This video on reality acceptance follows up on the radical acceptance video in the previous post. When we allow in our unpleasant experience, accept them, and let them be, we take away their power. Reality acceptance doesn’t make distressing experiences go away, but it makes them more tolerable.
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Radical acceptance is a DBT distress tolerance skill that relies on mindfulness to help us accept the reality of situations and experiences we can’t change. And when we’re able to accept reality, although we still may feel some pain, we reduce our suffering.
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One of the most distressing aspects of feeling anxious can be the physiological or physical symptoms and body sensations that accompany anxiety. There is no end to the physiological reactions and physical symptoms associated with anxiety:
And whenever we notice one of these symptoms, our anxiety tends to increase. And just like with the emotion anxiety, the best way to respond to physiological symptoms associated with anxiety is with acceptance. Not because we like feeling this way or having these sensations. But because the more we try to fight them, the more intense they tend to feel. But if we’re able to accept these physical symptoms and sensations, we take away some of their fuel, and they usually start to become less intense.
This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.
Think about what it feels like to be sad or anxious or angry. How do you know that you’re experiencing a certain emotion? What is it that signals to you that you’re sad rather than happy or content? Or that you’re anxious or angry rather than calm or relaxed?
We generally experience our emotions through our bodies. And we often use the words emotions and feelings interchangeably. And talk about feeling sad feeling angry and so on. And that’s because we really do feel our emotions. There are actual physical feelings in our bodies that we associate with them. In my last video we learned how to regulate our emotions by naming validating and accepting them. In this video we’ll learn to regulate emotions through how we relate to the physical sensations in our bodies associated with our emotions.
There’s often a general physical feeling that accompanies an emotion. Our bodies feel heavy when we’re sad, jittery or tense when we’re nervous or anxious. We might feel hot if we’re angry or warm all over when we’re happy, and so on.
There’s also usually a sensation in a specific and localized part of our bodies that goes along with our emotions. We might feel a lump in our throats or broken-hearted if we’re sad. Or a tightness in our throats or chests, or heart palpitations or butterflies in our stomachs if we’re anxious. Or our heads might feel like they’re going to explode if we’re angry.
So because of this close relationship between our emotions and physical feelings in our bodies, if we’re able to calm the physical manifestations of our emotions and they start to subside, our emotions tend to calm down and feel less intense as well.
So in terms of a general feeling throughout your body associated with an emotion, if you’re feeling some sort of physiological arousal like with stress or anxiety or anger and your heart rate or blood pressure are elevated, or you have a lot of pent up energy and have trouble sitting still, in order to regulate your emotion you need to calm this physiological response.
One way to do this is by slowing down your breathing, and a good way to do this is to breathe in through your nostrils and then breathe out through pursed lips because the pressure of your lips forces your exhalation to be slower. And once you slow your breathing down for a couple of minutes your level of physiological arousal will naturally start to decrease.
And doing something a little active like going for a walk can also help, but a slow relaxing mindful walk not a frantic pacing back and forth. And perhaps tying your walking in with your slowed down breathing, so walking relatively slowly and then taking three or four steps per breath. So in, step, two, step, three, step. And out, step, two, step, three, step. And walking like this is a great way to decrease physiological arousal and calm yourself down.
Or in the case of feeling lethargic or a lack of energy that often accompanies sadness or depression, doing something a little more active can help lift the feeling of heaviness in your body. And i talk about this in more detail in my video on behavioral activation that you’ll find in the playlist that accompanies this video, in the description and pinned comment.
And now let’s look at the more localized physical sensations like a tightness in our throats or chests or, butterflies in our stomachs that often accompany our emotions. But first we’re going to do a quick exercise.
So in a moment I’m going to ask you to take a deep breath and hold it for as long as you can. And I’ll keep a timer on the screen, but try not to look at the timer until you’re done. And then make a note of how long you held your breath for. And I’ll keep talking about emotions while you’re holding your breath so you don’t get bored and go watch something else instead.
So I’ll count down from three and then take a deep breath and hold it for as long as you can. Three, two, one, go.
Now these localized physical sensations that we feel in our bodies that are related to our emotions can be very distressing. Sometimes they can be acute and come and go throughout the day and when we do become aware of them they can feel extremely intense. Other times they can be more chronic and we notice that feeling in our chests or throats or stomachs from the moment we wake up until the moment we go to bed and fall asleep. And if we wake up during the night it’s still right there.
