Coping Strategies – Mark Beré Peterson: Hauntings, Urban Legends, History, Folklore, Mythology and Witchcraft

What to Know Before Admitting Yourself to an Inpatient Psychiatric Hospital

Coping Strategies, Mental Health, Psychiatric Hospitals

A few ideas and options:

Bring your best advocate with you. It may be your spouse, parent, close friend, or relative—someone who knows you and is familiar with your situation.
Breathe. Recognize that the staff wants to help you, not hurt you.
Be patient. It’s a process—there are steps to go through and paperwork to be completed
Once inside, advocate for yourself. The doctor will see you. Be honest with him.
Your picture will be taken, and no, they are not stealing your soul.
You will be in a secured unit, locked in. At times they let you out of the unit for visits or short excursions.
Do your best to cooperate with staff and your fellow patients. It may be a while before you are discharged, so bear in mind you are there to get better. Plus, you’ll earn extra “points” for being polite and pleasant.
Read your patient rights and understand them.
Your personal belongings will be inventoried, so they will take out shoestrings, belts, hoodies, nail clippers, razors, and anything else deemed potentially dangerous.
Don’t mind the eccentric behaviors of the other patients, they’re fighting a similar battle.
Accept that the insides of the building may not be the most aesthetically pleasing. (That said, don’t concentrate on abstract paintings if they have them. Abstract art is a bad idea for psychotic symptoms).
If you are in a state of psychosis, the TV may sound as if it’s calling your name. It’s not, but if the AV stimulation is too much, try to leave the room or focus on a different activity.
Be mindful of the opposite sex (or the same sex if you’re so inclined). Establish personal boundaries and adhere to them; the psych ward is not a place to start a romance.
Listen to the staff and don’t give them a hard time.
Be friendly and polite. Remember, there are human beings here with feelings.
Seek out a friend and get to know some people.
Read.
Give yourself time and space. You are on a journey to getting better and that takes time and space.
Take a photograph in your mind’s eye. Journal about it. Capture the chaotic and colorful journey. Write about it. Express yourself. Get to know who you are at this time.
Be kind, regardless. Don’t expect people to respect you because a.) everyone’s imperfect and b.) they can’t respect others if they don’t respect themselves.
Challenge your mind and do a puzzle, but don’t read into it—it’s just a brain exercise.
Take advantage of physical activity when there’s recreation time. Your body needs a physical outlet to help process the stress your mind is going through.

The Fight, Flight or Freeze Response

Anxiety, Coping Strategies, Mental Health, Panic, Trauma, Triggers

The fight or flight response has been around as long as human beings have been around. It’s the body’s hardwired alarm system. If you think of the human body as a computer, the fight-or-flight response is an essential part of the operating system. You couldn’t really function (or live that long) without it.

When you encounter a dangerous or threatening situation, this alarm system goes off, and your body goes through a number of changes. For example, during the fight-or-flight response, you may experience the following symptoms:

An increase in heart rate
Perspiration or sweating
Narrowing of field of vision (also called “tunnel vision”)
Muscle tension
Sensitive hearing
Racing thoughts
Shortness of breath
Goose bumps
Dry mouth

These experiences aren’t random; they all serve a very important purpose. They prepare you for immediate action. They are preparing you either to flee the situation to avoid any harm or to fight if escape is not possible. In situations where fleeing or fighting is not necessarily a good option, your body may also freeze (kind of like a deer caught in a car’s headlights).

This response is automatic. It occurs without thinking. This is important because it allows you to respond quickly when you are in a dangerous situation. For example, let’s say that you are walking through the woods and come across a bear. Your fight-or-flight response will be activated, and you will likely freeze or flee. The sudden and automatic changes that your body goes through will help keep you alive in this dangerous situation. Now, if you had to think about the situation before the fight-or-flight response was activated, you would waste precious time. You would have to evaluate the size of the bear and the sharpness of its claws and teeth. And, by the time you figured all of that out, you would probably be supper for the bear! Therefore, the fight-or-flight response is incredibly helpful and adaptive. We likely wouldn’t be alive as a species today without it.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

Identify Your “Triggers”

Cognitive Behavioral Therapy (CBT), Coping Strategies, Mental Health, Therapies, Triggers

Each person has specific types of situations that set their automatic negative path in motion; these are their triggers. To address your problems, you need to know which situations are difficult and trigger your negative path.

While many people are aware of their triggers, some have trouble identifying their specific trigger situations. For example, a person may tell you that they are “always” sad, or “always” drink too much, and can’t identify specific problematic situations. Identifying your triggers helps you start to see patterns and then know what to focus on in therapy.

A helpful first step is to monitor your problematic feelings or behaviors and see if there are some situations where your feelings are stronger or your behavior is more extreme. For example, a person came to therapy because they were always angry. When asked for examples of specific situations, they responded that they were angry “all the time.” The first homework assignment was to monitor their angry feelings and see when they were strongest. They came back having discovered that they were the most angry when their teenage son didn’t do what they wanted him to do; for example, when he did his homework at 2 a.m., broke curfew, or did not do his chores. They discovered that their anger toward her son was spilling over into the rest of her life.

