Action 41

I manage my strong emotions (anxiety, depression, anger, guilt, shame, moral injuries). I can rein in the emotional part of my brain, and control my emotions before they have a negative impact on me and on others around me. Negative emotions are signals that something is wrong and that there is a difference between the way a thing is and how I want it to be. Emotions are a trigger to activate my action plans, like asking for help or using my mindfulness and tactical breathing, or some other coping skills.

How To: Steps to My Emotional Fitness: Things I Can Do to Help Feel More In Control

  • Tune into my feelings, monitor and “spot check” how I am feeling. I have the ability to control my attention and choose what “emotional channel” I will select. I can learn my bodily clues of distress (“My telltale signs of stress are…”). Spot early warning signs.
  • Name or label my feelings. (“Do I feel angry, afraid, sad, hurt, confused, frustrated, guilty, ashamed, calm, grateful?”) Naming the emotion helps me regulate how I feel and control my brain. If I can name it, I can tame it.
  • Locate the feelings in my body and use my coping skills to manage my emotions. I can learn to “decondition” my intense emotions and get grounded. When I notice that my mind is “spacing out” and I am taking on that “thousand mile stare,” I can use my emergency procedure of “getting grounded” by bringing myself back to the present. I can refocus my attention to the immediate environment by describing in detail the external environment, naming the location of where I am, colors, sensations, and remind myself that I am “here and now” and in a “safe situation,” instead of time-sliding back to the past. I can reorient and use my breathing retraining exercises. I can regulate down and deescalate my intense emotions and reduce the hold of my memories. Remind myself that the past is just a memory, not really happening right now.Another way to control my emotions and negative self-talk and refocus on the present is to use some form of self-stimulation. For example, get some ice cubes and hold them in your hands. This is a way to stop your mind from wandering and reduce your “mental chatter.” It stops the Amygdala (part of your brain) from hijacking your emotions. If you cannot access ice cubes, you can take the stem of your watch and press it hard into your skin, not so hard to do damage, but just a reminder of the here and now. Another way to get grounded is to take a rubber band and place it around your wrist. Snap it when you notice you are reengaging in your negative self-talk habits. In this way you can learn to refocus your attention.
  • Increase my “trigger awareness,” namely the situational cues, my warning signs, red flags, both external cues (what people say or do, or what they fail to say or do), as well as internal cues (my feelings, thoughts, flashbacks, memories and cravings). I can ask myself, “What was happening before the feeling began?” I can avoid being blind-sided by reminders. I can learn to detect my “trip wires,” “mental icebergs,” or deeply held beliefs that lead to emotional over-reactions, “hot button issues” that “light my fuse.” I can ask myself the following Hinge Questions:
  • “Are my present feelings and thoughts too intense and over-reactive based on the current situation of what just happened?”
  • “Do my initial thoughts and feelings carry with them memories of past trauma?”
  • “Are these ‘old tapes’ playing out or ‘old anger’ coming out?”
  • “Is this situation where I usually get triggered?”
  • “Can I engage in ‘clever guessing’ by hypothesizing or figuring out what is triggering my emotional state?”
  • “What happened right before I got upset/angry/scared?”
  • “Can I identify and prepare for such possible triggers?”
  • Tolerate and accept my negative feelings and unwanted thoughts. Stay centered and follow the rise and fall of my emotions (“Like riding a wave”). Acceptance means letting myself experience my emotions without ignoring them or feeling guilty or ashamed, nor trying to change or challenge them.
  • Be actively mindful. What is mindfulness training? What are the benefits of being mindful? How can I engage in mindfulness?

“Mindfulness is paying attention on purpose, in the present moment, nonjudgmentally.”

—Jon Kabat-Zinn

Mindfulness is a learnable set of skills, involving ongoing, moment-by-moment focused awareness and openness to the here and now without judgment and with acceptance. Mindfulness training involves the deliberate intention to pay attention to momentary experiences and a clear focus on all aspects of moment-to-moment experiences. Mindfulness is an increased awareness to everything that is going on around you, being in the present time and place without interference from the past or the future. Being mindful means identifying one’s thoughts and feelings without getting stuck in them. It requires an attitude of openness, acceptance, kindness, curiosity and patience in order to engender feelings of tranquility and equanimity. A dispassionate, nonjudgmental, nonevaluative and sustained awareness can contribute to mindfulness. It is a polar opposite of avoidance. Mindfulness training helps individuals learn to realize that one’s thoughts are only thoughts, and one’s feelings are only feelings-not necessarily accurate information or reflection about the reality of the situation. Mindfulness is the ability to observe one’s thoughts and feelings without getting stuck in them, nor growing them. By staying in the present with emotional pain, the mind develops the ability to process painful aspects of the past so these memories lose much of their emotional sting.

