So distressed you can't think straight? Lower the intensity with these 4 skills

Shireen Rizvi is a professor of psychiatry and behavioral sciences and co-wrote the book Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships. Jesse Finkelstein/Sonya Barlas/NPR hide caption

Think about the last time you were distressed. How did you cope?

Did you lash out at someone? Drink alcohol? Pretend like it never happened?

There are healthier ways to deal with the pain. "Those behaviors are the result of not knowing how to tolerate what feels intolerable," says Shireen Rizvi , a professor of psychiatry and behavioral sciences at Montefiore Medical Center. "In those moments, we have to learn how to accept the distress and respond in a more effective way."

She explains how to do just that in her book Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships , published earlier this year.

She and co-author Jesse Finkelstein, a clinical psychologist, use engaging diagrams and illustrations to teach skills rooted in dialectical behavior therapy (DBT), a form of therapy that helps people manage difficult emotions. There's a decision tree on how to use DBT skills to resolve conflict, for example, and an infographic on how to practice mindfulness.

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DBT was first developed by psychologist Marsha Linehan in the 1980s to treat borderline personality disorder. Since then, many studies have shown that "DBT skills are helpful for lots of different people with many different types of problems," write Rizvi and Finkelstein in their book — not just for those with complex mental health issues.

TIP: What to do when you're so distressed you can't think straight

Rizvi, a board-certified DBT therapist, shares a set of techniques from her book called TIP. The acronym stands for temperature, intense exercise, paced breathing and paired muscle relaxation.

You can use these four distinct skills in moments when you're so distressed that you can't think straight, she says. For example, if you get in a big fight with your partner, or if you're dealing with a big life event like illness or death.

TIP can quickly bring down the level of emotional intensity from extreme to moderate. They can "help you go from, say, a 100 to an 80 on a scale from zero to 100," Rizvi says. Then when you're at an 80, you'll have more clarity to do something else to help yourself.

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T: Lower your temperature

How to do it: Fill a large kitchen bowl with cold water and ice, take a deep breath, and plunge your face, eyes and temples into the water while holding your breath. Stay there for as long as possible, Rizvi says.

Why it works: It triggers the mammalian dive reflex , which happens when mammals are submerged in cold water, Rizvi says. It increases the likelihood of survival by slowing down your heart rate and respiratory rate. "Those are things we also need [our bodies to do] when we are in high degrees of distress."

Rizvi does not recommend this maneuver for those with a heart condition or those taking beta blockers. "A sudden decrease in heart rate could obviously be a problem," she says. But if you don't have those conditions, it's worth a try.

I: Do some intense exercise

How to do it: Do anything that can get your heart rate up quickly, Rizvi says. Run up the stairs, do some jumping jacks or pushups. Sustain that movement for 30 seconds or longer.

Why it works: The idea behind this skill is "almost paradoxical," she says. "In that moment of high agitation, you're revving yourself up." Then, when you stop the exercise, your heart rate decreases, making you feel calmer — and your endorphins kick in.

P: Try some paced breathing

How to do it: Make your exhale longer than your inhale, Rizvi says. Breathe in for a count of four, then breathe out for a count of six.

Why it works: When we're distressed, we tend to breathe from our chest, "which is more like hyperventilating, the opposite of relaxing," Rizvi says. Paced breathing can slow down your heart rate and lower emotional intensity.

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P: Practice paired muscle relaxation

How to do it: Go through your body, muscle group by muscle group, and tense the muscles as tight as you can — then release them. Breathe in as you clench your body. Then, as you breathe out, say or think of a word that you associate with relaxation, like "relax" or "calm," as you unclench. That's the "paired" part of the exercise, Rizvi says.

Why it works: "The idea is that if you tense your muscles as hard as you can, then relax, you get a greater sense of relaxation than if you just try to relax without tensing the muscle first," she says.

Intense moments don't last forever

One of the biggest things people get wrong about distress is that they have to get rid of the feeling right away or it will last forever, Rizvi says.

But it doesn't, she says. "One thing we want people to learn is that whatever it is you're feeling, no matter how intense, no matter how awful it feels in this moment, it will pass."

The story was edited by Meghan Keane. The visual editor is CJ Riculan. We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org .

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