Dr Adler's 1-2-3 re-regulation guide
If you are very upset (distressed) and the impact of the distress is affecting your physiology (body), emotions and thinking, instead of doing one coping skills, you may need to do 3 steps in order so you can feel ok again. The fancy term for this is to re-regulate or self-regulate.
1. First to calm the body (eg dial down the fight or flight response in your brain and body)
2. Second soothe feeling and emotions
3. Last, use cognitive strategies (think about your thinking, if you might be making assumptions, blowing things out of proportion etc)
WHY 3 STEPS & WHY THIS ORDER?
It isn’t possible to think your way out of distress if you are experiencing:
1. Strong physical symptoms
a. Shaking
b. Racing heart, heaviness, pain or pressure in your chest
c. Feels like you can’t breathe or you are breathing too fast
d. Upset stomach, feeling nauseous (or worse!)
e. Stress headache or muscle tension/pain
2. Extreme emotions that feel out of control (fancy term for this = dysregulated)
a. Very sad, bursting into tears or feeling like it on the inside
b. Mad, angry, enraged
c. Scared, panicking
d. Strong feelings of guilt or shame
In fact, trying to tell yourself that you are having too big of a reaction or challenging negative thoughts at this stage can you feel even worse. Your body and your emotions are still sending loud alarm bells that are fighting back hard against your rational thoughts. Because talking yourself down with logic can be so hard to do in those circumstances, using those techniques right away might make you feel like a failure and an emotional wreck at the same time, which is a really tough way to think and feel.
Sometimes, this is when people feel SO bad that they might think about doing something unhealthy or self-destructive to make the feelings stop. Another direction people might turn is "going down the rabbit hole" of negativity. They might resign themselves to crying for hours or thinking through worst case scenarios about
themselves, the world, other people and/or the future.
Some people may try to use a body-based skill like deep breathing or holding ice, which may help them calm down in the short term, but report that 20 minutes later, they go back to thinking about what’s upsetting them and all those thoughts, feelings and body sensations return.
BUT HOLD ON, IT DOESN’T HAVE TO BE THAT WAY!
Doing skills step-by-step that sequentially help calm the body, soothe the emotions, and shift the thoughts, the process can be quite effective in calming down and staying calmer.
If you are aware of feeling intense distress and discomfort in your mind and body do all 3 steps
If you are not at the point where you are feeling muscle tension, sick to your stomach, or shaky but are feeling very strong emotions and thoughts, you can start with step 2
STEP 1: CALM THE BODY
1. Temperature change
HOT (helps with stress, fear, sadness, can relax tense and sore muscles)
a. Heating pad on shoulders and neck or on belly
b. Electric blanket or wrap up in warm fuzzy blanket
c. Take a hot bath or shower
d. Sit near fireplace, woodstove or space heater (please observe safety
precautions!)
COLD (helps with panic, anger, aggression urges towards self or others, avoiding or
stopping prolonged crying spells)
a. Ice pack or ice roller or cool compress
b. Splash face with cold water, run cold water over wrists
c. Hold an ice cube or ice pack to wrist and neck
d. Cool shower
e. Step outside without a coat for a few minutes on a cold day
f. Drink a glass of very cold ice water slowly (if possible, through a straw).
h. Crunch ice if needing more to reduce agitation, high level of internal tension
2. Touch/pressure
a. Weighted blanket
b. Rice-filled stuffed animal that can be frozen or microwaved and placed on body
c. Hug a pillow or wrap up in a blanket
d. Use putty, clay, squishy or stress ball
e. If you have a pet, snuggling or petting him/her/them can be an option
3. Progressive muscle relaxation and/or deep, slow diaphragmatic breathing.
a. YouTube
b. Calm app
c. GoNoodle Flow
4. Intense exercise (getting your HR up - only needs to be for 5 min)
a. Running (jogging in place is fine, too)
b. jumping jacks
c. Zumba
d. Dance along to video online
THEN
STEP 2: SOOTHE THE EMOTIONS
1. Notice and name the emotion or emotions you are feeling (anger, outrage, resentment, betrayal, jealousy/envy, sadness, fear,anxiety, guilt, shame)
2. Allow yourself to feel compassion towards yourself for how hard it is to feel this way (eg self-validate). Don’t worry about whether or not others would understand why you have the feelings you do or react similarly.
3. Try not to beat yourself up or justify engaging in destructive actions. Just sit with your emotions and be gentle with yourself and make space for your feelings whatever they may be. But remember you don’t have to be ruled by your emotions. You can still make choices based on your values and long terms goals.
4. Notice action urges or urges to shut down/suppress feelings but count to 20 and let before deciding whether to act on the urges.
