Thoughtful Therapy

This post is by my friend and colleague, Cole Modlin.

We often see vague references to “coping skills” in self-help books or online psychology articles, but what does it mean to cope? Also, what stressors are severe enough to warrant using coping skills? I believe that all people are already coping with life events whether they are aware of it or not. For instance, turning on the TV or getting a drink with some friends are ways to cope with stress. When experiences become overwhelming and the methods of coping stop working, people tend to escalate their behaviors in negative ways or seek new alternatives. In this post I would like to describe types of coping skills and discuss how to use these skills effectively when dealing with distress or trauma.

It is helpful to separate coping skills into three basic categories:

1. Coping strategies focused on distraction

2. Coping strategies focused on grounding

3. Coping strategies focused on processing

In the category of distraction we have some of the following skills:

Counting – up to 100, down from 10, down from 100 by multiples of 7, etc.

Puzzles – Sudoku, crosswords, Lumosity, word games, cards, and anything else that occupies your mind

Exercise – walking, jogging, sports, aerobics, dancing, etc.

Sleeping – resting when we are emotionally exhausted

Music — listening or playing music of any kind

Media — playing video games, watching a funny TV show, YouTube clip, or movie

These are positive skills that provide a necessary relief to people in crisis. Our bodies simply cannot stay in a state of crisis indefinitely. Choosing healthy distractions can give us permission to experience some brief normalcy and relief when we are preparing to process events. In fact, recent studies are supporting the possibility that playing a distracting game like Tetris soon after a traumatic event can reduce the long-term negative effects of the trauma.

Of course, constantly using these distraction techniques can become a form of avoidance or denial. Moreover, one can actually build tolerance to distracting activities; thus, your favorite TV show or video game may cease being enough to keep out intrusive thoughts. If distraction efforts stop working, it is not uncommon for people to begin escalating to other more dangerous forms of escape, such as alcoholism or addiction. Hence, getting stuck on distraction may be an indication that developing skills at the next level of coping will be necessary to manage distress effectively.

Coping skills that focus on grounding the individual in the present:

Relaxation – progressive muscle relaxation, massage, diaphragmatic breathing exercises, bubble bath, yoga, prayer, meditation, etc.

Safe Place Imagery — developing a safe place in your mind connected to each of your five senses

Awareness – focus on your current environment (e.g., the feel of the floor beneath your feet, the texture of the chair you are sitting in, the smell of a candle, etc.)

Physical Senses — hold an ice-cube, pet an animal, enjoy a peppermint

There is some overlap between the distracting skills and the grounding skills. I think it is beneficial to draw the distinction between these categories because I see grounding skills as moving a person closer to dealing with the trauma or distress. These are activities that you would not typically engage in on a conscious level. Using safe place imagery or diaphragmatic breathing demonstrates awareness that support is needed and life has changed.

Finally, we come to the third category of coping, which is conducive to processing:

Journaling — putting words to your experience in private can sometimes be the first step in organizing your memories into a cohesive story

Verbalizing – talking with a support person or professional about your story

Sharing – writing a letter, giving a testimony about your experience, writing a blog, etc.

Commemorating Healing – planting a tree, getting a tattoo, writing a song or poem, creating something, etc.

This is the deepest level of coping and it usually requires the most emotional energy. With the distraction and grounding skills a person is primarily using stress management. The processing skills, in contrast, are aimed at healing from negative experiences. Activities at the processing stage are highly personal and their effectiveness for coping will often vary drastically between people, even in the same family. It is important to note that staying at this processing level for extended periods can lead to total exhaustion. We need to take care of ourselves when facing trauma. Adequate self-care requires coming up to the distracting and grounding levels at times when processing gets too overwhelming.

Many people can manage for most of their lives by using skills from the distraction category without needing to venture beyond this point. If trauma or a loss has occurred, it is much more likely that distraction will stop working. When anxious or disturbing thoughts begin invading your work and personal life despite your attempts at distraction, you could benefit from grounding yourself in those moments. However, grounding is still a temporary solution in that it places you firmly in the present but ignores the past experience.

If you do intend to begin processing your experiences, I encourage you to build a strong support system around you. Processing is hard work and you will need people to lift you up and remind you to take care of yourself. For some people it will also be essential that they talk to a mental health professional. A good therapist will help you navigate the complexities of your trauma, encouraging you to engage in distraction at times but also affirming you that you can press in to greater healing with support.