Shireen Rizvi is a professor of psychiatry and behavioral sciences and co-wrote the book. Real Skills for Real Life: A DBT Guide to Coping with Stress, Emotions, and Relationships. Jesse Finkelstein/Sonya Barlas/NPR hide title toggle title Jesse Finkelstein/Sonya Barlas/NPR Think about the last time you were distressed. How did you manage? Did you lash out
Shireen Rizvi is a professor of psychiatry and behavioral sciences and co-wrote the book. Real Skills for Real Life: A DBT Guide to Coping with Stress, Emotions, and Relationships.
Jesse Finkelstein/Sonya Barlas/NPR
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Think about the last time you were distressed. How did you manage?
Did you lash out at someone? Drink alcohol? Pretend it never happened?
There are healthier ways to cope with pain. “These behaviors are the result of not knowing how to tolerate what feels intolerable,” says Shireen Rizvi, professor of psychiatry and behavioral sciences at Montefiore Medical Center. “In those moments, we have to learn to accept 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 Coping with Stress, Emotions, and Relationshipspublished earlier this year.
She and co-author Jesse Finkelstein, a clinical psychologist, use engaging diagrams and illustrations to teach skills rooted in dialectical behavioral 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.
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 useful for many different people with many different types of problems,” Rizvi and Finkelstein write in their book, not just those with complex mental health problems.
TIP: What to do when you’re so distressed you can’t think clearly
Rizvi, a certified DBT therapist, shares a set of techniques from her book called TIP. The acronym stands for temperature, intense exercise, rhythmic breathing and paired muscle relaxation.
You can use these four different skills in times when you are so distressed that you can’t think clearly, he says. For example, if you are having a big fight with your partner or if you are dealing with a major life event, such as an illness or death.
TIP can quickly reduce the level of emotional intensity from extreme to moderate. They can “help you go from, say, 100 to 80 on a scale of zero to 100,” Rizvi says. Then, when you’re at 80, you’ll have more clarity to do something else to help yourself.
T: Lower your temperature
How to do it: Fill a large kitchen bowl with cold water and ice, take a deep breath, and submerge your face, eyes, and temples in the water while holding your breath. Stay there as long as possible, says Rizvi.
Why it works: It triggers the mammalian dip reflex, which occurs when mammals are submerged in cold water, Rizvi says. Increases the probability of survival by decreasing heart and respiratory rates. “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 people with heart disease or taking beta blockers. “A sudden decrease in heart rate could obviously be a problem,” he 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, says Rizvi. Run up the stairs, do some jumping jacks or push-ups. Hold that movement for 30 seconds or more.
Why it works: The idea behind this ability is “almost paradoxical,” he says. “In that moment of great agitation, you are speeding up.” Then, when you stop exercising, your heart rate slows, making you feel calmer and your endorphins kick in.
Q: Try to breathe at a rhythm
How to do it: Make your exhale longer than your inhale, says Rizvi. Inhale for a count of four and then exhale for a count of six.
Why it works: When we’re distressed, we tend to breathe from the chest, “which is more like hyperventilating, the opposite of relaxing,” Rizvi says. Rapid breathing can slow your heart rate and decrease emotional intensity.
Q: Practice paired muscle relaxation
How to do it: Go through your body, muscle group by muscle group, and tense the muscles as much as you can and then release them. Inhale while squeezing your body. Then, as you exhale, say or think of a word you associate with relaxation, such as “relax” or “calm,” as you relax. That’s the “matched” part of the exercise, Rizvi says.
Why it works: “The idea is that if you tense your muscles as hard as you can and then relax them, you’ll get a greater sense of relaxation than if you just try to relax without tensing the muscle first,” he says.
Intense moments don’t last forever
One of the biggest things people get wrong about heartbreak is that they have to get rid of that feeling immediately or it will last forever, Rizvi says.
But that’s not the case, he says. “One thing we want people to learn is that whatever you’re feeling, no matter how intense, no matter how horrible it feels right now, it will pass.”
The story was edited by Meghan Keane. The visual editor is CJ Riculan. We would love to hear from you. Leave us a voicemail at 202-216-9823 or email us at LifeKit@npr.org.
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