Author: Emily Sanchez, LCPC, Senior Group Therapist, Oak Brook
One person’s stressor is another person’s crisis. While we cannot always anticipate if, and or when, a crisis will happen, we know crisis is inevitable. As mental health clinicians, we are often confronted with the urgency to act fast. But what if we can successfully teach, strengthen and generalize the interventions of using coping skills for those we meet in crisis, so they are better able to begin managing distressing situations confidently without making matters worse, or even more so, reducing the likelihood of crisis altogether?
This article will cover helpful information to discern the difference between what a crisis is and is not and how to support individuals in crisis by applying easy tangible interventions from Dialectical Behavior Therapy (DBT), a skills based therapeutic intervention aimed at targeting distress through a manualized skills application. Additionally, this article will cover ways to support individuals who have experienced crisis to move through distress and successfully transition back into the moment.
According to an article published by the American Psychological Association (APA) “We are facing a national mental health crisis that could yield serious health and social consequences for years to come” (Stress in America, 2020). Furthermore, their study indicated that across all age groups, rates of stress have significantly increased following the aftermath of the 2019 Coronavirus, leaving people to struggle with uncertainty, and social unrest in addition to the already existing concerns amongst the general public. Therefore, the need for crisis support will likely increase as we continue to navigate these uncertain times.
It is also important to know and understand that while not everyone in crisis would be diagnosed with a clinical mental health diagnosis, knowing the specific diagnoses of Anxiety disorders, will help Clinicians effectively discern the difference between a crisis and symptoms of a clinical mental health diagnosis. Anxiety disorders include but are not limited to Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Specific Phobia, Social Anxiety Disorder, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder and Separation Anxiety Disorder.
Below we will look at the differences between what a crisis is not and what a crisis is, to better assess appropriate interventions, as not all situations require immediate crisis intervention skills. More specifically, if crisis management skills are applied to situations that are not in fact a crisis, the effectiveness of the skills decreases and can potentially decrease distress tolerance overall.
What a Crisis is NOT |
What a Crisis IS |
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There are many varied forms of therapeutic interventions that can support distress tolerance. Specifically, modalities such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) offer opportunities for building awareness of how Cognitive Distortions and related behaviors can negatively impact situations and outcomes. More specifically focused here, DBT offers skills based therapeutic interventions that specifically target Distress Tolerance and Emotion Regulation. Combined, CBT and DBT will support building awareness of cognitive distortions, problematic behaviors and the application of skills to support mitigating crisis and building coping skills that promote long term sustainability in managing distressing situations.
Below is a reference for the Skill Wave, which depicts how to best support an individual in crisis along the full trajectory of their emotion. Referencing this Skill Wave, we are able to experience the full span of an emotion and using distress rating on a scale of 0-10, with 10 being the most intense distress (Crisis Phase). Therefore supporting an individual along the full Skill Wave, depicts the emotional intensity rising and then returning to baseline as we employ skills along the way to support overall crisis management.
More specifically, with an emphasis on the Crisis Phase, shows a distress rating of 8-10/10 as shown. When an individual is in this Crisis Phase, we must acknowledge that access to rational thought is difficult and/or significantly impaired. In this phase, an individual is not able to access details or insight to recognize what behaviors may be helpful in the long run and merely want to feel better quickly. Additionally, providing skills coaching in this phase, allows the individual to simply respond to prompting rather than rely on overlearned action urges that are likely to make matters worse in the moment.
Related article: Understanding the Need for Immediate Mental Health Care
Implementing and utilizing Crisis Management skills, requires consistent effort and reinforcement under appropriate conditions to practice and specifically use in moments of crisis for most effective outcomes. Communication with the individual and Therapist especially when crisis occurs, can be essential to act quickly and efficiently. During moments of crisis, the Therapist can assess and determine crisis (see above) and can then determine how to support as necessary, specifically assessing for safety of the individual in the moment. Once safety has been established, the Therapist can offer skills coaching in the moment to stabilize the crisis, and to support returning to the present moment, while presenting opportunities to plan ahead to manage stressors should situations become difficult to manage. In the long term, collaborating and working together with the Interdisciplinary Team as well as encouraging the individual to build insight and awareness of prompting events that elicit distress, recognizing thoughts, emotions and behaviors will be key factors to empower the individual to gain confidence and ability to better manage distress independently and more effectively over time.
With this in mid, recognizing the role of Healthcare Professionals is multi-faceted. Healthcare Professionals can be a part of a multidisciplinary Team of Primary Care Professionals, Therapists, Psychiatrists, as well as other specialty care providers. Collaborative communication amongst an individual’s Treatment Team as well with the individual is most important as it will support continuity of care and sustainability in the long term for supporting a sustainable way of living overall.
In Summary, stress can leave anyone vulnerable to chronic mental health problems, such as anxiety and depression and experiencing crisis under many different conditions. As mentioned, being able to discern what is a crisis and what is not considered a crisis, is the first step in effectively managing distressing emotions in the moment. Utilizing skills from Dialectical Behavior Therapy (DBT) will provide individuals tangible tools to safely manage their crisis and effectively return back to the present moment feeling more capable.
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Additional Resources Linehan, Marsha M. (2015). DBT Skills Training Manual, 2nd ed. New York: Guilford Press. American Psychological Association (2020). Stress in America™: A National Mental Health Crisis. Support Groups and Helplines Crisis Help line Dial 988 Crisis Help Chat 988lifeline.org |