Frequently, people will describe their trigger situation in vague terms, and don’t really understand what happened. They need to become more specific and concrete. A specific and concrete description includes what happened, with whom, and the specific time and place it occurred. For example, a vague description of a situation would be “My partner doesn’t respect my work”; a more concrete and specific description would be “My partner told me that they thought their work was more important than mine.”

The more specific and concrete your description of the situation, the more you will be emotionally engaged with the situation, and the more you will have access to your feelings and thoughts. Think of someone you are a little annoyed with. Now, think of a specific situation when you were annoyed with this person. Try to remember the situation in detail. Chances are that as you thought about a specific situation, you became more annoyed and your feelings and thoughts became more immediate.

Sometimes your situation is a long, complicated story. In this case, consider the whole story and then ask what was the worst or most difficult part for you. It is helpful to identify a situation that lasts from a few seconds to three minutes, any longer and you will probably have a large variety of feelings and thoughts, and it will be hard to focus on the main ones.

Sources: CBT Made Simple

A Structured Cognitive Behavioral Therapy (CBT) Session

Cognitive Behavioral Therapy (CBT), Coping Strategies, Mental Health, Therapies

A structured session means that there is an order and organization to the therapy session. Here is a brief overview of the five basic components.

Check in. This is a quick update on what has happened since the previous session and includes a bridge to that session.

Set the agenda. You and your therapist decide together which problems to focus on in the current session. Homework from the previous session can be reviewed during the check-in or as part of the agenda-setting process.

Work the agenda. This involves addressing the identified problems on the agenda.

Homework. You and your therapist collaborate to develop homework for the following session.

Review. At the end of the session you briefly review with your therapist what was covered in the current session and give feedback.

Sources: CBT Made Simple

Communication Styles and Mental Health

Coping Strategies, Dialectical Behavioral Therapy (DBT), Mental Health

Passive Communication
Passive people often don’t communicate verbally. They tend to bottle up their emotions instead of expressing them, perhaps out of fear of hurting others or making them uncomfortable, or maybe because they don’t believe their feelings or opinions matter as much as those of others. People with a passive communication style usually fear confrontation and believe that voicing their opinions, beliefs, or emotions will cause conflict. Their goal is usually to keep the peace and not rock the boat, so they sit back and say little.

Aggressive Communication
Aggressive communicators attempt to control others. They’re concerned with getting their own way, regardless of the cost to others. Aggressive people are direct, but in a forceful, demanding, and perhaps even vicious way. They tend to leave others feeling resentful, hurt, and afraid. They might get what they want, but it’s usually at the expense of others, and sometimes at their own expense, as they may later feel guilty, regretful, or ashamed because of how they behaved.

Passive-Aggressive Communication
Like passive communicators, those who have a passive-aggressive style fear confrontation and don’t express themselves directly. However, because of their aggressive tendencies, their goal is to get their way, but they tend to use indirect techniques that more subtly express their emotions, such as sarcasm, the silent treatment, or saying they’ll do something for others but then “forgetting.”

Assertive Communication
Assertive people express their wishes, thoughts, feelings, and beliefs in a direct and honest way that’s respectful both of themselves and of others. They attempt to get their own needs met but also try to meet the needs of others as much as possible. They listen and negotiate, so others often choose to cooperate with them because they’re also getting something out of the interaction. Others tend to respect and value assertive communicators because this communication style makes them feel respected and valued.

Sources: DBT Made Simple

Watch Your Emotions

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health

People often try to avoid their emotions because they find them too painful. When you haven’t learned how to regulate your emotions you are in a lot of pain, and you don’t have the skills to manage and tolerate your emotions. You can use the acronym WATCH to help summarize the skills that will help them reduce their avoidance of emotions and improve their ability to manage emotions:

Watch: Watch your emotions. Mentally note your experience of an emotion, acknowledging how it feels physically, the thoughts, memories, or images that accompany it, and so on.

Avoid acting: Don’t act immediately. Remember that it’s just an emotion, not a fact, and that you don’t necessarily need to do anything about it.

Think: Think of your emotion as a wave. Remember that it will recede naturally if you don’t try to push it away.

Choose: Choose to let yourself experience the emotion. Remind yourself that not avoiding the emotion is in your best interests and will help you work toward your long-term goals.

Helpers: Remember that emotions are helpers. They all serve a purpose and arise to tell you something important. Let them do their job!

Sources: DBT Made Simple

Three Levels of Self-Validation

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health, Mental Illness Treatments

Acknowledging: The most basic level of self-validation is simply acknowledging the presence of the emotion rather than judging it; for example, telling yourself, I feel unhappy. Just acknowledging or naming the emotion and putting a period on the end of the sentence rather than going down the road of judging it validates the emotion.