And these sensations can be so distressing, not just because they’re so uncomfortable, but because they’re so persistent. We’re sure there’s a physical medical issue that’s causing them. And it’s not uncommon for people to make multiple trips to multiple doctors to try to figure out what’s wrong with them. And when the doctors can’t find any underlying medical issue it can be hard to believe that all of this physical discomfort can be caused by emotions and psychological distress.
So what can we do to try to calm these physical sensations, and as a result help calm our emotions as well. Like with all of our unpleasant internal experiences the first step is to accept them. Not because we like them, but because anything other than acceptance is only going to make things more unpleasant. And if you don’t know what we mean by acceptance in this context check out the videos i link to in the pinned comment and description.
Okay it’s been a while now so you’re probably not holding your breath anymore, so just make a note of how long you held it for and we’ll talk about why you just did this in a few minutes.
Unfortunately we can’t just make these body sensations go away because we don’t like them. And when we fight with our internal experiences like thoughts emotions and body sensations and try to ignore them shut them out, or force them to go away they only gain more strength.
Our bodies tense up as we strain to fight these feelings, which exacerbates the feelings of tension in our throats chests or stomachs. And any negative reactions we have to them like, damn it’s still there, why do i always feel this way, when is it going to end, it’s just going to make them more difficult to tolerate, because our subjective experience of them will be worse, because now we’re faced with not just the unpleasant physical sensation but with our negative thoughts about them as well.
And our negative thoughts have a negative effect on our mood and will tend to increase the intensity of our emotions, which in turn will make the physical sensations more intense as we get stuck in this vicious cycle. And that’s something i talk about more in my video on distress tolerance and the difference between pain and suffering. So once again we’re left with the problem of how do we accept these things that we find so unpleasant.
Well first we can try to adopt an attitude of acceptance through calming thoughts and statements that we say to ourselves such, as whatever’s here right now is okay. This is my experience right now. Whatever it is, is already here. There’s nothing i can do to keep it out. There’s no need to fight it or struggle with it or try to make it go away. And just allowing myself to be open to it.
And the more you stop resisting your unpleasant body sensations the less they have to fight to be acknowledged. And as a result the more likely they are to lessen a bit in intensity. Now this doesn’t mean they suddenly go away. Our emotions and corresponding body sensations are like waves. They may seem like a constant and monolithic force but when we start to pay attention to them we can start to notice their ebbs and flows.
They often come into our awareness when they’re at their peak, either because that’s why they’ve drawn our attention, or because when we check to see if they’re still there they tend to perk up like they know we’re talking about them and they start to swell a bit. But if we’re able to just allow them to be there, after the initial swell they tend to crest and then start to dissipate and trough. And then they’ll swell up again and then contract and continue like this to ebb and flow and wax and wane.
And so when you have an uncomfortable feeling in your body rather than fighting it, just allowing it to be there and noticing what’s going on in your body as you hold it in awareness. And tuning into any feelings of tension or tightness or discomfort, and then breathing into these sensations using your breath to bring your awareness to them on the in-breath, and then breathing out of these sensations and seeing if they soften or relax on the out breath. And just letting your experience of these sensations be whatever and however they are from moment to moment. And if you’d like to try a short guided meditation that incorporates some of what we’ve just talked about in the last section of the three-minute breathing space we practice breathing in and breathing out a physical sensations in our bodies.
So let’s go back to the holding your breath exercise. We’re going to do it again now but this time with some guided instructions. While you’re holding your breath, and again there’ll be a counter on the screen but try not to look at the time until you’re done and then make a note of how long you held your breath for, so counting down from three, two, one, start holding your breath.
And now while you’re holding your breath, whenever you notice you’re having the urge to breathe, try to notice exactly where you’re feeling this urge in your body and whatever the body sensations associated with this urge to breathe are.
And then seeing if you can just allow these uncomfortable feelings to be here without taking a breath yet. And seeing what happens to this urge to breathe as you just open yourself up to it, allow it to be there, and allow yourself to experience it however it feels, without fighting it. And seeing if you can continue to hold your breath despite the uncomfortable feeling you’re having. And then when the urge to breathe starts to become overwhelming, take a breath and record how long you held your breath for. And I’ll just leave the timer up for a little bit longer in case you’re not done yet.
