know what this matters? It means that I care about this person. It means that this relationship is really important to me. Or if I'm super ashamed and overwhelmed and having anxiety about talking to someone because I've done something that I'm guilty about.

[00:31:06] I'm like, I care about this person. I care about what they think about me. I feel bad. I wouldn't against my values. Like it makes sense that I am feeling this way. Same for anxiety, maybe about a test. I care a lot about my education. I care about my future. I want to do well. I've worked hard, so it makes sense that I'm experiencing this emotion.

[00:31:22] There is meaning. The anxiety isn't just coming from nowhere. The P is for prayer. You can either pray to a higher being. You can ask for a strength to be able to navigate this. You can use mantras here, I find to be really effective.

[00:31:35] Like this two shot pass. , life is impermanent and that impermanence will be on your side. There are so many things you can say here, but the idea is that you are kind of letting go of some of the control, , and asking for support. The R is for relaxing activities. We talked about some of these in the improved skill, but at things like taking a bath, taking a shower, drinking tea, doing some yoga, breathing, changing your facial expressions, all things to feel calmer and again, reduce that emotional intensity.

[00:32:03] Oh, it's one thing in the moment. So you are going to focus your entire attention on one thing, and we get outta that place of, well, we're multitasking, we're having anxiety, we're trying to also focus on something else. You are really letting go of those thought spirals and focusing on one thing mentally and physically.

[00:32:17] So put yourself in the moment, stay in the present. Make sure your mind is in the present and you are focusing your entire attention on what you are doing. The the is for taking a brief vacation. So you are either mentally going to take a brief vacation, maybe take a vacation for the night. You're like, I cannot continue this conversation.

[00:32:35] Like, I'm feeling really overwhelmed. Let's revisit it tomorrow. Or, I am so anxious about this test, I'm. Do it. The end of the class period instead of the beginning. I said test, but I meant speech. Like you could probably decide when you're gonna take your test, but you got the idea like you're taking a brief vacation with the commitment that you will revisit.

[00:32:52] But taking that emotional vacation can be really effective. So as, as you can do, you can get into bed, you can pull the covers up, you could go outside, go into nature, turn off your phone. Take a break from any work or responsibilities that you might have. All of those are really effective to kind of take a load off, decrease some of those stressors.

[00:33:11] And the E for improve is self encouragement and rethinking the situation. This is where we're really getting into that self-validation. The PEP talks, this is one of my biggest skills when it comes to anxiety saying this who. life is, IM permanent. This, IM permanent, will be on your side. It makes sense that you're feeling anxious about this.

[00:33:28] It a hundred percent , is, is valid that I'm feeling this way. All of those can be really effective ways to cope with the emotion, to fully feel it and process it. , and some other ideas that D B T gives is to cheerleader yourself saying You've got this. I will make the most out of this. I'm doing the best I can.

[00:33:45] I can stand it. This too shall pass. I will be okay and it won't last forever. I love having listed my favorite mantras in my phone. So again, you can pull from those and really lean into those when things are tough. So those are my essential D B T coping skills for anxiety. You only need to remember, stop there.

[00:34:04] Are gonna use the tips to go, to get rid of the emotional intensity quickly, immediately. It will always work. We're then going to use the distract scale, which is the acronym accepts, and we're going to improve the moment with the improved scale. So you got this. That is exactly how you will cope with anxiety.

[00:34:20] I promise it will work. I've used it many a time, especially with the tip scale. I can assure you that a hundred percent of the time that will work. And it's so relieving to know that you have a tool in your toolkit that will work 100% of the time to have that g. that that physical sensation from your anxiety can go away and it will go away if you use that skill.

[00:34:39] Having the. Trust in yourself that you know skills that will work and that you can get yourself out of that stressful situation is a game changer, and it gives you a lot of hope. So I hope that learning these skills has provided that a little bit. Try them. Let me know if they work. Let me know if you have any other skills that you would add to this master list and I can share them on Instagram and give tips to the communities.

[00:34:59] They can also use these to cope with their anxiety. Thank you guys for hanging out, talking all things anxiety, listening to my story time. You guys are the best. I hope this was helpful and I'll talk to you next week.

[00:35:12] Thank you so much for listening to this week's episode of she persisted. If you enjoyed, make sure to share with a friend or family member, it really helps out the podcast. And if you haven't already leave a review on apple podcasts or Spotify, you can also make sure to follow along at actually persisted podcast on both Instagram and Tik TOK, and check out all the bonus resources, content and information on my website.

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