Allowing: The second level of self-validation is allowing, which is essentially giving yourself permission to feel the feeling; for example, telling yourself, It’s okay that I feel unhappy. This takes not judging the feeling one step further, affirming that it’s okay to feel this way. This doesn’t mean liking the feeling or wanting it to hang around; it just means acknowledging that you’re allowed to feel the emotion.

Understanding: The highest (and hardest) level of self-validation is understanding. This level, which goes beyond not judging the emotion and saying it’s okay to feel it, involves having an understanding of it; for example, It makes sense that I feel unhappy, given the difficulties I have managing my emotions and the chaos this causes in my relationships and my life.

Source: DBT Made Simple

Crisis Prevention: Experience Intense Sensations

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health

Experience Intense Sensations

Sometimes generating intense physical sensations can distract the mind from painful emotions. This helps explain why many people resort to cutting or hurting themselves in other ways: because it can actually help them feel better temporarily. Obviously, the key here is to help identify intense sensations that aren’t harmful. Think about physical sensations you can generate that might take your mind off a crisis. For people who engage in self-harm, try holding an ice cube in one hand. This can cause physical pain if held long enough, and the sensation is intense. For some people, this can take the place of self-harming behaviors. Here are some examples of other things you might do to get your mind off a crisis:

Take a hot or cold bath or shower.
Keep a rubber band on one wrist and snap it—not so hard that it causes a lot of physical pain, but hard enough to generate a sensation that will temporarily occupy the mind.
Chew on crushed ice or frozen fruit.
Go for a walk in cold or hot weather.
Lie in the hot sun (with sunscreen on!).

Again, add whatever intense sensations you can think of to your list of activities to help survive a crisis.

Sources: DBT Made Simple

Distress Tolerance Skills: Reframe

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health

Reframing refers to changing one’s perspective about something—in other words, helping make lemons out of lemonade or helping to see the silver lining. Of course a therapist, has to be careful that in doing so they don’t invalidate patients or minimize their worries. Here’s an example:

Patient: I can’t believe that I’ve been in therapy and doing all of this work for almost two years, and I’ve started bingeing again. What’s wrong with me that I can’t stop? I know how unhealthy it is, and I don’t want to gain weight again!

Therapist: Yes, you’re struggling, Anna, but it makes sense given all of the stressors in your life right now (validation). If this was two years ago, how do you think you’d be coping with everything that’s going on?

Patient: Well I’d probably be in the hospital already. At the very least, I’d be feeling suicidal and wouldn’t be functioning very well.

Therapist: Right. So even though you’ve gone back to an unhealthy behavior, you’re not where you were two years ago. In fact, you’re coping quite a bit better than you were back then, right?

Patient: Yeah, I guess you’re right.

There are many different ways to reframe. The above dialogue is an example of a patient comparing herself now to how she was in the past, at a time when she wasn’t coping as well. This can often help patients acknowledge the changes they’ve made, even though they may still be struggling.

The way patients talk to themselves about what’s happening in their lives can also change the way they think and feel about things. Often, especially when depression and anxiety are a problem, people tend to get fixated on the negatives. They focus on how bad the situation is and catastrophize or think about the worst possible thing that could happen. If you can change how you think about the situation, you’ll find that it’s more bearable than first imagined and you will be more likely to get through it without engaging in behaviors that could make it worse.

To help with self-talk, you should write out coping statements to use when you get into situations that you’re struggling with and that trigger intense emotions. That way you won’t make it worse with self-talk and can actually help yourself cope more effectively. Here are some examples:

I can get through this.
The emotions are intense and uncomfortable, but I know they won’t hurt me.
This pain won’t last forever.

Sources: DBT Made Simple by Sheri Van Dijk

Exercise as a Coping Strategy

Coping Strategies, Distractions, Mental Health, My Schiz Life

Exercise is, of course, a natural antidepressant. It leads to the release of endorphins, those chemicals in the brain that help us relax and feel happy. Exercise also simply helps people feel good about themselves because they know they’re acting effectively and doing something that’s good for them. Some studies suggest that exercise is as effective as antidepressant medications at reducing symptoms of depression among adults diagnosed with major depression. Both the biological effects and the psychological effects (increasing self-efficacy and self-esteem and reducing negative thinking) of exercise are thought to be responsible for its positive influence on mood.

In addition, there is abundant evidence that exercise has positive effects on blood pressure and cardiovascular disorders, improves learning and memory, delays age-related cognitive decline, reduces risk for dementia, and improves medical conditions such as diabetes, osteoporosis, and Alzheimer’s disease.

While there are guidelines about how much exercise people should get, anything more than what you’re currently doing is a great start. This perspective helps take the pressure off and makes it more likely that you’ll actually increase your exercise, whereas telling yourself you need to exercise for twenty minutes three times a week could overwhelm you and result in not exercising at all. Of course, if you are working to reform an eating disorder, you may need do the opposite and reduce compulsive or excessive exercise.

Source: DBT Made Simple, by Sheri Van Dijk