Dr Emily - Overcome With Overwhelm?

0:00What I'd really like to explore today is how we survive when you're really overwhelmed and when distress is very high. What do you guys think overwhelm is? It's too much for me to manage. Yeah, I feel like my intellect kind of shuts down. Too many people wanting too much of me at a certain time and then the feeling of wanting to call mum and dad. In essence, it's like when the system is overloaded. You know, if you imagine basically like a window, inside this window is everything that you can tolerate.

0:29But when the demands of a situation pushes out to the windowsill, we now move into overwhelm. The larger the window, the more resilience I can experience. So you grow the window. Grow the window, yeah. Okay, so what do we do when we're outside of our window? Shall I dive in? Yes. Okay. Give us the tools. Yeah, all right. Quick, is anyone here a doctor? Yes. Her name is Dr. Emily, and she's a psychologist. Please welcome to The Imperfects, our very own psychologist.

1:04And we are fresh off a lovely lunch together. We all went out for lunch. Em, you were very impressed with your meal. It was good. Yeah. Just good? Quite good. Very good. It was very good. It was very large. What did you have again? A pumpkin salad. Yeah. Great. Yeah. If M were a genre of music, what would she be? Oh, great question. Industrial metal? Or... Like... I don't know what the genre is, but I know the artist. Like there's this guy, Olaf Arnold.

1:45It's like Scandinavian kind of peaceful. Like ambient classical. Ambient, beautiful music that makes you feel nice. That's very good. Thank you. Perfect. Okay. Great. All right. Small talk. Check. Dr M, as some people know, as most people know, every month you drop on by, pick out an episode from the past and expand on it in a clinical way because you're a bloody psychologist. Today, what episode are you flashing back to? I would like to flash back to Mick Fanning's.

2:21Oh, Mick Fanning. Pretty incredible story. I often flashback to Mick Fanning's episode in my mind. Yeah? Yeah, I just think about the episode. No, the episode, just him. Oh, yeah. Just him. Yeah. Just him. Yeah. So, Em. So, what particularly about Mick Fanning, other than how great of a guy he is, what did you want to talk about in particular? Yeah. Well, so obviously there were so many different themes in what he was sharing, but one of them to me related to how we survive crisis.

3:00And that in clinical terms is often referred to as distress tolerance. And so I will play a little grab, but what I'd really like to explore today is how we survive when distress is really high. Yeah. Because this, before we play the clip, I mean, for those who haven't heard the Mick Fanning episode, it was really surprising to hear his story because I think most people would know Mick Fanning as one of the world's greatest ever surfers and famously had an incident with a shark during a, during competition.

3:32But his personal life and his upbringing and stuff are things that I was really, really surprised to hear about and quite traumatic for him. Yeah. So let's play. Any context for the clip? It's in reference to the losses that he'd experienced and this kind of choice that he made around how to deal with them. Yeah, okay, great. You know, if I take the bad path or the dark path, where's that going to lead me to? Is that going to lead me to alienating myself?

4:02Is that leading me to alcohol or drug depression? Is that going to lead me to doing something worse? Or look at the good path and say, find strength, better yourself, try and learn from mistakes, and just keep, as we always said at the start, just do your best. And, yeah, looking at those two pictures, this one didn't look great to me. And so I was like, I'm just going to keep my best. And, yeah. It's not going to be like, you know, you walk through a door and it's green fields and stuff like that.

4:46It's more, it's going to take work. And with anything, you've got to work hard at getting through these situations and... And there's definitely been times where I couldn't get out of bed. There's definitely been times where I was so deep and dark in depression where I would close up the room, didn't want to see anyone. But over the years, I've sort of been able to – almost put a label on it. Like at the end of 2015, like I had the shark attack, I had a marriage breakdown and then my brother Peter passed away at the end of the year.

5:32And a picture that came to me was like imagine like a giant barrel, like a wooden keg sort of thing. And, you know, if it's filled with water, you're having a lot of fun. I looked in mine at the end of that year and it was just bone dry. Like there was no light in it. There was no life. It was just empty. And I made a decision that I'm going to do things for me, do things that make me happy and do things that I want to do to fill that barrel back up.

6:09Mm-hmm. And it took me a good couple of years. Yeah. But, yeah, the barrel's pretty bloody full. Beautifully said. Wow. Pretty powerful stuff. Yeah. I mean, most obviously that was a very powerful episode and so highlighting around the fact that, you know, for all of us, we will experience, you know, great suffering and points in life that are so challenging to our sense of self, our sense of wellbeing and our sense of safety. And so I thought that it might be really helpful to have a look from a clinical point of view, you know, how we go about surviving at those crisis points, you know, when you're really overwhelmed and when distress is very high.

7:02Jeez, that is very, very helpful. That's scary. Yeah, yeah, it is. And you'd be hard-pressed not to feel a great deal of fear or sadness or struggle when you listen to that episode, for example, too. Yeah. That, you know, here we are, these humans with this capacity to experience such significant loss and such significant suffering, but at the same time we also have a life that's worth living here as well. Yeah. It's a thing that will happen to all of us at some point if it hasn't already, a moment where your world gets turned upside down and then the thought of continuing on is like, it's like an improbable, impossible task.

7:45But you have to… Yes, and I think it's interesting because a lot of people will say to people that are going through something really difficult, I don't know how you've done it. And so often the people that are going through it are saying, what choice did I have? But I will say that in the clinical work that there are ways that we cope that can make things better and there are also ways that we cope that can make things worse. And so obviously I wanted to talk today about some of the skills that we can practice and learn that helps us get through a crisis or helps us get through a really difficult time without making things worse.

