Strategies for Managing Emotional Crises in Schools Alison M. Yaeger, PsyD Director, 3 East Outpatient DBT Program Instructor, Harvard Medical School Maggie Gorraiz, PhD 3 East Outpatient DBT Program,

Crisis Survival Skills: Not for everyday use Help students carry on and avoid making a situation worse. Help students stop from acting on impulsive behaviors

Students are in a crisis when a situation is: Highly Stressful e.g. students report their emotions are 6.5 or greater/ 10 Short term (that is, it won’t last a long time or there is no immediate solution) Creating intense pressure to resolve the crisis now. Mazza , Dexter-Mazza, Miller, Rathurs & Murphy, (2016) DBT Skills in Schools

Use Crisis Survival Skills when: Students have intense pain that cannot be helped quickly. Students want to act on their emotions, but it will only make things worse. Emotions threaten to overwhelm, and the student needs to stay skillful. Students are overwhelmed, yet demands must be met. Students’ arousal is extreme, but their problems can’t be solved immediately. Mazza , Dexter-Mazza, Miller, Rathurs & Murphy, (2016) DBT Skills in Schools

Do not use crisis survival skills for: Everyday Problems Solving all life problems Making your life worth living. Mazza , Dexter-Mazza, Miller, Rathurs & Murphy, (2016) DBT Skills in Schools

BIOLOGICAL CONSTRUCTS High Sensitivity Students react Immediately Reactions with only a little provocation High Reactivity Extreme Reactions Experiencing high arousal where thinking clearly becomes difficult Slow Return to Baseline

Sensitivity & Reactivity TIME

DISTRESS TOLERANCE SKILLS Teach how to tolerate emotion urges when experiencing intense emotions. Are used to get through a bad situation without making it worse. Can be used when there is not an immediate solution to highly stressful situation.

DISTRESS TOLERANCE SKLLS Validates that an a event is stressful and teaches students to not be taken over by emotions or try to avoid the emotion. Distress tolerance emphasizes how to bear pain skillfully without making a situation worse. Distress Tolerance skills are helpful for situations where students might not be able to control a situation and at the same time need to manage their responses.

Crisis survival strategies : DISTRESS TOLERANCE: Crisis survival strategies : Temporarily distract with ACCEPTS Self-soothe IMPROVE the moment Pros and Cons TIP Realty Acceptance Strategies Radical Acceptance Turning the mind Willingness v. willfulness

Self Soothe with the 5 Senses VISION Look at a picture or poster that you like; look at the stars; look at nature around you; make one area of your locker look nice; walk through a beautiful part of school or a park, notice colors in the classroom or outside; look at a specific photo album. HEARING Listen to beautiful or soothing music; pay attention to the sounds of nature or the different sounds in your school; sing your favorite song; use your playlist. SMELL Put on your favorite lotion/perfume/cologne; aromatherapy; make popcorn TASTE Have a good meal; have your favorite soothing drink (tea, hot chocolate); sample flavors in an ice cream store; chew gum or suck on a piece of candy. Really taste the food you eat. TOUCH pay attention to the way different fabrics feel; have a massage; sink into a really comfortable chair; hug someone; brush or braid your hair; change into comfortable clothes.

Distract with ACCEPTS Activities Do something. Write in a journal, call or visit a friend; play video games or sports; go for a walk, read a book. Contributing Contribute to someone. Give something to someone; volunteer; do something nice for someone. Comparisons Compare yourself to a time in the past when you weren’t as skilled or effective as you are now. Emotions Create different emotions; half smile, relaxation, listen to music (soothing or upbeat), watch a funny TV show Pushing Away Push the painful situation out of your mind temporarily; build an imaginary wall between you and the situation, give yourself a brief vacation. Thoughts Create other thoughts; count; notice the colors in something, do a sudoku or crossword puzzle, read a book, complete an A-Z list Sensations Intensify other sensations. Create other intense sensations; hold an ice cube in your hand, squeeze a rubber ball very hard, eat something sour or spicy.

Time to Practice Cochlear Implants: People hearing for the first time. https://www.youtube.com/watch?v=mbe7x8GP2Ds

THINKING OF PROS AND CONS Identify one crisis, or emotionally upsetting situation, where you found it REALLY hard to tolerate distress, avoid ineffective behavior and not act impulsively. List the pros and cons of both engaging in and of resisting the ineffective behavior   Identify if this is a short term (ST) or long term (LT) pro or con Identify the pattern: does engaging in the harmful behavior have more short term benefits? Do the pros of behaving skillfully outweigh the pros of acting impulsively?

1. Feel masterful and better about self   RESISTING IMPULSE (Example: Going back to class) ST LT ACTING ON IMPULSE (Example: Calling parent to leave school early) PROS  1. Feel masterful and better about self 2. Stay on top of class material  LT  1. Feel relief from anxiety. 2. Can spend time watching TV  ST CONS  1. Increase my anxiety in the moment 2. Increase chance of passing class this term. Feel more anxiety the next day Feel like a “failure” for the day

TIP to manage extreme emotions Temperature Tip the temperature of your face with cold water to calm down fast (mamillian ice dive) Intense Exercise To calm your body when it is revved up by emotion. Paced Breathing Slow your pace of breathing way down.

IMPROVE THE MOMENT WITH: Imagery Imagine a very relaxing scene. Imagine a secret room within yourself, see how it is decorated. Imagine yourself coping well. Imagine hurtful emotions draining out of you like water out of a pipe. Meaning Find or create some purpose, meaning, or value in the pain. Focus on whatever positive aspects of a painful situation you can find. Make lemonade out of lemons. Prayer Open your heart to a supreme being, greater wisdom, God, or your own wise mind. Ask for strength to bear the pain. Relaxation Try muscle relaxing by tensing and relaxng each large muscle group, download a relaxation audio or video, stretch. One thing in the moment Focus your entire attention on what you are doing right now. Keep yourself in the very moment you are in. Focus your attention on physical sensations. Do mindfulness exercises. Vacation Give yourself a brief vacation. Take a breather, take a short walk, unplug from electronic devices. Encouragement Cheerlead yourself. Repeat over and over: “I can stand it,” “It won’t last forever,” “I will make it out of this,” “I’m doing the best I can.”

Now what do I do? Brainstorm ACCEPTS to use with students in emotional crises Experiment with TIP so you can share your experience with your students Use a pros and cons in your personal life to increase empathy for the challenges your students face Create your own self sooth kit. Encourage students to do the same. Ask them for feedback.