Mindfulness activities have been found to have mental and physical health benefits. Mindfulness contributes to enhanced cognitive flexibility, decreased rumination, improved concentration, mental clarity and emotional regulation (less anxiety and depression), increased distress tolerance and improved ability to relate to others. At the physical level mindfulness training has been found to increase immune functioning, lower somatic distress, and alter brain functioning such as amygdala activity that is involved in emotional regulation.

How To: Do Mindfulness

  1. Learn to notice, observe, be aware of, and describe your private experiences (emotions, sensations, thoughts), as you are experiencing them in the moment, even if the experience is distressing. You can be nonjudgmental and concentrate on one thing at a time by letting go of distractions. You can become an observer of your emotions, instead of engaging in some type of “escape” or “avoidance” behaviors. You can live in the present with awareness and work on improving the moment. You can develop a friendly accepting interest in my present experiences.
  2. Slowly scan your entire body, starting with your toes. Notice any sensations in your body without trying to change them.
  3. Notice your body sensation of each in and out breath. Direct your continuous focused attention on your breathing – inhale and exhale. This is a good starting point for learning how to raise awareness. Close your eyes and with curiosity and being non-judgmental allow whatever emerges in your awareness to be there, letting it come and go. Mentally label your experiences such as smelling, feeling, thinking, as you sit for a few moments.
  4. “What is happening right now?” “What are you feeling right now?” “What is your experience right now?” “Can you stay with what is happening right now?” “Can you allow and accept this feeling and stay in touch with it without reacting to it?” “If not, what is happening in your experience that is reacting to this feeling?”

For examples of mindfulness activities visit the following websites www.mindful.org and www.umassmed.edu/Content.aspx?id=41252 and works by Dr. Kabat-Zinn, including Full Catastrophe Living (1990) and Wherever You Go, There You Are (1994).

  • Let my feelings go. Release my feelings. Let them subside naturally. Allow them to float away, resting on a wave. My thoughts are like a sailboat resting on its moorings. Have the ability to calm my mind and quiet my thinking. Pay attention to my breathing. Immerse myself in the pleasure of the moment. Develop the ability to move in and out of strong emotional states.
  • Distance myself from my emotions by engaging in some other activity such as exercising, calming myself down, relaxing, using a pleasant memory or imagery, remembering a beautiful place or activity, change my self-talk or what I am telling myself, pray, seek soothing and comforting support and reassurance from others. Contemplative skills such as meditation and yoga and Chinese mindful movement practices such as tai chi and qui gong are associated with both physical and psychological benefits.
  • Use my relaxation skills. Breathing is a key to relaxation. Use tactical breathing exercises and slow deep breathing to control arousal. I can also use muscle relaxation consisting of tensing and releasing various muscle groups, especially where I feel any tension. Control my attention and use positive imagery, meditation, yoga, or whatever works for me. Take a “time-out” and when I am calmed down, then call “time-in.”

How To: Use Tactical Breathing

Tactical breathing involves learning how to use slow breathing, rather than hyperventilation or quick shallow breathing, or deep breathing. The body is physiologically more relaxed during the process of exhalation. Hyperventilation and shallow breathing can increase anxiety and associated physical symptoms such as muscle tension. The goal of Tactical Breathing Retraining is to learn to take normal breaths but to extend the process of exhaling to enhance relaxation.

Take a moment to conduct a “body scan.” Ask yourself, “How do I feel in my body”? Use your body as a clue to find out how you might be feeling. Now begin by focusing your attention on your breathing. In order to more fully relax, your breathe out should be longer than your breathe in. For example, as you breathe out slowly count to ten then as you breathe in slowly count to six. Inhale slowly and then let the air out slowly. The air should flow over your lips, as if you were blowing on a spoon filled with hot soup and you did not want to spill it, just cool it down. Or imagine that you were exhaling slowly as if you were flickering a candle without blowing it out. Note the sensations of relaxation and calmness that develop. Try the following steps to further develop your ability to calm yourself down and stay relaxed.

  1. Breathe in slowly for six counts
  2. Hold for two counts
  3. Breathe out for ten counts
  4. Hold for two counts
  5. Repeat

Feel free to alternate breathing in and breathing out to a count that best suits you. Just remember that the breath in count should be shorter than the breath out count.

In order to develop the skills of Relaxation and Tactical Breathing it takes practice like learning any other skill. First, find a comfortable chair and sit with your arms and legs uncrossed so you can learn how to practice diaphragmatic or calm breathing. The goal is to learn to breathe in through your nose and out through your mouth, with the air going all the way down to your lower belly. Tense or anxious breathing causes your upper chest to rise and fall, and the air only goes into your upper chest. Relax or calm breathing causes your lower stomach around your belly both to go up and down into your lower abdomen. Breathe in through your nose for a count of four and then hold the breath. As you breathe in your stomach will extend. Keep your chest still. Hold it. Now tighten your stomach muscles and notice your breath as you slowly breathe out through your mouth for a count of six.

