Monday, April 9, 2012

Driven to Distraction

In my last post, on urge surfing, I mentioned distraction as a coping strategy for intense urges, with the goal of getting your mind off the urge while waiting for it to pass. On the other hand, I've also mentioned in several posts that avoidance tends to increase rather than decrease distress. Isn't distraction just a fancy name for avoidance?

Yes and no. The purpose of both is to limit your exposure to distressing thoughts and feelings. However, true avoidance seeks to limit exposure indefinitely, while distraction (when used appropriately) is intended to be a time-limited break from distress, with the assumption that you will ultimately deal with the problem at hand, when it is less overwhelming to do so.

Since this line between distraction and avoidance is so fine, I think it is important for clinicians who introduce distraction to clients as a coping skill (e.g., as part of DBT skills training) to also educate clients about when and how distraction can become problematic, and be observant for signs that they may be over-using distraction as an avoidance strategy.

So, why introduce distraction at all? Well, clients often come to treatment with limited ability to tolerate and manage their own thoughts and feelings, and many have developed unhealthy coping strategies to avoid distress/discomfort (e.g., addictive behaviors, numbing/dissociation). It would be overwhelming to ask them to face and fully experience all of their internal experiences at once - particularly since those internal experiences tend to be heightened in intensity early in treatment. Overwhelming someone that way can lead to decompensation and relapse rather than stabilization and recovery. While tolerating, processing, and modulating thoughts and feelings without needing to distract is the ultimate goal, I'd much rather that someone distract than relapse!

Here are my general guidelines for healthy distraction:

1) It should be time-limited, and the client should return to the problem/distressing thought/feeling as soon as they are able to safely do so.

2) Distraction is better for distress/triggers that are by nature time-limited, rather than an ongoing problem or emotional state. For example, distress works well for urges, or physical discomfort that will pass (e.g., fullness for clients with eating disorders), but less well for a problem that requires action (e.g., school difficulty, relationship conflict), or an emotion.

3) It should not be the first coping strategy the client tries. They should first try strategies that allow them to process their internal experiences (mindfulness, self-soothing, journaling, seeking support, etc.), and only turn to distraction if these other methods aren't working, and they don't think they can safely continue trying other things.

What do you think about distraction as a coping strategy? When is it helpful, and when might it be harmful?

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