Friday, December 29, 2017

Stress Reduction for Distress Tolerance & Emotion Regulation

"I'm freaked out; what do I do?"
Because the same question is asked so often, here's a rundown of the techniques I have used successfully since 2003.
My No. 1 immediate go-to now is the Reverse Ratio Breathing I learned from Robert Sapolsky in his Why Zebras Don't Get Ulcers, and for which he credits Joseph Wolpe's work from the 1950s. Often, btw, I do RRB while I go for a walk away from the site where I was triggered.
But I also remember that The Feeling is Always Temporary, and use the 10 StEPs of Emotion ProcessingBenson's Relaxation Response, and the Go Limp Drop Drill. The Drop Drill is a very fast-acting form of progressive muscle relaxation (developed from Benson's, Ogden's and Porges's work) that allows gravity to "draw down" the neck, shoulders, facial and jaw muscles to trigger the vagus nerve to summon the action of the parasympathetic branch of the autonomic nervous system towards homeostasis

Levine's Pendulation is another useful technique for dealing with sudden stabs of the fight-flight-freeze response to "threat" or recall thereof.
Lately, btw, I have been using an ancient yoga pose that is strongly supported by Ogden's and Porge's discoveries: I lay on the floor on my back and slowly bring my outstretched legs up over my body until my toes touch the floor "above" my head. It stretches the back muscles that get compressed under stress, which feeds back to the brain as per Porges's "polyvagal theory." (Virtually anything that stimulates the vagus nerve reduces the activity of the sympathetic branch of the ANS.) 

I've also begun to use a mechanical distraction technique I picked up from Shapiro's Eye-Movement Desensitization & Reprocessing psychotherapy and old Yogic Hindu practices. I close my eyes partially and then move the eyeballs back and forth, left to right to left to right for about ten to 15 seconds, stop, repeat, stop, repeat, and stop... just as is done in EMDR. If the anxiety or stress loading I was experiencing is not unduly great, that little exercise seems to reduce it for a while, though I may need to do it again in a few minutes. It does not seem to work rapidly for me if my SUDS level is too high, however. BUT... done over time (like every night for a week while I was out walking), I noticed a considerable reduction in body tension and emotional reactivity. 

Beyond that, I continue to stay in touch with the "distress tolerance" and "emotion regulation" skills I learned from Dialectical Behavior Therapy, and the "mind-body bridging" technique I acquired from Mind-Body Bridging Therapy.

Everything listed above is in accordance with recent research on the operations of the sympathetic and parasympathetic branches of the autonomic nervous system during the fight-flight-freeze response. This includes very new information on acute sympathetic activity during what many with PTSD and CPTSD experience as "overload," "overwhelm" or "freak." Major (usually neuroleptic antipsychotic) or minor (benzodiazepine) tranquilizer medication is usually required if the "freak" becomes chronic and turns into "fry," because the neurotransmitters required to bring the ANS back to balanced homeostasis are "used up." 

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Comment added 12-01-2018: See my addition of a long quotation from Alan Watts's The Wisdom of Insecurity: A Memoir for an Age of Anxiety in "Interoception vs. Introspection."  

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Comment added 06-08-2018: This is what works for me. But I'm not sure one can acquire these techniques while in extremis. I had to do it while I was relatively "right-side-up" for a while to make sure it worked when I wasn't.

If the recycling of a fight-flight-freeze response from earlier trauma continues without abating for a day or two, I would get to the ER for a low, nightly dose of a sedating, major, neuroleptic tranquilizer like Seroquel quetiapine, Zyoprexa olanzepine or Clozaril clozapine... as opposed to self-administration of any minor tranq like Klonopin clonazepam, Ativan lorazepam, Xanax alprazolam or any other, potentially dependency-inducing benzodiazepine.

The main thing is to use a mantra like the first eight of those 10 StEPs to dis-I-dentify with and distance from the FFF recycling until it runs its course. And if one can do the interoception in StEP nine, StEP ten just sort of "arrives" by itself.

(I have tried trauma expert Pete Walker's methods, btw. They're not "all bad," but they don't get the job done for me.) (Some of us are -- as they say in AA and NA  -- "sicker than others," I guess.)

Related Article
Treat Autonomic And Cognitive Conditions in Psychopathology? 

References & Resources
Benson, H.: The Relaxation Response, New York: Morrow, 1975. (Early MBSR)
Block, S.; Block, C.: Come to Your Senses: Demystifying the Mind-Body Connection, New York: Atria Books / Beyond Words (Simon & Schuster) 2005, 2007. (MBBT)
Block, S.; Block, C.: Mind-Body Workbook for PTSD, Oakland, CA: New Harbinger, 2010. (MBBT)
Block, S.; Block, C.: Mind-Body Workbook for Stress, Oakland, CA: New Harbinger, 2012. (MBBT)
Block, S.; Block, C.: Mind-Body Workbook for Anxiety: Effective Tools for Overcoming Panic, Fear & Worry, Oakland, CA: New Harbinger, 2014. (MBBT)
Chapman, A.; Gratz, K.; Tull, M.: The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free from Worry, Panic, PTSD & Other Anxiety Symptoms, Oakland CA: New Harbinger, 2011. (DBT)
Chapman, A.; Gratz, K.; Tull, M.: The Dialectical Behavior Therapy Skills Workbook for Anger: Using DBT Mindfulness & Emotion Regulation Skills to Manage Anger, Oakland CA: New Harbinger, 2015. (DBT)
Knaus, W.: The Cognitive Behavioral Workbook for Anxiety, Oakland, CA: New Harbinger, 2008. (CBT)
Marra, T.: Depressed & Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression & Anxiety, Oakland, CA: New Harbinger, 2004. (DBT)
McKay, M.; Wood, J.; Brantley, J.: The Dialectical Behavior Therapy Skills Workbook, Oakland, CA: New Harbinger, 2007. (DBT)
McKay, M.; Fanning, P.; Ona, P. Z.: Mind and Emotions: A Universal Treatment for Emotional Disorders, Oakland, CA: New Harbinger, 2011. (all of the above)
Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015. (SP4T)
Pederson, L.; Pederson, C. S.: The Expanded Dialectical Behavior Therapy Skills Training Manual, Eau Claire WI: Premier Publishing, 2012. (DBT)
Porges, S.: The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation, New York: W. W. Norton, 2011. (SP4T)
Sapolsky, R.: Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases and Coping, 3rd Ed., New York: Holt, 2004. (MBSR)
Stahl, B.; Goldstein, E.: A Mindfulness-Based Stress Reduction Workbook, Oakland CA: New Harbinger, 2010. (MBSR)
Van Dijk, S.: The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life, Oakland, CA: New Harbinger, 2009. (DBT)
Van Dijk, S.: Calming the Emotional Storm, Oakland, CA: New Harbinger, 2012. (DBT, ACT, MBCT)
Van Dijk, S.: DBT Made Simple: A Step-by-Step Guide to Dialectical Behavior Therapy, Oakland, CA: New Harbinger, 2013. (DBT)
Wolpe, J.: Psychotherapy by Reciprocal Inhibition, Palo Alto, CA: Stanford University Press, 1958. (Early MBSR)

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