Again breathe in through your nose …1, 2, 3, 4, with your stomach extending out. Hold it. Pay attention to your breath as you breathe out through your mouth: 1, 2, 3, 4, 5, 6 pulling your stomach muscles in. Remember to let the air go all the way down to your lower abdomen.

Stay in the moment. Begin to breathe more deeply into your abdomen, with the belly rising and falling with each breath. Imagine your breath coming in and out of your belly and into your chest like a wave. Now slow the breath down by counting to four with each inhalation and to six with each exhalation. As you exhale slowly, as if blowing on a spoon of hot soup without spilling it, say the word “relax” to yourself. Notice the sense of calmness and ease you have been able to bring forth. With practice, you will be able to learn to use this Relaxation Response whenever you feel stressed.

Tactical Breathing is what snipers use to calm their nerves and steady their hands. It can lower your heart rate by six to ten beats per minute that controls arousal and calms emotions. It can be used in any stressful situations, but it requires practice of at least 15 minutes a day. This practice is worthwhile because learning to use the Relaxation Response decreases muscle tension, reduces blood pressure, restores energy, turns off mental chatter, quiets down thinking, and fosters mindfulness. Find the best way for you to relax—meditation, mindfulness, imagery, yoga, prayer or tactical breathing.

  • Use “safe place imagery.” Think of an image that makes me feel safe and calm. It can be somewhere real or imagined, indoors or outdoors, with other people or on my own. Focus my mind on this image. Concentrate on my feelings of being calm. Think of a single word that captures this image like “breeze, beaches, mountain.” Practice using this word to bring up the image and my feeling of being calm. By learning to find a safe image for myself, I will learn to calm my body down and take control of my reactions (feelings, thoughts and behaviors).
  • Practice “containment.” Hold my feelings in check in order to share and process them at a later time, in a safe place, with a trusted person.
  • Compartmentalize—I can put worrisome thoughts aside for the moment since not doing something right now won’t make a difference. I can come back to it later when I am better prepared to handle it. For example, write the specific thoughts and label the accompanying feelings on yellow posties. Then put the posties in an envelope labelled “Do Not Disturb.” I can file these aside until later on so I can break the rumination cycle. I can take out these posties when I wish and can process them with someone else.
  • I can persist in trying to achieve my goals even in the face of emotional distress. I can learn to tolerate psychological pain and accept it as part of my life, but it does not need to defeat me, define me, or control me. I can surprise myself and others by how I handle my feelings and behavior.
    Our solutions to emotional and physical pain may keep us from recovering, by shutting us down just when we need to open up and process what has happened to us. In order to move out of pain, we have to sit with pain, even if we prefer to avoid this. The journey of a trauma survivor can require great courage and bravery to approach, rather than avoid, reaching out when isolation seems like a better idea.
  • I can use my SOS Skills and improve my staying power in stressful situations. I can do things that help me feel better for at least thirty minutes (listen to music, exercise, call my best friend).
    S—Slow down and take a break, “turn down the volume,” clear my mind, inhibit impulsive acts and be patient with myself and increase activities slowly
    O—Orient, pay attention to bodily senses and cues, both internal and external triggers, thoughts, and feelings
    S—Self-check, make rapid ratings of my current stress level and choose from my “coping kit”
  • Anger is a strong predictor of the severity of PTSD, no matter what population one considers. The greater the level of anger and hostility, the slower the recovery process in crime victims, emergency relief workers, victims of torture, as well as in returning service members. A blaming style and an attitude of cynicism (view others as selfishly motivated), mistrusting (view others as being hurtful and intentionally provoking) and denigrating (view others in elevated terms as being stupid, ugly, deceitful, dishonest), will undermine the development of resilience. When such attitudes are paired with rumination (visualizing and recollecting “old hurts” and “old anger,)” plus the presence of substance abuse, a potential “powder keg” of emotions can be reactivated. In order to get from anger to aggression an important contributing factor is the attribution of intentionality, or the belief that the person did this “on purpose.” These sets of thought are the lubricant that move individuals from being irritated and annoyed to the point of fury and rage.Try a small experiment. Close your eyes for a moment and think of a situation that got you really angry. Now consider what would have to change in this situation, and in you, so you only felt annoyed, bothered and mildly angry? What do you have to say to yourself; what do you have to do and not do in order to reduce your anger thermometer? How would your selftalk have to change so you view the situation as a problem-to-be-solved, rather than as a personal threat, or as an instance of being wronged, disrespected and devalued?

