Crisis survival skills are skillls you can use in the moment to help tolerate, and survive, a crisis situation. These are used when a crisis is unavoidable, and aim to get you through the crisis situations without making them worse. These skills are designed to be used in the short term, to help you survive a highly stressful situation.

We looked briefly at the six crisis survival skills in the previous lesson, here we will look at them individually.

STOP: Stop, Take a step back, observe and proceed mindfully

• Stop – pause in the moment, don’t react to what is happening (remind yourself that you are in charge of your emotions)
• Take a step back – detach from the situation, give yourself a moment to calm down and think
• Observe – gather factual information about what is happening around you and within you
• Proceed mindfully – look at the best action to take, considering the consequences, and taking action

As we learned in earlier lessons, when emotions take over we act impulsively in the moment, without thought, which means you don’t have time to use these skills. To be able to use the skills you have learned, using the STOP skills while you help you stay in control and move through the situation.

Pros and Cons

Using a pros and cons list allows us to accept the facts of the situation, manage our distress effectively, and make choices that enable better outcomes.

Pros and cons list can be used for a specific action, such as looking at what the positive and negative results of a particular action. For example, if I were to react angrily, what are the pros and cons of that? It might be a positive outcome that it makes me feel better, but it would also have a negative outcome for the other person and the interpersonal relationship going forwards.

It can also be used to look at two sides of a situation. For example, you are struggling and want to take drugs, so you write a pros and cons list of what would happen if you take drugs. You then write a pros and cons list of what would happen if you didn’t take drugs. You can compare and review the lists, using them to make an informed decision with a clear mind.

It’s a good idea to keep your pros and con lists in a file with your other worksheets and journals. At some point in the future, you may repeat this exercise and it can be helpful to look at your older worksheets and remind yourself that you have overcame distress before and can do it again.

TIP – Temperature, intense exercise, paced breathing nad paired muscle relaxation

There are four tips skills, although there are only three letters in the acronym. Each one of these skills is designed to help you quickly change your biological state, thereby helping to reduce your emotional distress.

• Temperature – submerging our hands in cold water, using an ice bag on our face or splashing our face with cold water
• Intense exercise – 20 minutes of intense aerobic exercise
• Paced breathing – slowing down your inhaling and exhaling to around fixe to six breath cycles per minute
• Paired muscle relaxation – relaxing muscles in tandem with breathing out

These skills are designed to use the human body’s nervous system to help alleviate emotional distress. The nervous system contains two parts:

• sympathetic – the ‘flight or fight’ syndrome
• parasympathetic – increased emotional regulation

These techniques help to reduce the sympathetic system, and increase the parasympathetic system. Physiological symptoms have a large impact on our emotional state. For example, if you are feeling anxious, heart racing and breathing fast, this is your sympathetic system on overdrive. A combination of tip skills helps reduce this and allow you to be more in control of what is happening.

Self-soothing

Self-soothing activities use the five senses (sight, sound, smell, taste, touch) to soothe yourself in a comforting, gentle and kind way. They help to calm us in the moment, allow us to reduce vulnerability to our emotions and prevent us from acting impulsively. They can also help us to tolerate pain, suffering and distress in a non-judgmental way.

Some people may find it difficult to self-soothe, you may feel you are not worthy of being comforted, or that you should get soothing activities from the people around you. You may feel guilty or ashamed if you don’t self-soothe. It’s important to find the right way to do this for you, and remember it will get easier with time.

Most of us are familiar with the 5-4-3-2-1 method of reducing anxiety, which is in itself a self-soothing exercise:

• Say FIVE things you see around you. It could be a pen, a painting, a humourous mug.
• Say FOUR things you can touch around you. It could be your hair, a pillow, the ground under your feet, a cold glass.
• Say THREE things you hear. This could be any external sound, such as a radio, your neighbours, traffic outside. Focus on things you can hear outside of your body.
• Say TWO things you can smell. A cup of coffee, baking bread, laundry detergent, perfume.
• Say ONE thing you can taste. Coffee, mints, peanut butter.

By focusing on these things, and saying them out loud, you are soothing yourself and removing the focus from the distress. Self-soothing then allows us to stop and use our skills to survive the situation.

There are many other ways to self-soothe in a safe, healthy way including meditations and body scans.

ACCEPTS – Activities, Contributing, Comparisons, Emotions opposite to the current negative emotion, Pushing away from the situation, Thoughts, and Sensations.

Often we use unhealthy methods to distract us from painful emotions or distressing situations, such as substance misuse, self-harm or reckless/impulsive behaviour. The ACCEPTS skill helps develop safe and healthy ways of distraction.

