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Covid-19 HSE Clinical Guidance and Evidence

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Coping with Distress

Coping with distress


Managing stress using distress tolerance skills

  • Distress Tolerance skills are for surviving crises when the crisis cannot be changed right away. The aim is to learn to survive crises, without resorting to any actions which are going to make things worse. Although we cannot change the fact that COVID-19 has had a huge impact on us personally and in society, we can manage our psychological responses.

When to use distress tolerance skills?

  • You want to act on your emotions but it will only make things worse
  • Your emotions threaten to overwhelm you and you need skills to help you through
  • You are overwhelmed yet demands must be met
  • Physical feelings of stress and overwhelm are extreme but problems can’t be solved immediately

The following are some key skills that may be useful if you find that you or a colleague are feeling under emotional stress or pressure.
 

'STOP' skills

We use this skill when our emotions are starting to overwhelm us.

  • Stop: Stop! Freeze! Do not just react. Do not move a muscle! Your emotions may try to make you act without thinking. Stay in control!
  • Take a step back: Take a step back from the situation. Take a break. Let go. Take a deep breath. Do not let your feelings make you act impulsively.
  • Observe: Notice what is going on inside and outside of you. What is the situation? What are your thoughts and feelings? What are others saying or doing?
  • Proceed mindfully: Act with awareness. In deciding what to do, consider your thoughts and feelings, the situation, and other people’s thoughts and feelings. Think about your goals. Ask yourself what actions will make it better or worse?
     
Self-soothing skills

Self-soothing refers to comforting, nurturing and being gentle and kind to oneself. This skill is essential to help you to cope more effectively when you are having a bad day or dealing with a lot of stress. Self-soothing provides both comfort and reassurance. It can help you stay grounded in your body and in the present moment and can act as a means of distraction from the difficulties you are dealing with. The goal here is not to fix the problem, but to take some time away from it so that the negative emotional volume goes down.

A way to remember these skills is to think of soothing using each of your five senses:

  • Soothe with what we see: Look at old photos or pictures that make you feel happy or that you associate with positive times in your life. Try to remember how you thought and felt at this time. See it as the antidote to current emotions. Can you focus on just noticing what you can see and attend to the thoughts and emotions you associate with this?

  • Soothe with sounds: This can be in the form of music or sounds from nature. What sounds change your mood? What makes you feel better or creates a sense of calm? Can you access this music or sound via a personal device or online? Can you focus on just noticing this sound and attend to the thoughts and emotions you associate with this?

  • Soothe with smells: What aroma or fragrance do you like. What makes you feel calm or brings back positive memories, a feeling of comfort or safety. Maybe it is the smell of freshly brewed coffee, herbal tea, home baking or even chocolate! Can you choose to focus on just noticing this smell and attend to the thoughts and emotions you associate with this.

  • Soothe with your sense of taste: Can you really notice what something tastes like. Can you choose something that you like and really savour the taste. So often we mindlessly eat our food and miss or don’t give ourselves time to fully appreciate the taste or how it makes us feel. Can you choose to focus on just noticing the taste of something and attend to the thoughts and emotions you associate with this.

  • Soothe with your sense of touch: Really notice what something feels like. Is something hard or soft, cold or warm. Maybe choose something that you like the feel of or that you associate with comfort. It could be a blanket, a favourite piece of clothing or maybe even something like a stress ball that you can squeeze!
     

Distraction skills

When our emotions run high, in the short term, we can use distraction as a way of turning down the volume on these emotions. Our wise mind will tell us that dwelling on negative thoughts will fuel emotions. A useful way to remember how to distract ourselves is to remember that wise minds ACCEPTS something needs to change. Check off what might help you.

Coping with Distress Distraction Skills
 

Radical acceptance skills
  • There are times when things are not as we want them to be. But despite us wishing things to be different in the moment it doesn’t change the reality of the situation.
  • Telling ourselves “I don’t like this” and “it should be different” also does not change the situation.

Why do we need to accept reality?

  • Rejecting reality does not change reality.
  • Changing reality requires first accepting reality.
  • Stress and emotional pain cannot be avoided; it is nature’s way of signalling that something is wrong.
  • Rejecting reality turns short-term emotional pain into longer term suffering.
  • Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, sadness, shame or other painful emotions.
  • Acceptance may lead to sadness but deep calmness usually follows.

What we need to accept:

  • Everything has a cause (including events and situations that cause you emotional pain and suffering).
  • Life is worth living despite painful events in it. 
  • It is what it is for now, but this won’t last forever.
  • Remember: Pain (emotional or physical) + Non acceptance = Suffering

Health Library Ireland, Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hli@hse.ie

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