    When people are highly emotional, their thinking processes tend to be categorical (“seeing things as being either good or bad, black or white, stereotyping others”); personal (“seeing things as personal provocations and intentional”); action-oriented (“seeing oneself at risk and in need to fight, freeze or take flight”); and unreflective (“not consider the consequences of one’s acts, nor consider alternative options”).

    Remember there is nothing wrong with the feeling of anger. It is what one does with the feelings of anger that is critical. Anger can be both helpful and unhelpful. Anger tells individuals that there is a difference between the way something is and the way they would like it to be. Anger tells individuals that there is a perceived “injustice” that needs correction. There would be no civil rights movement, women’s liberation and other social change without anger. The key is what one does with one’s anger.

  • Pinpoint anger early and dampen arousal. Stay cool under fire. Identify and change the thoughts that fuel anger. Take a “time out” by saying:“This is important, but I need some time to calm down first.”
    “I need a break. I need to chill before we talk this over.”
    Do not forget to call a “time in” afterward, using my communication skills.

    Do not let my anger get control of me. I can change my relationship with my anger. I will not allow my temper to get the best of me. I will manage anger and not allow anger to manage me. For instance, I can:

  • Watch out for red flags and warning signs.
  • Learn to relax and turn down my arousal level.
  • Take my Time Out and remember to call Time In.
  • Rehearse what I want to say and do.
  • View provocations as a problem-to-be-solved.
  • Change my self-talk. Ask myself, “Is this really worth getting upset about?”
  • Turn my anger into assertive responses.
  • Avoid situations that make me angry.
  • Let my anger and stubbornness go so I do not stew in my ‘hostile juices.’
  • Override my negative emotions, and not harbor grudges forever.
  • Get help if I need it.
  • Stay the course. Maintain my coping skills and eliminate any anger intensifiers such as the use of alcohol or drugs, caffeine, lack of sleep, and the like.
  • Use humor to defuse my stress, what is called “gallows humor”…making fun even in the worst situations. Have the ability to view things with a twist. Humor helps me undo the knots of negative emotions. It gives me a breather from my worries. I watch the comedy channel or listen to comedy channels on Sirius radio. I read humorous books and watch funny movies. Smiling and laughter help.
  • Allow my training to “kick in.” Focus on what must be done in the given situation. Be flexible and choose the best strategy that meets the needs of the situation. If one technique does not work, then try another one. “Adapt and overcome” is my motto. Increased control and preparedness makes me more resilient and better able to adapt flexibly to challenging situations.
  • Ask myself “What is my plan if this happens again?”

Quotable Quotes

“Since I have gone through mindfulness training I try to just break down each moment into the space of a breath, so that I will feel whatever I am feeling. I just tell myself that it is ok whatever I feel. Not judge the feeling as to whether it is good or bad, or ask myself do I want to feel this way. I know that the feelings will pass. It will pass as long as I keep focusing on my breathing.”

“Since I learned to use my Relaxation Response, I am able to relax my body from head to toe and then focus on my breathing. Every time I breath out, I repeat the word “Calm” or “One,” or sometimes say a prayer. When other thoughts enter my mind, I disregard them by saying “Oh well!” I view my thoughts like an ocean wave that will continue to rise up and make a wave and then watch it leave. This took some practice since it is like a ‘mental muscle’ that needs exercise in order to become habitually automatic.”

“It’s hard to explain. Since the trauma experience settled down, I am getting along with people better, and I do not get as angry as I used to. The way I look at things is different. I don’t seem as afraid of or worry about things that I used to be afraid of or worry about. I pay more attention and spend more time with the people I love. Many of the beliefs about life that I used to hold don’t seem to fit with who I am now.”

“Taking these Steps to Emotional Fitness will lead to a happier and healthier me and lead to better relationships with those I care for.”

“Remember: those who fail to plan ahead may plan to fail.”

In summary, whenever I experience intense negative emotions I can become an “emotional detective” by:

  • Taking my emotional temperature and spot-checking my emotional state
  • Naming and taming my feelings
  • Locating and deconditioning intense feelings
  • Increasing my trigger awareness
  • Tolerating and accepting intense feelings (“Ride the emotional wave”)
  • Be mindful and stay centered
  • Get grounded, if need be
  • Use relaxation and tactical breathing
  • Change my self-talk
  • Practice containment and compartmentalize (put things on the “back burner”)
  • Use SOS skills (Slow down, Orient, Self-check). Engage in Opposite Actions
  • Use humor
  • Share my “story” and what I am feeling with others I trust to be supportive

By doing these things I can have a “corrective emotional experience.”

Action 42