• Activities – engaing in activities that are positive and can help reduce impulsive urges. These are used to distract our attention in the short term with thoughts, images and sensations that are not crisis-related.
• Contributing – focusing on someone else’s wellbeing refocuses the attention on someone else in need and what we can do for them, this also helps us increase our meaning in life and our self-confidence in ourselves.
• Comparisons – it isn’t helpful when we tell ourselves that we shouldn’t be upset because others have it worse, but sometimes comparisons can be a useful tool in distress tolerance. By focusing on those who are less fortunate but coping well, or by looking at our past and comparing the present to the past, we are comparing in a positive way.
• Emotions – this skill teaches you to generate a different emotion to the one you are feeling. This requires you to think about how you currently feel (for example, angry) and then experience a different emotion through activity. This might be to watch a movie or read a book that will generate a different emotion. It’s important to remember you should not generate a new feeling that will make you feel worse.
• Pushing away – pushing away from a crisis situation can be done by physically removing yourself, or be blocking it with focused activities. For example, you could imagine you have put the difficult emotions in a box and put the box in a cupboard, until you are equipped to deal with it. It’s important to note that this is a short-term activity carried out during crisis and shouldn’t be over-used, or it will not be useful if you are in crisis again in the future.
• Thoughts – in crisis, we often find we can’t stop thinking negative thoughts or outcomes. By filling your head with other thoughts, this helps remove the negative emotions that are circling. For example, you could sing a song in your head, focusing on the words and melodies, the instruments used, the high and low notes. Another useful example is counting – if you in an emotionally distressing situation, count the number of bricks on the wall, count the number of circles you can see, or words that you can see around you.
• Sensations – introduce new sensations that you can focus on, such as holding an ice cube. Some therapists have a bowl of ice cubes and when things get too much in session you can hold one in your hand so you can distract from the distress in the moment. You can also distract yourself with smells, tastes or sounds (such as music)

IMPROVE – Improving the Moment

Improving the moment is using your skills to replace the negative experiences of the current situation with positive ones. There are different approaches to these skills, such as encouraging yourself, relaxing, praying, and focused activities – all deisgned to help you with acceptance and letting go.

If you are feeling overwhelmed in a short-term crisis situation, and distractiong and self-soothing isn’t working, you can try improving the moment.

IMPROVE stands for: Imagery, Meaning, Prayer, Relaxing actions, One thing in the moment, Vacation, Encouragement.

• Imagery – therapists often use mental imagery, or visualisation, when discussing painful or distressing events. They may ask you to imagine a safe place, somewhere you feel safe and secure, and when things are difficult that is where you go mentally. They may ask you to describe the safe place, including the furniture, decor and doors. This helps to solidify the safe place in the mind, so you can go there whenever you need to. Imagery can be useful to help you self-soothe, distract and provide you with confidence that there is always a safe place you can go to mentally.
• Meaning – finding or creating meaning in life helps many people in crisis, the time old saying of making lemonade out of lemons is the idea that we can always create meaning, no matter the situation. For some people, they may find meaning in creating art, for others it may be volunteer work, for some it may be learning.
• Prayer – the idea of prayer is opening yourself up fully to yourself in the moment. You don’t need to believe in a higher power to pray. You can use prayer to get in touch with your pain and ask yourself for the strength to continue.
• Relaxing actions – this is about taking part in an activity that you enjoy and makes you feel better. For some people this may be running or jogging, for others it may be art and colouring, whereas some people might find books and music relaxing. Feelign relaxed makes it easier to think and review your pros and cons
• One thing in the moment – we already looked at one-mindful behaviours, and although this can be difficult in crisis situations, it’s important to remember that this one moment we are in is the only that exists right now. We need to use this moment to focus on what matters, and exclude the potential to ruminate over negative thoughts.
• Vacation – everyone needs a break, or vacation, sometimes. We need a chance to rest and recover. Taking a vacation from adulthood for a short period of time can be useful in taking a moment to just take care of ourselves. Your vacation should be brief – less than one day – but should allow to take time to focus on yourself, do activities that relax you, and destress before resuming what is going on in life.
• Encouragement – you should talk to yourself as you would talk to someone you care about who is going through a rough time. Be just as kind, gentle and compassionate with yourself. Cheerlead yourself through difficult situations, say more positive things to yourself than negative ones. You are essentially in a relationship with yourself, so treat yourself as well as you would a partner. The idea is to help you realise that situations aren’t hopeless, things will get better, and you are much stronger than you think.