8:29Right. So like alcohol, all those things. Yes. So when I say like making things worse, it would be like basically being extremely reactive to what's happening and that in that space of reactivity that you might drink, you might abuse drugs, you might self-harm, you may attempt suicide, you could lash out and be very aggressive and angry or violent, or you could completely withdraw and shut down. Now, all of those responses, I want to emphasize, again, are always very understandable.

9:01So when distress is very high, our automatic reaction is in some ways to get rid of this pain. So very understandable that we will have this kind of response. But there are absolutely ways in which we can learn to ride through that, I don't use this metaphor, to ride through the wave, of immense pain and discomfort to get to a place where I've now grown my resilience in some ways. And doing that, I guess, doing that must take practice. I mean, some people are better at it than others because I know that whenever I've – and I've never faced that level of sort of trauma and heartache that Mick has – But, you know, in times where I've really been going through it and I've got that kind of pain in my body and I just, as you described, I just want it out.

9:54I just want to get me out of this situation. I really struggle, even though I know the tools and Jan might remind me, you know, try this. I just don't want to do anything. It's almost like I do want to feel better, but I don't want to do anything to get better. It's like I'm angry at the tools or something like that. Yeah, I think there can be a very big obstacle. There's this feeling, basically like this feeling tone that's here brings with it an urge.

10:24This is actually where we can talk about what's called doing the opposite action or action urges. So if you think about our primary emotions, all emotions bring with them an urge to act and behave in a certain way. So if you think about like the emotion of happiness, happiness. When you feel happy, what urge does it bring with it? What does it make you want to do? Connecting mainly. Yeah. And so it promotes pro-social action usually. If you think about anxiety, anxiety brings with it an action urge, which would typically be what do you think?

11:02Like go to bed. Yeah. So usually like a flight response often. So withdrawing, avoiding, something like that. That's the action urge. When we think about sadness, the action urge often is a shutdown response. So staying in bed, listening to sad music, engaging in something that feels really consistent with the emotion. Yeah. Again, that's an action urge. When we can go through all of the different emotions and they will all bring with them some kind of urge to behave in a certain way.

11:34What about, I know we won't go through all of them, but what about anger? Like when you're really angry? Yeah, so anger primarily promotes a fight response. Like if we really tune into it so often, but it depends upon your learning history. So I know that whole thing. So just in a really basic way, you know, you feel angry, it prepares the body. So the body's mobilised with all of this adrenaline, cortisol, and other hormones that are kind of surging through the body.

12:02And in essence, it's promoting some kind of fight response. But if you have been socialized as a child, for example, to not be angry, to not express anger, then we can actually have an internalized response that might be something like a ruminative cycle internally. Or it can actually be that it's even really hard to hold anger. It actually moves into sadness. So some people that may have had experiences in childhood where anger was not allowed, it was not expressed, and it was like a bad feeling to have, they may have a lot of difficulty actually feeling angry and that it may be an emotion that they don't really kind of even relate to.

12:51So how does it, if they can't feel, if they're angry about something, but they can't feel anger, how does that- They may not notice that they feel angry about something. They may notice they feel sad. Ah, okay. But in some of, this is kind of slightly off track, but in some of the work for people that have that experience, it's actually like, how do you bring them up to feel the anger? Because the anger has a really important function. And that function would be that it points to when something's been violated for you and that the action there would be to stand up for yourself.

13:21Yeah. But if I only feel sadness, then I might withdraw and I might not actually take action when really it might be needed. Right. Yeah. So all emotions bring with it information. It's how we tune into them and what we do with them that's really important. Yeah. Brilliant. I've been thinking about that a lot recently, just with our kids and trying to talk about emotions. And that thing that all emotions are information, I just have this picture in my head of like a cartoon character coming out with a file.

13:50Like it's got the emotion on the front and not giving it to him. You've got to sift through it all. Like there's a lot of information in this. You need to go through it. And that's kind of like the analogy I've been trying to present to my kids but it makes no sense to them. But it does to me. That's probably all that is important at the moment too. Probably the problem is you're talking to them about a filing cabinet. No one uses those anymore. What's paper, Dad?

14:12So, like, when we think about when life feels distressing, I want to mention that there's obviously a really big range of what is going to elicit a feeling basically of overwhelm. So that's kind of what we're looking at here is any time that you're feeling really overwhelmed. It's going to vary between individuals. It's also going to vary across your lifetime. So if we just start by even looking at what is overwhelm, Sometimes I will, you know, we'll even hear people say like, how are you feeling?

14:40Overwhelmed. What do you guys think is the, what overwhelm is? How would you describe it? I mean, like for me, it's too much for me to manage. It's like the emotions are too – I don't know what to do right now and it's the stress of not having a solve for this problem. Yeah. I feel like – Yeah, I feel like my intellect kind of shuts down. Like I feel raw emotion and catastrophe and my ability to cope, my perception of my ability to cope disappears.

15:22Yeah, that's great. Yeah. Mm-hmm. My version is too many people wanting too much of me at a certain time and then the feeling of wanting to call mum and dad to vent. Yeah. So it's a good, it's, it's good just, I think, even to name and to notice when is it that overwhelm is here. Overwhelm is not one single emotion. It's a, it's usually a combination of many, but in essence, it's like when the system is overloaded and that, um, yeah. Like in clinical practice, we often might use the term window of tolerance.

15:54And you may be familiar with what that looks and feels like. But in essence, is that the demands of the situation or my internal situation have exceeded my window of tolerance. So they've exceeded my ability or my perceived ability to cope. So the notion of a window of tolerance, it's used a lot in trauma work. It was really kind of popularised by Dan Siegel, who is a psychiatrist. And, you know, if you imagine basically like a window and you've got the top end of the window and the bottom end of the window.

