Coping with Stress and Anxiety in Uncertain Times: Part 2 - Distress Tolerance and DBT Strategies

This podcast episode, the second part of a series, delves into practical strategies for tolerating distress when external circumstances are beyond one's control. DocSnipes emphasizes that while some stressors cannot be immediately changed—like waiting for medical results or market fluctuations—developing effective coping mechanisms is crucial to prevent the detrimental health impacts of prolonged stress, including effects on blood pressure, blood sugar, immune function, and even cancer risk. The core of the discussion revolves around techniques derived from Marsha Linehan's Dialectical Behavior Therapy (DBT), specifically the acronyms ACCEPTS and IMPROVE, which provide a structured approach to crisis response.

The ACCEPTS acronym outlines strategies for immediate distress tolerance: engaging in **A**ctivities for distraction, making **C**omparisons to gain perspective, **C**ontributing to others or causes, focusing on positive **E**motions, **P**ushing away distressing thoughts, and using intense **S**ensations to jolt oneself out of rumination. Each technique is elaborated with practical examples, such as gardening for Zen, comparing one's situation to more severe global crises, volunteering, watching funny shows, consciously redirecting thoughts, or using cold water/ice cubes for sensory distraction. The underlying principle is to shift focus and calm the body's threat response system (HPA axis) when direct problem-solving isn't possible.

The IMPROVE acronym offers further techniques for managing difficult emotions and finding meaning: using **I**magery to visualize positive outcomes or a 'happy place,' finding **M**eaning in challenging experiences, engaging in **P**rayer for those with a higher power, practicing **R**elaxation techniques, focusing on **O**ne thing in the moment, taking a mental **V**acation, and seeking **E**ncouragement from positive support systems. These strategies aim to engage the mind in constructive ways, reduce mental clutter, and foster a sense of hope and calm, allowing for clearer thinking or simply a temporary respite from overwhelming thoughts.

Beyond the DBT acronyms, the episode provides additional crucial advice for maintaining well-being during stressful periods. These include setting healthy boundaries, learning to say no to avoid overwhelm, limiting exposure to negative social media and news, maintaining a consistent daily routine to regulate circadian rhythms and stress hormones, regularly reviewing personal goals and values, and practicing self-compassion. The importance of managing the mind-body connection is highlighted, recognizing how negative thoughts amplify the stress response and how physical stressors like sleep deprivation or dehydration can exacerbate anxiety. The overarching message is to proactively cultivate resilience through a combination of cognitive, behavioral, and self-care practices.

"Sometimes we can't change it... you're gonna have to tolerate that stress because you can't make the results come back any faster."

"So we need to develop strategies so the stress doesn't kill us because stress impacts our blood pressure it impacts our blood sugar it impacts our ability to fight off diseases and too much stress for too long is also associated with cancer."

"When you feel distressed and there is nothing you can do about it... thinking about it for separating on it getting frustrated freaking out... that's not effective."

"Push away those thoughts when you start thinking oh my gosh I'm never are gonna be able to retire or what happens if this person gets elected and you start working yourself up into an anxiety turmoil make a conscious effort to push it away."

"When you're holding ice cubes you're not thinking about anything else when you're listening to loud music you're probably listening hearing the music and not thinking about any anything else."

"Use guided imagery imagine visualize whatever it is resolving successfully or visualize for lack of a better term your happy place and use all your senses."

"Sometimes we just need to say you know what there is nothing I can do about this at this point in time so for my own health and well-being I need to allow myself to relax."

"People who are your cheering squad people who are your positive supports are going to be the ones that are going to help you balance out the negativity and provide you that hope that we're all so desperate to find."

"When our threat response system is turned on we are running all cylinders wide open which exhausts a lot of our energy even if we're not doing anything that emotional turmoil is exhausting."

"Don't judge yourself and say I shouldn't be feeling this way or I'm stupid to feel this way you feel how you feel you react how you react in large part."

"When we are thinking stressful thoughts it turns on our stress response system and it gets us anxious if we are anxious then we are going to notice unpleasant things in the environment we are gonna have more negative thoughts which is gonna turn that stress response system up even higher."