5. Once you’ve done all of the above if you are still feeling high intensity emotions you can try one of these options:
a. Journal about your feelings to get the “out of your system” then re-read and see if there are places where you can try to soften or let go of a difficult emotion. There may or may not be and if journaling is amplifying your negative mood, try a different technique
b. Soothe with 5 senses - eg listen to music that provokes a positive memory or emotion, make the room’s lighting soothing to you, wear or hold something with a feel and texture you enjoy. Some people like using the 5-4-3-2-1 technique. That is, tune into your surroundings with your senses. Name five things you can see, 4 that you can hear, 3 that you can touch, 2 that you can smell, and 1 that you can taste*.
c. Watch a show or video clip that engenders humor or happy feelings or just puts you into a different mind state (eg old sitcoms or late show episodes or clips, goofy animal videos)
d. Play a game on your phone or tablet to distract yourself
e. Listen to a podcast, chapter of an audiobook or read
f. Color or draw (on paper or on an app). Color/paint by number tends to be especially good.
THEN you can work on examining thoughts, stepping back and noticing distortions or assumptions, and shift your thinking. Here are some ways of doing that:
1. Practice “zooming out” -- If your thoughts are laser focused on a particular bad interchange with another person, imagine mentally stepping back several paces to take in more information about your historical interactions with the person in question.
a. Think of recent times they have been thoughtful, kind or loving, if applicable.
b. Think about what the stressors are in their world that might cause less skillful interactions.
c. Think about times you may have spoken to them in ways you regret.
d. Allow the bigger picture to “dilute” or soften the intensity of the thoughts connected to the distress you are feeling emotionally and also realize that you may not have the whole story.
e. You can also use this technique to notice more positive things in your world by asking yourself the question “ok and what else happened today?” Our brains can be a little bit like the targeted advertising we all have experienced when using the internet. When you are focused on think about that is wrong, your brain keeps finding examples of similar situations in the past or predicting what may go wrong in the future because that's what you seem to be showing interest in. But that negative filter means that you may dismiss or not notice the positive things that are happening around you. Even small things like seeing the first snowdrops push through the soil in early spring, or a particularly excellent cup of tea or coffee can bring you moments of joy if you tune in to them. That does not mean that if you can find anything positive in your life that you "should not" notice negative things or be upset by them. It's just about stepping back to take in a bigger variety of experiences.
f. If this is hard to do mentally, you can first practice by looking at an image (through a window, a painting or photograph in your room or on a computer). First hone in on the main thing you see, what is in the center or foreground. Then broaden your perspective and pay attention to everything in the back or to the sides of the image. Take in as much detail as you can by asking yourself, ok, what else can I see.
2. Review the language of your thoughts and dial down the intensity.
a. Notice if your reactions or thoughts are exaggerated or in all or nothing terms. (eg are you actually dying of starvation or just really hungry)
b. Ask yourself if the size of the problem matches the size of the reaction. If not, try to rescale the problem in your mind and stay with just that-sized problem in the here and now. Sometimes when the reaction seems outsized it may because you are connecting with emotions related to events from the past or fears about the future. Try to draw a mental box around what is happening right now and stay with just what is inside of that box.
3. Check the facts
a. Look for thought distortions. Some examples of distorted thinking include:
1. Thinking in black and white or going to extremes.
2. Catastrophic thinking - focusing on the worst possible outcome
3. Over-generalizing - eg assuming that because something happened one way once that it is true across all circumstances. For example, assuming all your new classmates are mean because the one student you tried to befriend snubbed you.
4. Predicting the future - thinking you know 100% that something will go poorly without actually testing things out in the real world.
5. Perfectionism or overly rigid "rules" - eg If I don't get a perfect grade, I'm a failure.
b. Challenge those distortions, and try to substitute with a more reasonable, less extreme thought. Eg If I don't get a perfect grade, I will be really disappointed.
c. If replacing the distorted thought is too difficult, just allow yourself to be aware of the distortions and allow that knowledge to let you step back and put a little distance between you and your thoughts.
4. Think about something else. Engage your mind in a new topic, read or watch something that allows you to learn new things.
Hopefully you will find one or two strategies in each category (body, emotions, thoughts) that you are willing to try out or get inspired to come up with your own ideas. Feel free to share your experiences or suggestions by posting a response.
Karen Adler, MD
Psychiatry and Psychotherapy
last revised 3/15/2023
Note: The concepts and skills listed are derived from the principles of CBT (Cognitive Behavioral Therapy) first developed by Aaron Beck, MD and DBT (Dialectical Behavioral Therapy, first developed by Marsha Linehan, PhD)