16:28So inside this window is everything that you can tolerate, that you can be balanced, calm. You can handle some stress and you can still function relatively effectively. But when the demands of a situation or our experience pushes out to the windowsill, we now move into overwhelm. It's like, I cannot tolerate this in this way anymore. And so we get two responses. If you imagine at the top end of the window, when the system is overloaded, when we're overwhelmed, we move into what's called hyperarousal.

17:11So that's when we get like a really big anxious response. Panic, big physiological symptoms. Like heart racing. Yeah, yeah. So really, in essence, what we've got here is the activation of the fight or flight response, which is a major physiological change in the body. So there's that response, okay? At the bottom of the window, though, is what's called hypoarousal, and that's when we get an activation of a different part of the nervous system that actually moves us down into numbness and shutdown.

17:46This is where we might have people collapsing physically They might be dissociating. They might be withdrawing and sleeping. It kind of looks like depression sometimes. So it's these two extremes of the window. These two ends of the spectrum represent a significant sense of being overwhelmed. And the work that we want to do is see if we can expand our window of tolerance so there's more space in there for us to be able to deal with the life's challenges, for example.

18:18So you grow the window. Grow the window. Yeah. And so really what we're looking at there is resiliency, is that the larger the window, the more resilience I can experience. Yeah. So a little renovation. Yeah. Yep. Having said this, I do really want to emphasize that it's very much valid and okay that we will move into hypo and hyperarousal. Very normal part of our evolutionary history, but we don't want to stay there too long. Yeah. Right, so we want to come back into the window.

18:48I reckon I was hypo last year. Mm-hmm. Full hypo. Yeah. Yeah, yeah. And what's that been like? In August, I was full hypo. Yeah. Yeah, awful. Awful. Yeah. To be someone who does a lot of stuff to find it hard to get out of bed is such a, like, that felt very confronting. My kids were so confused. Why are you still in bed? It is. That is. It's so strange to hear, to imagine that you not being able to go to bed. Yeah. It's a strange. It's, yeah, I've had it once before.

19:24But, yeah, to have it again and to, oh, I had to say to my kids, it's called hypoarousal. I'm outside my window. Yeah, exactly. Yeah. So it is, there are times when we will find ourselves in, you know, at either ends of the spectrum and there's nothing wrong with that. Again, to me, it's always, you know, bringing this compassionate understanding as to, okay, so here I am. How have I got here? And how do I get myself back? And, you know, sometimes like in polyvagal theory, we would talk about this idea of like coming back to home base, so coming back to safety.

20:02And it's from this place of feeling safe enough that we're then able to perform and live life well. When you say, just to quickly recap, to come back to home base, what do you mean by that? So home base is the place that you feel calm, safe, engaged, connected, present. That's like mentally you mean. Yeah. So how do we come home to safety rather than how do we run away to safety or how do we shut down so I don't feel anything anymore. Yeah. Okay.

20:30So if we have this frame of this window of tolerance, obviously we want to be able to bring awareness to when we're tipping into either end. But really what I want to have a look at today is, okay, so what do we do when we're there? What do we do when we're outside of our window? And probably one of the most evidence-based approaches for crisis survival skills is based on dialectical behaviour therapy or DBT. And let me be clear that there are very many other approaches as well, which may be equally as helpful.

21:03This is the one that I will often use and I think can be very, very helpful. It's based on, I've mentioned this in the past, but it's based upon initially the treatment of borderline personality disorder. And that disorder is characterized by what probably what we'd say is like a lot of emotional instability. So emotions can be very high and very distressing and can often prompt really unhelpful behaviours like self-harming, for example, or more reactivity in your relationships.

21:35So it was originally designed for the treatment of that, but it has enormous applicability to all of us. And it can be a really useful kind of set of tools and techniques to help us manage when things get really overwhelming. Yeah. So shall I dive in? Yes. Okay. Give us the tools. Yeah. All right. I love how Em is like so good at just pausing to give us a chance to hear this. to say something, but then we're like, no, no, just tools, please. Yeah.

22:00It's like, it's like at this point I'm at the drive-through window and the person's like talking to me, holding the bag of like my food. It's like, yeah, no, this is great, but I want the burger. Like I'm really, really hungry for the good bit. Yeah. Okay. Yeah. So the first thing is. Not to say that everything's been boring or anything. I'm just doing like the set up. Yeah. The first thing is that we need to be able to in some ways be able to recognize how distressed I am.

22:26And so often using this technique, we'd actually invite you to rate how distressed you feel. And we might get you to rate it out of five. So five out of five, I'm at my maximum. I'm absolutely overwhelmed in a state of panic, feeling deeply distressed. And then obviously, you know, one would be I'm feeling safe and calm. Now, the more distressed we feel, the less able we are to use our cognitive capacities. Yeah. Much better way of saying what I was trying to talk about before.

22:57Yes. Yeah. So this is really key that we need to be able to know and practice these things when we're feeling calm for a start. So we want to have this like in our toolbox to be able to pull out when distress is really high. And it's really important that we know that we cannot rely on our rational, higher order, executive functioning brain to be able to help us when distress is very, very high. It's not online. We're really functioning from the threat center of the brain.

23:29So the amygdala and the limbic system. Okay. That system, its goal is to keep you alive. It does not care for strategies at that time. Right? Okay. So when you know, if like let's say you're at a three to a five, Okay. So a three to a five level of distress, we need to implement some strategies quickly and we need to focus them a lot on the body. So if we think that the window of tolerance really is all based upon a physiological response, it makes sense that we then want to look at the body first to change the state of the body in order to then go and implement the more advanced techniques.

