We don’t often try to define a crisis, but we certainly know when we in the middle of one. The first thing to know is that a crisis is a stressful or traumatic event that is characterised by heightened emotions that often feel out-of-control. Most often, logical thought is impossible and we are at the mercy of our feelings and urges. I’ve often heard people describe their experiences of being in the middle of a crisis as “physically painful” or “an emotional maelstrom” or “so desperate to stop the pain, dying seems like a way out”. They talk about having a crisis as something they want to avoid at all costs, there is the realisation that they are somewhere on an emotional cycle and can always sense it building up gradually from one episode to another. This cycle always ends with a crisis, like a dam that’s about to burst, people get ‘flooded’ with emotions and it’s impossible to know what to do. It’s intense. Desperate to stop feeling this way “right now”, they are pushed beyond their ability to tolerate the feelings and often react impulsively, making things worse by harming themselves or even trying to end their life. One thing that’s impossible to see, or acknowledge is that a crisis doesn’t last forever. That is, they are by nature, short term events, “If it’s something that lasts forever and you think it’s a crisis, it’s your life, not a crisis” Marsha Linehan.
Ok, so it’s one thing to know when we are having a crisis, and at this point I usually get asked “so how do I stop it”!
Assuming the crisis is not a problem that can be solved in the moment, we try to ‘survive the crisis without making things worse’. Being in the middle of a crisis is bad enough, but often in our desperate attempts to escape the pain, we act in ways that can prolong our pain, damage relationships or cause serious harm or injury to ourselves or others. As with a hurricane, it can take a long time to clear up the inevitable mess once our crisis has wound itself down. When we act impulsively, we also ‘shape’ our environment to respond in a particular way.
Sally keeps absconding. Every time her ex boyfriend ignores her attempts to contact him, she runs to a hotel and takes a bottle of pills. This has happened 3 times, each time she was rescued by her parents who managed to find her in time. Now she is out of hospital and living back at home and complains to me bitterly that she has no freedom or private space from her parents.
“They keep checking up on me every 5 minutes, coming into my room asking me loads of questions. If I go out, they are on my case and if I dont text back immediately, they to crazy! It’s
just not fair”. Sally’s actions when she was in the middle of her crisis, caused her parents reaction, she shaped their behaviour to be hyper-vigillant. The fact that she did not like the consequences of her actions was an example of “making things worse”. Her life became harder, not easier.
BEING SKILLFUL vs BEING LUCKY
If we get through a crisis without using skills, we are simply lucky! The following is the Crisis Protocol or prescription I use with my clients to help them understand in simple terms, how to manage a crisis skilfully.
CRISIS MANAGMENT LIST
Or as I prefer to call it a “stoplight” system. We focus on developing a series of increasingly more distracting activities that can aid us depending on how far into the crisis we are. It’s important to recognise that we don’t get distressed instantly, there is usually a gradual increase in our distress before we hit the alarm button. So, it’s easier to think of it as GREEN (mildly distressed) / AMBER (moderately distressed / RED (severely distressed). I ask my clients to try to pick up their level of
distress as early as they can and gauge where they are on the stoplight scale. They can then use the skills that would be most helpful, ie; there is no point trying to distract yourself from your crisis by reading a book when you are already feeling suicidal! It just won’t work. Some of the Red strategies use (TIP) skills. Temperature (usually ice), Intensity (short sharp bouts of exercise) or Paced breathing (belly breathing and extreme cold, stimulates the vagus nerve and
deactivates the fear system).
| Green | Amber | Red |
|---|---|---|
| Sleep | Walk dog | Ice diving |
| Watch TV | Calling a friend and talk about their stuff |
Shower hot/cold |
| Singing | Get someone to take me for a drive |
Peas on back of neck |
| Write poetry, draw, colouring book |
Gym | Break something unimportant |
| Cleaning out wardrobe | Short fast run |
Digging in the garden |
| Creative planning | loud music | Email Amanda for help |
| Organise cupboard | Rubber band around wrist | Call a friend/be safe with someone else |
| Help someone who needs it | Red ink and Ice | Drive to A&E or Doctors Surgery. Sit until crisis passes |
| Plan a holiday | Rip up old clothes | Clap hands hard 30 times and hold 1 inch apart. |
| Read inspirational stories of other people who have survived difficult situations |
Paced Breathing | Hit a punch bag |
CRISIS MANAGEMENT PROTOCOL
It’s important to know exactly what to do ahead of a crisis and equally important to practice doing it AHEAD of the crisis. Nine times out of ten, when a person is unfamiliar with the steps
they can take to get through their crisis, they end up defaulting to old self destructive behaviours. Follow the Protocol as closely as you can. For those who are not working with me, if you have a DBT therapist, they should provide you with out of hours support as part of the treatment plan.
Each therapist will have their own boudaries and should make a clear contract with you about how and when you are able to reach them. The contact is essentially “skills coaching” so no
“dumping” of your emotions, there will be a clear concise pathway to managing your crisis and the therapist will ‘coach’ you through until you are safe. Your therapist will not ‘rescue’ you.
CRISIS MANAGEMENT PROTOCOL
If you are in crisis or heading for a crisis, then please follow the guidelines below.
STEP ONE
STOP!!! Whatever it is you are doing, wherever you are!
Start with taking a single breath. Count …. Slowly in for 7 and out for 11
Repeat slow breath, focus only on your breath
Once again……
One final time, repeat slow breathing
Then:
Use crisis management list.
Decide which level of crisis you are in, either green, amber or red. The aim to to try to notice and be aware of your crises earlier and more often so that you can work up to the skills as things get worse.
Do this for at least 2 hours, moving from one skill to the next.
STEP TWO
If you have spent 2 hours trying to reduce your Distress but it is still rising, email Amanda giving the as much of the following details as you can:
A: Trigger - what happened to trigger the crisis, where were you, who were you with?
B: What did you do/urge to do, What (if you can remember) was going through your mind?
C: Consequence - did anything happen as a result of the above or what are you trying to avoid happening?
When you send this information via email and get a response, follow instructions from Amanda and try to think of anything else that you may need that would be helpful. Take 30 minutes to follow guidelines and report back to Amanda via email if crisis is reduced or passed.
STEP THREE
If crisis is still ongoing or getting worse, call someone to come and stay with you to keep you safe. Call samaritans or Crisis team and talk it out until crisis has passed.
STEP FOUR
Take yourself to Police station, (preferably with a responsible adult) and ask to sit there because you feel unsafe/at risk OR go to A&E and ask to sit there until your crisis has passed. Do not create a scene but sit quietly practice your mindfulness skills and paced breathing. When crisis has passed, inform staff that you are feeling more in control and are safe to leave. When you can, inform your family or loved ones where you are and that you are safe.