Let’s talk about self-soothing

I talk to a lot of health professionals and it amazes me how often people look at me blankly when I introduce the subject of self-soothing activities. As the conversation progresses I can see most of the blank looks turn to some degree of understanding as they begin to acknowledge the familiarity of the concept in their own lives, but GPs in particular are not generally familiar with the fact that teaching people about emotional management strategies is a core part of therapy, and an intervention that is entirely available to them in general practice.

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I talk to a lot of health professionals and it amazes me how often people look at me blankly when I introduce the subject of self-soothing activities. As the conversation progresses I can see most of the blank looks turn to some degree of understanding as they begin to acknowledge the familiarity of the concept in their own lives, but GPs in particular are not generally familiar with the fact that teaching people about emotional management strategies is a core part of therapy, and an intervention that is entirely available to them in general practice.  

How should we start the conversation?

In talking to health professionals about self-soothing, I find its good to start the conversation with a discussion what they do to manage their own emotions. People often don’t realise that the cup of tea after a difficult consultation, the long run during study time, the break to pat the dog or the sudden need to play loud music and sing along constitute emotional self-management. They also don’t realise that lots of people who get into trouble with emotionally-driven behaviour simply have no idea how to manage their emotions for themselves – or indeed that such a thing is possible.

In my experience the best way to start a conversation with a group of health professionals (or a patient for that matter) is to give them some examples of the things I, and the people I know, do to help themselves through rough patches. Somewhere in all that the lights start to go on.

Do we really need to be taught these things?

I don’t remember actively teaching my children about emotional management – they seemed to work it out for themselves. Either that or they just watched what was happening around them and modelled their behaviour accordingly. Not all children have the capacity to work such things out for themselves. Not everyone experiences good modelling. And some of us simply have such intensity of emotion that we are too overwhelmed by our emotional states to ever think about actively intervening.

Marsha Linehan acknowledged all this when she made emotional management a core part of Dialectic Behaviour Therapy’s (DBT) skills learning modules. Yes, difficulty with emotional management is central to the borderline personality disorder that DBT was developed to treat, but it extends way beyond that. Difficulty managing emotions is often a big part of childhood behaviour difficulties. Often adults with anger management problems have never learnt ways of managing their emotions generally, not just anger. There are many people whose only emotional management strategy is to use drugs and alcohol, and therein lies whole other set of problems.

Self-soothing with sensory interventions

Most of us already understand about sensory interventions at some level. We feel better when we move, when we listen to our favourite music, when we smell the roses, when we eat something tasty, when we take a shower or a bath or a swim or just stand in the rain.

I think this article by an occupational therapist about sensory interventions in traumatised children that I found on the Australian Childhood Foundation blog is of great interest. It opened my eyes to some new kinds of sensory strategies that can be used in difficult situations to help manage behaviour.  It underlines the need to be sure include the sensory element in the conversation about self-soothing, not just the cognitive.

Harmful self-soothing

The most important thing to remember in a quest for improved emotional management is that self-soothing behaviour should not be harmful. Deliberate self-harm works to mitigate emotional extremes for some people, but it is definitely not, by definition, harmless. Alternative strategies need to be found. Some places on the internet (and some therapists) advocate techniques that involve pain to help soothe frayed emotions (eg holding ice in your hands until you can no longer stand the pain) but these sorts of techniques need to be approached with caution, if at all. They are often in themselves potentially harmful and can be only a step away from actual self-harm.

Some people call self-soothing strategies “grounding techniques”. If you put either of those terms into your favourite search engine you will find an overwhelming amount of advice. It’s important that people experiment to the strategies that suit them best. The internet can help them find ideas but a practitioner willing to have one or more conversations with them about how to find the best strategies for them may be a more inspiring option.  

When should we bring up the subject of self-soothing?

Anyone who is stressed (ie. almost everyone who seeks the advice of a health care professional) probably needs a reminder about the ways they can help themselves through a difficult period. A simple enquiry is all that may be needed to bring the issue to the front of mind.

It’s important that people, especially children, understand that consciously finding and using strategies to help manage their emotions is a normal part of growing up and definitely a subject worth discussing.

Let’s not wait until our kids have discovered the excellent self-soothing capacity of drugs, alcohol, starvation and self-harm before we talk to them about it. Let’s start talking about it now!

 

 

 

 

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Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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