24:13Yeah. Okay. Is that making sense? Absolutely. Okay. So the more distressed you are, this is also important, the more distressed you are, the more things you're going to have to do to bring you back into some kind of regulation. The more tools you're going to have to reach for. Yeah. So, like, for example, it might not be uncommon that I might make a suggestion of one technique and they, you know, someone might come back and say, Emily, I tried this and like it just really didn't do anything.

24:40And then the question might be, well, you know, how distressed were you at that moment? And they were like, I'm maxing out. I was like, okay, so one is not enough. One skill there is not enough. To really kind of what we're trying to do is bring you to a point where you can implement other strategies that are going to be helpful. Yeah. Kind of like really bringing you back more into like sitting on the windowsill rather than being way out of the window.

25:05Yeah. To put it in a way that like a bloke like me can understand, it's almost like there's a big reno job to do. And God, it's a real mess in there. There's like the wall's fallen down, the door's come off the bloody hinge, and I'm going to need more than a screwdriver, I'll tell you right now. I'm going to need the screwdriver, I'm going to need the drill, I'm going to need the level. I'm going to bring all the tools out of the core. Yeah, I need the level.

25:28Yeah, totally fine without it. So, yeah, I hear you, Dr. M. Yeah, you need more tools. You need more tools. The more of a mess it is. Exactly. Yeah, correct. To continue that analogy. Go on, mate. Do you need to, are you saying that the tools can work when the house is falling down or you need to be getting in there before the house is falling down? That is a good question. Well, you know, in an ideal world, we would be able to... We can kind of differentiate this basically between what are called cold skills and hot skills.

26:00Hot skills are for very heightened distress. And the cold skills are the kinds of things that help us probably not get to the point of needing the hot skills. Yeah. But life is uncertain. Life is going to throw stuff at you that you can't prepare for. Yeah. So we want to be able to practice the skills. And we also want to use more of them when distress is really high. Yeah. Because there's kind of two parts there. Yeah. So I wanted to start with, you will know from a previous episode that I've done that DBT is a fan of acronyms.

26:33Oh, yeah. So I have another good one for you. And the acronym is TIP, T-I-P-P. And before I go into it, I'm just going to put a big disclaimer in here. Any of these strategies that I mentioned are general, I feel like I'm going to go on a radio show, it's general advice. I do really encourage you because it's using the body to seek medical advice around this, particularly because one of the strategies involves cold water. And obviously, if you have any conditions that are going to be exacerbated by the use of cold water, then please seek your own attention around that.

27:07If pain persists. Yeah. Yeah, yeah, yeah. But what's tip? Okay. So tip is four separate skills, four separate strategies to use, and they are used once again for crisis moments. They're not going to make your life happier. They're going to help you get through a period of time without the situation becoming worse. Yeah, really good clarification. So the T is temperature. Now, if you were to Google this strategy, there are many different ways in which you can use this.

27:40But one of the most effective involves using a basin of water. So let's just say things are really distressed, like you're feeling really distressed. So the tea is you go into the bathroom, you fill the basin with cold water. If you wanted to, you could put some ice cubes in there. You take a breath, you hold your breath, and you submerge your head into the sink. Your whole head. And you hold it there until you safely can come up again. And you do that three, maybe three to four times.

28:14Okay. So once again, please attend to medical advice here. But this practice here is so swiftly changes the state of the body. And this is the head. Head goes in. Your face goes in. You don't have to get your all in back. But your face goes in to the basin. of cold water and it's the holding of the breath too that's really integral. Yeah. So there's a whole physiological change that is occurring with the breath and with the temperature. This is for those very overwhelming moments where you're in danger of doing something that could make it worse or that you just cannot be with this feeling anymore.

28:58Yeah. Okay. So the holding of the breath and the submerging the face in the water three to four times. Okay. Yeah. And three, like as in like how long do you go? Like only a couple of seconds I'm assuming? Well, whatever feels safe enough for you, right? So you take a breath, maybe it's four counts, you hold and then you come up again. You take another breath, you hold it and then you go down again. Straight back in, okay. Okay. Great. So what we're getting there is a very swift physiological change.

29:27So often it might be, for example, that you're sitting in a chair the sympathetic nervous system activation, which is fight or flight, and that this would kind of bring us back down into parasympathetic. Now, this change may be enough if you're not super, super distressed. But it may not be enough if you are really. But what it will do is offer a very quick circuit breaker. Yeah. Okay. So it's not going to change, for example, it's not going to change the heartbreak that you're experiencing if someone has ended a relationship.

30:01Yeah. But it will help you get through to the next moment. Yeah. So that's the T, temperature. Yeah. The I is intense exercise. And that... Really, like the recommendation generally is around 20 minutes of exercise that elevates your heart. Yeah. Okay. And sorry to jump in, but I'm assuming that to do the T first is somewhat important before the I. Because to go straight to it, I don't think I could possibly go to intense exercise before. first because if I'm so overwhelmed, it's like there's no way you're getting me doing that.

30:41Yeah. But if the circuit break at first with the tape. Sorry, are you saying you do all these four things in a row or is this just like you could do this one or you could do that or... Well, there isn't a strict kind of criteria around it, but I think it requires us also being able to tune into what is going to work for us. The temperature can be very good, I will be honest. Yeah. Particularly when there's like self-harming urges showing up, I think that can be a really good one.

31:06But if you know, for example, Ryan, if you know that like there's no way I'm going to go and intensely exercise when I feel this, that you might need that. Yeah. There is a suggestion that you can do them in order and that you can stop when you're feeling okay enough. You may not need to use all four techniques, for example. Tip might be fine as opposed to tip up. Yes, exactly. Or you may notice that let's just say the intense exercise is your thing and you get to the end of that 20 minutes and you're like, I'm okay enough.