Now take a moment to think about any differences you noticed between the two times you held your breath both with respect to how long you were able to hold your breath for and what your experience was like while holding your breath.
Most people find that they hold their breath longer the second time, when they’re simply accepting of their experience for what it is allowing in that discomfort and urge to breathe and just watching it and letting it be there without resisting fighting or trying to change it or make it go away.
And so this exercise can help illustrate that the way we respond to discomfort and unpleasant feelings can change how we experience them. And that if we simply let them in and allow them to be there instead of engaging in our tendency to try to fight them or shut them out, they can become more tolerable and manageable.
And this is borne out by research into pain management that shows that responding to chronic physical pain with mindfulness and acceptance can reduce subjective pain intensity ratings by an average of forty percent. Now that’s a lot less than a hundred percent, so acceptance isn’t a magic cure that automatically makes discomfort go away, but a forty percent reduction is significantly better than nothing.
So when we don’t have the option to make our uncomfortable or unpleasant body sensations related to our emotions just disappear, why not try accepting them and make them significantly more tolerable and manageable? And the more we’re able to just accept these uncomfortable physical sensations, the more likely they are to lessen in intensity. And as a result we begin to experience a corresponding reduction in the intensity of the emotions associated with these sensations. So by learning to accept these uncomfortable physical sensations we learn to regulate our emotions as well and in the next video we’re going to look at the difference between emotion regulation and distress tolerance.
Panic attacks are a great example of this relationship between anxiety and physical symptoms. Panic attacks are often a reaction to intense physical symptoms and sensations. And these cause us to start to panic. And the more we start to panic, the stronger these sensations become. Which leads us to panic even more, and so on.
But if we can react to these physical symptoms with acceptance, we reverse this cycle. Our symptoms become less intense. And as a result we feel less panicked. And then our symptoms subside even more. And then we feel less panic. So the better we’re able to accept the presence of these uncomfortable physiological symptoms and sensations, the less likely we are to experience a full-blown panic attack.
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When we have anxiety, or any uncomfortable emotion, we generally want to stop feeling this way. So we try to think our way out of feeling anxious, control our anxiety, or block out and avoid anxiety altogether. Unfortunately these strategies don’t work. And rather than reduce our anxiety, they tend to make us even more anxious.
When we try to out-think, control, bock, or avoid anxiety, we just give our anxiety more fuel and make it more intense. That leaves us with one alternative. We can learn to accept our anxiety. It may seem paradoxical, but as soon as we’re able to accept that we’re feeling anxious, our levels of anxiety tend to decrease.
Whenever we experience a strong, uncomfortable emotion, acceptance is our best initial response. We don’t accept our unpleasant emotions because we enjoying feeling this way. We accept them because when we struggle or fight against emotions, they fight back. And when they fight back, they grow even stronger.
But when we practice acceptance, our emotions start to lose their strength. And this is particularly true of anxiety. The more we can accept the fact that we’re feeling anxious, the less anxious we start to feel. Acceptance not only helps manage anxiety. Acceptance is also the best way to respond to the onset of a panic attack. The more we fight against a panic attack, the quicker our panic escalates. But if we can just accept that we’re starting to panic, our panic attacks will often slow down.
Once we’ve accepted the fact that we’re feeling anxious or starting to panic, we can then employ a variety of other techniques to reduce our anxiety, many of which we’ve already covered. But whenever anxiety or panic arise, the best way to respond is with acceptance. “I’m feeling anxious (or I’m feeling panicky), and that’s okay.” And then we can continue with other strategies to manage anxiety and panic.
Acceptance can seem paradoxical and is often a difficult concept to grasp. The next post is also about anxiety and acceptance, and then I’ve included a couple more posts about acceptance in order to describe in more detail what we mean by acceptance in this context. If you have any questions or comments, please leave them on the YouTube video page.
The 5-4-3-2-1 grounding exercise is a grounding technique that calms anxiety and panic by bringing us back into the present moment. The 5-4-3-2-1 grounding technique helps get us out of our heads, as we connect with the outside world through our senses.
