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It's OK to Not Be OK: 4 Ways to Manage Difficult Times

Learn the skills mentally strong people use to manage stressful times.

Key points

  • Many people are struggling with their mental health after the cumulative challenges of the last two years.
  • Techniques drawn from DBT can help reduce emotional vulnerability, thus offering protection against stress and anxiety.
  • Radically accepting what is can help someone focus their energy on the things they can change.

It's been two years since the onset of the COVID-19 pandemic and the world shutting down. And if the pandemic-related ups and downs of the past 24 months weren’t enough, there were also myriad simultaneous socio-political events that occurred over the same time period.

Stressors such as civil unrest, political protest, domestic terrorism, natural disasters, global warming, inflation, and impending (now ongoing) war are unsettling for most people, and some have even argued that they resulted in a kind of collective trauma. On top of that, each of us has had to balance our own personal challenges, including births, deaths, financial issues, health problems, marriage, divorces, and more.

It's little wonder that many are feeling stressed, anxious, worried, and overwhelmed. It's not just the content of the occurrences but their duration that is causing people, even the mentally resilient, to not feel “OK” at times.

What Makes Someone Mentally Resilient?

Mentally resilient people—those who bounce back from setbacks and grow from life's challenges—generally have personality traits that are adaptive and flexible and that demonstrate emotional maturity. They also tend to utilize emotion regulations skills during difficult times to reduce their propensity for emotional vulnerability.

In the field of counseling, we rely on theories—such as those underlying dialectical behavior therapy, or DBT (Linehan, 1993)—to teach individuals the emotion regulation techniques that could help them cope with adverse events. Knowing these skills, and knowing when to use them, could help you regulate your emotions during unsettling times. The techniques outlined below, particularly those drawn from DBT, may help you reduce emotional vulnerability and foster positive emotional states.

What Is DBT?

DBT is an integrative approach originally created to treat patients with borderline personality disorder (BPD), and it's the most used and extensively studied approach for this clinical population (Stoffers et al., 2012). For example, a meta-analysis of five randomized controlled trials demonstrated that DBT was effective at stabilizing and controlling self-destructive behavior—including suicidal and parasuicidal behavior—in people with BPD (Panos et al., 2014).

DBT has also demonstrated efficacy for other psychiatric disorders and mental health concerns, including post-traumatic stress disorder (Harned et al., 2014), depression (Lynch et al., 2007), anxiety, and hopelessness (Lothes, 2014). The hallmark of the theory behind DBT is that emotion regulation and distress tolerance skills can be taught to reduce suffering and decrease mental health symptoms.

4 Techniques to Reduce Emotional Vulnerability

Drawing on theoretical tenets from both DBT and CBT may help you manage stressful times by helping to “check” your emotional mind. Start with the below:

1. Realize you can feel “bad” but be “doing well.”

How you feel is different than how you're doing. One of the most common misconceptions I see in my clients is the belief that it's not “normal” to have good days and bad days. I've heard things like, “I woke up this morning in a funk and I don’t understand why—what's wrong with me?” or “I've had a bad few days, but I don't know what's going on!”

It's unrealistic to expect that you will feel happy and content most or all of the time—especially after the last two years. It's important to realize that one may be feeling sad, anxious, or overwhelmed, but still be “doing well” overall.

What does this mean? From a clinical mental health perspective, having problems in one’s life that are unmanageable often leads to what we call impairments in social and occupational functioning. In contrast, it's normal to feel poorly from time to time but still be able to manage life reasonably well.

When someone is feeling irritable, sad, anxious, or “off,” questions to ask themselves include: “Did I go to work today?” “Did I feed my kids?” “Did I do my homework?" "How am I doing in school?” or “Am I meeting the expectations of my work, my family, and my social circle?”

If the answer is yes to most or all of these questions, that likely means that someone may be feeling poorly but still doing “well.” Of course, if the feelings continue over a duration of time or start to have impacts on these areas, then it may be that seeking mental health care is appropriate.

2. Limit news and social media exposure.

Chronic news exposure may worsen distress. For example, researchers found that people who were exposed to the media daily during an ebola outbreak in 2014 demonstrated poorer functioning and increased distress, compared to those who limited their media intake. Similar studies after the 9/11 attacks found that chronically consuming distressing media was associated with impairments in mental health. Therefore, choosing to limit one's exposure to distressing images and consuming media in manageable doses is vital.

3. Implement PLEASE skills.

Linehan (2015) used the acronym PLEASE to highlight those factors that may increase your emotional vulnerability on a daily basis. Taking stock of these factors each day can help guard against your emotional mind taking over.

  • PL: Have you treated physical illness? Are you attending to your physical health? Are you taking prescribed medications?
  • E: Balanced eating. Are you eating regularly? Eating healthy nutritional foods whenever possible is key.
  • A: Avoiding mood-altering substances. Research suggests that both alcohol and drugs can damage the brain and increase negative mood states.
  • S: Balanced sleep. Adequate amounts of REM sleep restore both the mind and body, especially over time.
  • E: Exercise. Exercise leads to healthier brain states (Amen, 2018), and both outdoor activity and exposure to the sun have other health benefits (such as boosting vitamin D). Some research suggests exercise may have even offered some protection against the omicron variant.

4. Implement radical acceptance.

Linehan also coined a useful technique, known as radical acceptance, that entails accepting reality for what it is—even when we don't want to.

Radical means all the way and completely. Acceptance means that you stop fighting reality because you don’t want to deal with it. Rejecting reality does not change it and only serves to turn temporary pain into ongoing suffering. Therefore, radically accepting those things you cannot change—such as war, civil unrest, or the death of a loved one—may help ease your suffering.

After radically accepting, perhaps you can think of positive actions that are within your control—like making a donation to a worthy cause or engaging in advocacy work. Radical acceptance can help you come to terms with the fact that life is full of both beauty and pain—and that no one moves through life without either. Accepting that life is well worth living and experiencing, even though there are painful moments, is key. You may even grow wiser and stronger along the way.

Originally published on www.drtracyhutchinson.com

References

Holman, E. A., Garfin, D. R., Lubens, P., & Silver, R. C. (2020). Media Exposure to Collective Trauma, Mental Health, and Functioning: Does It Matter What You See? Clinical Psychological Science, 8(1), 111–124. https://doi.org/10.1177/2167702619858300

Linehan, M. M. (1993a). Cognitive behavioral therapy of borderline personality disorder. New York, NY: Guilford Press.

Lothes, J. & Mochrie, K. (2014). The Effects of a DBT Informed Partial Hospital Program on: Depression,Anxiety, Hopelessness, and Degree of Suffering. Journal of Psychology and Psychotherapy. DOI:10.4172/2161-0487.1000144

Panos, P., Jackson, J., Hasan, O., & Panos, A. (2014), Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). Research on Social Work Practice 24(2), 213-223. DOI:10.1177/1049731513503047

Stoffers, J. M., Völlm, B. A., Rucker, G., Timmer, A., Huband, N., and Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database Syst. Rev. 8:CD005652. doi: 10.1002/14651858.CD005652.pub2

Thompson, R. R., Jones, N. M., Holman, E. A., & Silver, R. C. (2019). Media exposure to mass violence events can fuel a cycle of distress. Science Advances, 5(4), eaav3502. https://doi.org/10.1126/sciadv.aav3502

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