31:37I don't need to go and do the others. Okay. So, again, it requires some attunement to like what do I need? The intense exercise, yes, 20 minutes is the recommended one, that kind of idea, and that we're really exercising at a point where we can't hold a conversation. So definitely that we're kind of out of breath, we're elevating our heart rate. Now, that intense exercise can look different. So you could, for example, do like maybe 10 minutes of high intensity interval training and that may be enough.

32:10You could do burpees, you could do skipping, you could do boxing. What is not- Yes, exactly. Anything that is really going to get you out of breath. What is not kind of recommended at this point is something like walking, It's not enough. And sometimes it will keep you trapped in this kind of cycle of rumination and engagement in like getting very hooked into the thinking. Yeah. I walk pretty fast but, yeah, I get your point. So really kind of what we're doing there is utilising – the mobilized response in the body.

32:44So the body is ready to fight or flee. So we use that response. To sort of work off the adrenaline. Yes, exactly. And I mentioned a long time ago, I think in an episode on stress and burnout, that there are some authors that have written a book called Burnout, Emily and Amelia Nagowski, and they talk about this idea that the exercise actually completes the stress response naturally. So we're really using this mobilized energy to tell the body that I am now safe once I finish.

33:18And that episode is Hall of Fame episode. We'll link to it in the show notes. Yeah. So that's, I mean, this exercise, again, this is another body. We're using the body here to change the state of the mind. Yeah. So that's the I, but make it work for you. So it doesn't have to be that you go sprinting. It can be generally that you're going to be doing like skipping at home, for example, or you've got a punching bag or actually having said this. When you're doing the intense exercise, be careful if there's a big anger response that's showing up and to not choose something that is going to exacerbate the feeling of anger.

33:56So boxing, as an example, you could continue to get really fused and hooked into this angry feeling. And now we're just exacerbating it by punching something, for example. Interesting. So we might want to be mindful in that choice around what we want to do. Okay. Yep. So that's the I. Yeah. I would recommend running a lap of an Astrac as fast as you can. It'll take, well, probably a bit more than a minute. Yeah. Tell us your time. It'll take you, you know, 40 seconds.

34:31It is. Like nothing destroys you more than that. And it takes a certain amount of time to be in a fast track. Yeah. Like if you've got an oval nearby, go to the oval and run as fast as you can and stretch and then run as fast as you can around the oval. Yeah. And how long would it take? How long would it take you? It doesn't matter. Doesn't it? No, no. Just, yeah. Yeah. So, I think it's important with the first two, I think it's important that we have some variations to them so that we can use them if, for example, we're not at home.

35:09So I will mention just briefly that with the temperature – So you're not at home, you don't have a sink. What you can do is maybe you have access to a water bottle that's cold. You place the water bottle on your forehead and you put your forehead between your knees and you hold your breath. So we're getting a similar kind of response. If you've got an ice pack, you can put it on your forehead or over your eyes, hold your breath, put your head between your knees.

35:38Same thing, mimicking the same response as the basin. Gotcha. So it's important that you're leaning over. Yeah, and there is a whole neurophysiology part to this that is reflective of what's called the dive response. And I'm not well versed enough in this to explain the actual mechanics. Is this an acronym within the acronym? No. So, you know when you go to the beach and you dive underwater? Yeah, good feeling. And your head goes first? Your head is above your heart and your lungs?

36:09What's that? Ryan doesn't do that. You don't go under? What? Remember you don't like doing that? Diving head first into the waves? Oh, yeah. Just don't want to hit the ground. Yeah. There's no real like particular fear. It's just like, yeah, I don't know if we'll cut this out. But yeah, it's true. I don't like doing that. No. Okay. Well, you're missing out because when you dive down, we get this kind of same response. Told you. Yeah. Great. Yeah.

36:39That's good. Yeah. And so when you emerge, do you not feel refreshed? I do. Yeah. And it's not the same. So hang on. Are we talking about not putting your hands first? You put your head first without your hands first? No. Oh, you put your hands first. That's what he's talking about. No, you just, when we go to the beach, you're like, no, I don't dive headfirst into the water because you saw a guy at your beach come actually to hit the sand. Oh, yes.

36:59He was in a lot of distress. Yes, but, you know, well, I mean, this is definitely a divergence, but he dove like a, did like a dolphin dive. Oh, that's so good. Just for fun. You know, he just wasn't thinking. Oh, okay. Yeah, yeah. So if your hands are first, you will dive. Yep, for the record. Okay. For the record. Sorry. If anyone's, anything else you want to know about my swimming? Do's and don'ts. Will's and won'ts. Next time that you do dive in, when you dive in headfirst with your hands out, you will have this similar kind of response because when you come back, when you emerge from the water, you always feel refreshed.

37:43Yeah. It feels very cleansing in some ways. It's the same experience that we're mimicking when we're doing the basin. So the head is below the heart and the lungs in essence. And again, there is some physiology to this that I am not smart enough to explain. But it is really based on our nervous system. And it's absolutely grounded in some good research. Are you guys able to get your head between your knees? Were you just trying? Yeah. I thought I saw your head going there.

38:10Yeah. I'm not sure I'll be able to. I've never tried. Yeah, I don't think I – not directly between, but – As long as I can. Just downwards, down. Yeah, I've never – why would I put my head down there? Why would I possibly put my head down there? What am I even trying to check? Don't worry, it doesn't matter. Anyway. Oh, no. So that's a variation that you – Got all my ribs. That you can do. Okay, we'll cut that out, we'll cut that out, we'll cut that out.