We can use this coping skill whenever we’re feeling panic, anxiety, or overwhelmed. It’s a great exercise for when our minds are racing, or we’re stuck in our heads worrying or dwelling or ruminating. The 5-4-3-2-1 technique can also help if we’re dissociating or experiencing depersonalization.
In the 5-4-3-2-1 grounding exercise we identify and name:
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When we’re feeling anxious, and especially if we’re having a panic attack, our breathing generally speeds up. This elevates our heart rates, making anxiety more intense, and escalating panic attacks. The advice in these situations is often to take deep breaths. But deep breathing can actually make things worse.
If we start breathing deeper without slowing down out breathing, we can end up panting or hyperventilating. And this can feel like we’re having trouble breathing or starting to suffocate, which escalates anxiety and panic attacks even more. So instead of trying to breathe deeper, we want to breathe slower.
There are many ways we can learn to breathe slower, such as meditation or just practicing breathing exercises when we’re not anxious. But the video below describes what I think is the best breathing exercise to slow down our breathing in the moment, when we’re having a panic attack or feeling extremely anxious. And when we slow our breathing down, we start to deescalate panic attacks, and reduce anxiety.
Someone requested a longer version of this breathing exercise, so the video below is the same as above, but looped a few times.
The actual best way to learn how to breathe during a panic attack is with Capnometry-Assisted Respiratory Training (CART), but this requires a portable capnometer device. If you’re interested, you can read about CART (along with a video demonstration), or read the the academic study. But if you’re like me, and don’t have your own capnometer, the breathing technique in this video is a simple and effective way to slow down your breathing during a panic attack.
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During a panic or anxiety attack, two main things generally happen. We experience distressing and often scary physiological reactions, such as:
And we have catastrophic thoughts about these physiological reactions:
And these physiological symptoms and anxious thoughts start a vicious cycle that pulls us in to a panic attack.
CBT is the most effective treatments for panic or anxiety attacks. CBT usually reduces the severity of a panic attack, and can even stop a panic attack in its tracks before it has a chance to start escalating. In CBT for panic attacks, we replace our panic‑inducing thoughts with panic‑reducing thoughts. And we calm physiological symptoms by slowing down our breathing, and practicing acceptance.
This video lays out the basics of how CBT helps us cope with panic attacks. In the next few posts we’ll learn breathing and grounding exercises that help deescalate panic attacks. And then we’ll look at how responding to the emotional and physiological components of a panic attack with acceptance helps calm panic and anxiety.
I’m working on a new and improved video about panic attacks, so if you don’t want to miss it when it comes out, please subscribe to my YouTube channel to get notified whenever I release a new video, and follow me on Twitter where I’ll post updates as I add content to this site.
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Learn how panic attacks escalate through a vicious cycle between physical sensations and anxious, catastrophic thoughts, and how we can break this cycle.
In the video I suggest that when we first notice a panic attack coming on, it can help to remove ourselves from the situation. There’s a great comment on this video about the danger of avoiding situations in which we’re prone to panic. As we learned in the post about exposure therapy, avoiding something that’s making us anxious increases our anxiety about that situation. So there’s a fine line between removing ourselves from a situation in which we’re starting to panic, and avoidance.
If we’re avoiding situations because we’re worried about having a panic attack, our anxiety will get worse. But once we feel a panic attack coming on, our first priority is to do whatever we can to disrupt the panic cycle. And if we can accomplish this by temporarily distracting ourselves or removing ourselves from a situation, that’s fine.
But we can’t allow ourselves to start avoiding that situation altogether out of fear of having another panic attack. If this starts to happen, we need to engage in exposure therapy, and use systematic desensitization to help us feel more comfortable in that situation in the future.
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Sometimes worry records can be difficult to fill out. This video describes some of the challenges of completing thought records and how to overcome them to make the thought record more effective. And since the worry record is a type of thought record, these tips apply to worry records as well.
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In the Three Minute Breathing Space we become aware of what we’re thinking and feeling in the present moment. Then we gather our attention around our breath and follow our breathing. And finally we tune in to any physical sensations we’re experiencing and breath with them, allowing them to calm and relax. The Breathing Space is a great way to relieve stress and anxiety, and calm ourselves if we’re starting to panic.
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