38:39No, it's a step too far. Okay. There are obviously a number of variations that you can use that are using temperature at a very, very easy way. If you're feeling overwhelmed and you're out, go into a bathroom and splash cold water on your face. Yeah. Yeah, similar thing, really swift, very easy to do. Yeah. With the intense exercise, let's just say you are at work. Go outside, do some star jumps. Yeah. So something that is going to really quickly get your heart rate elevated.

39:08Yeah. Running on the spot. It doesn't need to be that you have access to gym clothes and a gym and an oval or whatever. Yeah. So you make this work for you. Yeah, that's really good because it's like I think sometimes I will do nothing because I can't do everything. Yes, exactly. Is that really something is better than nothing and it's going to shift the dial just a little bit. And then when you do get home or when you do get access to whatever you need, then you can do that properly.

39:35Yeah. But we're just talking about really shifting the needle back as much as we can to get us to a place of being okay. Yeah. Okay. So that's the T and that's the I, temperature, intense exercise. The first P is called progressive muscle relaxation. Knew it. Yeah. And so this practice is readily available everywhere on the internet and that will probably be on all of the apps that you might use for meditation practice. It's not a meditation. It's a very active way of changing the state of the body.

40:12Okay. I could do a mini version now if you want me to. Yeah, please. Yeah, okay. So if you're driving, please don't close your eyes and maybe practice this another time. Okay. So when you do this at home or when you get access to this ordinarily, that we could do this for up to, you know, 20, 30 minutes if we want to. This is a micro version, so it'll be five minutes at most. Yeah. Okay. All right. So whenever you're ready, if you wanted to close your eyes.

40:44Just taking a few slow grounding breaths here. And seeing if you can direct the focus of the attention all the way down to the feet. And as you do that, I want you to clench all the muscles in the feet and the toes. And so hold the tension here, holding it. And then the next out-breath, letting go. So letting the feet and the toes fully relax. Now shifting the attention to the calves and tightening the calf muscles, if that feels safe to do. Holding the tension, holding it here and letting go.

41:30Fully relaxing, shifting up to the thighs and clenching the quad muscles here. And letting go. coming into the pelvic region and the buttocks and clenching this part of the body and gently letting go. Coming now into the abdominal region and clenching the tummy muscles here. You're holding and letting go. Coming up now into the chest area and clenching the muscles And letting go. Moving down now into the forearms and all the way out to the hands and the fingers and tightening the hands.

42:30Letting go. Up into the biceps and the triceps, tightening the muscles here. Letting go. Coming up into the shoulders, so you might like to put the shoulders up towards the ears. And letting go. Coming now into the face. And so you can just do the face all at once and just holding a lot of tightness and tension in the face when this is screwing up the nose and the eyes. And letting go. And now taking one slow in breath. And one long, slow out breath of feeling this full sense of the body letting go.

43:17And whenever you're ready, coming back to the room. Okay. How was that? Whose scrunched up face was funniest? I could tell you because I couldn't help but look. Did you? It would be quite funny footage to look back on. YouTube's going to be great. Yeah. So that's the progressive muscle relaxation. I'm curious, what did you notice? Well, I guess it felt like meditative in like a sort of grounding sort of – it makes you present, I guess. Yep. Because you're focusing on different things.

43:57A little bit conscious that my pec muscles wouldn't flex that much. That was a bit disappointing. I was thinking about Hugh. I was like, Hugh's going to look really good in this one. I was a bit distracted then. But otherwise, yeah, it was really, really nice, yeah. Yeah, so this is a really, really brief version. But what we're kind of exposing ourselves to is what it feels like to hold tension and that this is often an experience that's happening when we're feeling very overwhelmed is that we are unconsciously and automatically contracting the muscles and...

44:27And we don't notice that we're actually holding. And so, for example, you might notice a lot of tightness in your jaw. You don't, you're not doing this on purpose. Some people might clench their tummy or their thigh muscles. And then we're doing this so habitually that we actually forget. But the body is sitting in this stress response that is occurring. So... I've actually noticed in the last couple of months that I've been really sore and I've thought recently, maybe it's because I'm tense and I keep noticing that my shoulders are tense and I keep dropping them.

45:03And it's amazing. And also, often when I do the Peloton bike exercises, often the instructors say, okay, just unclench your jaw. And they always know that I'm doing it. It's like, how did you know I was doing that? Yeah, yeah. So it's kind of teaching us what it feels like to hold tension. And then really importantly, it's teaching us and exposing us to what it feels like to let go. So the letting go is actually a practice of emotion regulation. Yeah.

45:31So we're letting go of this holding and this bracing that's here. And that is, again, shifting the state of the body. It's probably related, a bit different, but I've really gotten into breath work this year and love it. And I know you do as well, Q. But my favorite part is when you get to do like a real clench at the end, like you've been doing breath work and you tighten up as many muscles as you can and then release on an exhale. It feels like I'm a whole new person after that.

46:02Yeah. So there's actually, there's a version of the progressive muscle relaxation that you can do that's actually called the Hulk. And look, I won't do it here. Is that why you tear through a city and knock over buildings? But it's this idea like if you don't have time or maybe you're at work or you don't have time to do the whole progressive muscle relaxation is that you literally stand like the Hulk and you clench all of your muscles all at once and you hold it all and then you relax.

46:32Yeah. God, that would be an embarrassing one for someone to walk in on. And you might do that three times, for example. Yeah. But it's again about using this body here to change the state of our emotional experience. Yeah. And that's a very quick way of doing that. Great. Awesome. That's the first P. The second P is paced breathing. So the reason why it's at the end is that you may not be okay enough to do paced breathing properly. as your first port of call if distress is really high.

47:07But maybe you are. But I think it's helpful to have it at the end of the acronym because you might need to do those other three skills before you move into paced breathing. Sometimes when we tune into the breath, it can actually be too overwhelming. Yeah. But paced breathing basically is referring to Diaphragmatic breathing or breathing that is allowing us to have a calm, regulated response. I mean, when we talk about breath work, there are so many different incarnations of how you could do paced breathing.

47:40Some of the very common ones would be box breathing. So you guys are familiar with box breathing? Yeah. I don't know. So imagine the shape of a box. You breathe in for four, you hold for four. Oh, yes, I do. You breathe out for four, you hold for four. And we just do this. So it becomes very regulating having this very timed breath. So that's one way. We can also do a different pace breathing that involves having a longer out breath. So as we know from in the nervous system that it's actually the out breath that is activating our parasympathetic nervous system.

48:21So it's really helpful to have longer out breaths because that's what activates the slowing down part. Whenever you're doing these breathing things, should I always be in through the nose, out through the mouth or does it not matter? Yeah. There's so many different instructions around that, to be honest. Okay. Yes, I think you can do in through the nose and out through the mouth, but there are other suggestions that say do it all through the nose.

48:45There are other people that say do it all through the mouth. So I think do what feels okay enough for you. Mm-hmm. But certainly when we have a longer in-breath than the out-breath, that will more likely trip us into hyperventilation or feeling more anxious. Mm-hmm. Physiologically, I'll tell you why that happens. So when we're in a resting state, we have input from the sympathetic nervous system, which is fight or flight, and the parasympathetic, which is rest and digest.

49:19So in a normal moment, like right now, I'm getting system input from both. So sympathetic nervous system is like the accelerator of a car. When I breathe in, the accelerator goes on. When I breathe out, the brake comes on. So we can see this through our heart rate. So for example, actually we might just do this now. If you want to, just finding your heart rate, if you can. And I just want you just to take one long slow in breath and then one long slow out breath and just observe what's happening with the heart rate.

50:06Okay, what do you notice? It's actually quite dramatic. It slowed down a bit. Yeah. Did it? Yeah. On the out. Yes. I'm watching it. I might watch. It's unbelievable. But it really accelerated as I was breathing in. Yeah. And so I actually find this so informative and such a powerful really biofeedback is that we see on the in-breath, your heart will elevate. Here we have sympathetic arousal, right? And then the brake comes on of the parasympathetic, it slows our heart rate down.

50:37So we're getting kind of this constant input, sympathetic, parasympathetic, sympathetic, parasympathetic. When we're getting overwhelmed and it's taking us into hyperarousal, we're getting too much accelerator and not enough brake input. So when we're doing paced breathing, we're bringing the brake on more and taking our foot off the accelerator. Yeah. I've been experimenting with trying something and I don't know if I should be with a child. But when my toddler is really distressed and losing it and definitely overwhelmed, I've been trying something recently that's worked pretty well.

51:15I'll get him away from the situation and then say let's have a competition to see who can take the biggest breath we can and then hold our breath for as long as we can. And I've been really surprised at how dramatically and quickly it gets him to a point where I can communicate with him again. Yeah, that's so cool. Yeah, it works because he's a little bit competitive. It works really well to play into that. Yeah. But I haven't really been thinking about the out breath.

51:41Maybe I need to incorporate something now for like, and now like who can blow it out like the longest, like who can extend that the longest possible. Absolutely. We can use that like as the dragon breath. So like the breathing out of dragon fire, that's quite a good one too. Okay. Yeah. Right. Yeah. And it shocked me. I was like, I'll try it once. And it really blew my mind that it changed his state completely. Yeah. So we're just looking really for these little changes here to bring us back online.

52:09So that's the tip method. And there are four skills in there. Temperature, intense training, intense exercise, PMR. Progressive muscle relaxation. Progressive muscle relaxation and... Paced breathing. Yeah, exactly. Paced breathing. Yeah, yeah. So you can go and Google this. There are worksheets and handouts on this everywhere across the internet and they'll give you other options there that you can use as well. So that's a really well evidence-based approach to like crisis in the moment.

52:44What can I do to bring myself slightly back into the window? Yeah. It's so liberating, I think, to hear that, There's something because the experience of being overwhelmed feels like there's nothing you can do. It's so liberating to know that there's just like there's things you can do to your body that are physical and concrete in that moment. It's like it feels counterintuitive or something, but it's awesome. Yeah. I think it's a really helpful thing to be just holding awareness of.

53:15And even if there's one thing that you use and maybe it tips you slightly into thinking. feeling slightly more okay. It's from that place that we can then make the better choices for ourselves as well. Now, this is like the tip method is just one set of crisis skills and there are a multitude of others. I find that's the most helpful for those really, really heightened points in time. The things like the cold skills that I kind of vaguely mentioned earlier, they would be things like being able to practice mindfulness meditation, being able to journal, being able to go for a walk, being in nature.

53:52So those things we use to really help us stay in the window. But they may not be as effective when a crisis is here. Yeah. We may get to them once we've used our crisis skills and now we can really use them to help us feel better. So they have a definite place, but they may not be as useful as doing some of these other skills at the time. Yeah. I think it's also really important to mention that when it comes to tolerating really overwhelming times, yeah, that it kind of brings into question or makes us reflect upon how we cope with more mild discomfort and that if when we're faced with mild discomfort, our strategies are ones of avoidance, then how on earth will we be when we're faced with the big discomforts?

54:49And so you're talking about like the thing that we all go through every day, which is like the small discomfort of a quick silence in a conversation and then we quickly pull out our phone and pretend we're checking our mountains of emails that we're not getting. Yeah. Or even things like you've had a really stressful day at work it's manageable. It might be relatively within your window, but it feels uncomfortable or aversive. And so you go through the normal rigmarole of getting home and then what you do to get rid of this unpleasant feeling is to go and scroll on your phone.

55:24We've spoken about this before. Extremely common. Makes a lot of sense. But is this actually really taking away or compromising our ability to grow our skills to tolerate discomfort and to be okay and accepting of it. Yeah. So if we can practice in those more mild moments, those cold skills that I mentioned, so things like movement, mindfulness, journaling, gratitude, any of those practices, if we can start to use those when the discomfort is mild, it gives us a much greater platform to then be able to be okay with the bigger ones.

56:01Hear, hear. I don't know if this analogy will work, but do you know like channeling, water channeling, how like water will, if you like allow, like if you say you got like sand and you trickle some water and the sand will kind of, the water will find its sort of natural path along the sand. It kind of feels like. So when little bits of water is coming along and you only let it go down that one path, when a lot of water comes, there's only that one way that the water can go.

56:32Whereas if you're directing the water down different paths each time, then when a lot of water comes, you've got many more ways for the water to disperse. Yes. In fact, it's funny that you say that because I actually often use in therapy, I often use the analogy of imagining a mountain and when it's raining, that the rain will find the pathway of least resistance. Yes. And then the rain always goes down that one path. Oh, yeah. Yeah. So same thing.

56:56And what we're doing from a neuronal point of view is actually creating new pathways, neural pathways by practicing these new skills. So the more that you're practicing resistance, The cold skills, for example, you know, being able to tolerate discomfort, being able to lean into it, to be accepting of it, it's actually changing the structure of the brain. Yeah. Awesome. That's really, it's amazing like that sort of stuff when you hear like, because we all know be on our phones less, but to have a practical like reason and like the benefit to not being on your phone or at least resorting to your phone to be comfortable.

57:33Yeah. That's really good to know. Yeah. Has anyone ever looked at the tip method, could you call it that, tip method, for addiction? Yeah, it has a huge applicability for that. Yeah. When we think about, for example, engaging in urges. Yeah. So really this is looking at this notion of like the action urge and delaying the urge. So whether it's addiction or self-harm or like suicidality, for example, you know, this – Really what we're looking at here is being able to stay longer in our...

58:11a state of not engaging and unhelpful behaviors, really, that I may be able to stay here enough to delay the urge response. Yeah. So kind of I've mentioned this before, this idea of urge surfing, right? Yeah. So that we're able to sit through the peak of the distress to notice that it's coming down. And there's something inherently... masterful about being able to sit through something that's very overwhelming. So when we engage in the unhelpful behaviors, it's like we actually miss the opportunity to have a real sense of mastery.

58:51So if I, the more I can practice this and the more I can see that I have some agency, that imbues more confidence. It also increases my sense that I can be okay even when there are really hard things here. Like that's such a vital kind of foundation really of psychological well-being. Yeah, I was going to ask about this earlier and I'm glad I didn't so we can talk about it now in that I found, and obviously this is not a crisis of some of the sorts that we're talking about, but a mild thing that I found overwhelming and distressing in work that I probably can't go into the details, but a couple of years ago where we had some difficult conversations with, and Bridge and I were working on some stuff together and the two of us had to go into meetings and have difficult conversations.

59:44I was really nervous about it. I'm like, I can't do this. I'm so bad at conflict. I'm finding it all very overwhelming. To go through it and get through it and come out the other side and think, oh, my God, I just did that. I felt so good afterwards and for like days and weeks afterwards, I felt like... on a bit of a high from it that I've actually done something I thought I couldn't do. Yeah. And you guys rehired me pretty quickly after that, but it was a pretty tense week.

1:00:11Yeah. I couldn't believe it. I was like, oh, I didn't see this coming. Yeah. At least I got some growth from it. Yeah. You did really well. You were very convincing. I mean, that's such an example here of how we're growing our window tolerance and growing our comfort zones. So there's something that is so powerful about showing yourself that you can get through hard things and not make that worse. Yeah. That, in fact, I didn't go and use my habitual patterns.

1:00:41I didn't go and use my kind of automatic reactions. And, in fact, I've now given myself space to make better choices. It's really powerful. Yeah. Yeah, it feels awesome. Nice way. Now, there are a whole lot of other things that I could go into, but I just wonder is that... Well, I think that's very helpful. And I think like if... So I guess if people... Tip is obviously so helpful and you've given so many helpful things. And like you say, there's probably so many more things that people can look into.

1:01:13And if the demand is there, we can maybe do another episode down the track and go into more stuff. But that feels like a pretty helpful... amount of stuff, I would say. I think especially like just the water thing is so, provided you're at home, it's such an easy thing to do, it's a quick thing to do. Yeah, that's great. Thank you very much. Thank you, Em. Great to see you. Great to be here. Yeah. If you enjoyed this episode and want a little more, you might enjoy our subscriber-only apps, available on Patreon and Apple Podcasts.

1:01:46If you want a little more but don't want to pay any more, then you can join our newsletter at theimperfects.com.au. And while you're there, you'll be able to see the names and faces of all the incredible people who helped make this show. A show made on the lands of the Wurundjeri, Woiwurrung people, and we pay our respects to elders past and present. The Imperfects is not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment.

1:02:09The advice given in this episode is general in nature, but if you're struggling, please see a healthcare professional or call Lifeline on 13 11 14.