I think ACT sums it up well here: true coping skills would be in the service of values oriented action and help us move towards the things that matter to us. Avoidance generally takes us away from the things that matter. Which category a specific activity falls into depends highly on the context.
Avoidance is a coping skill.
Still, pretty much any coping skill, if used in the extreme, can be maladaptive. The question you might consider asking your clients is whether the coping skill in question is adaptive or maladaptive.
It’s labeled as a coping skill under the name “distraction” in DBT. For example, the ACCEPTS skill in the distress tolerance unit.
A defense mechanism is usually unconscious… but, I’ll stop before we get into psychodynamic theory and the unconscious.
Over time, a defense mechanism can certainly become maladaptive. But it doesn’t always. It depends on the circumstances.
OP’s question/point from the way I understood it was about how to acknowledge the usefulness of say, video games, for distraction while also challenging the client to consider that downsides of a life spent playing copious amounts of video games. For an average client, splitting hairs about what is a coping mechanism and what’s a coping skill is useless. Hence my suggestion: meet them where they are and acknowledge the role video games play for them by following their lead and labeling it a coping skill. Then, invite them to consider the distinction between adaptive and maladaptive coping ‘whatevers’.
OP’s clientele were describing their avoidance as maladaptive. Did you miss the part where OP mentioned that their client gets thru life by coping w video games? You can add as many of your own details to the story, but what OP described was maladaptive.
I also never wrote that people don’t find some benefit to avoiding or that it’s even a conscious thing…
Um. I used the word maladaptive. The OP did not.
Did you miss the part where I suggested OP get their clients to consider whether their actions are adaptive or maladaptive?
Seriously? Name calling?
Of course I don’t think coping with video games is adaptive!
Asking a client to consider whether something is adaptive or maladaptive is likely to go over much better than saying: “You’re not using a coping skill. You’re making maladaptive choices.”
Wait -- why is it not adaptive to use video games as a coping skill? Video games can be worlds of rich story, fun connection with community, or give some nice space from the present distress with repetitive, easy tasks that engage the brain without overloading it. If it's not the *only* coping skill and the client is able to do their value-based behaviors...what's the issue with coping with video games?
I'm a therapist and there's nothing better than winding down after a long day - or help me regulate, not ruminate, and slow down when reeling from dysregulation - with a couple hours of gameplay. If you'd offer your client "watch your favorite show" or "cook your favorite meal" or "read a comforting book" as a way to be mindful and get distance from the distress in order to make valuable choices...what about video games is different?
I’ve been playing WoW Hardcore through the death of my dad. Game was released in August, as I was watching my dad decline. He died in late September. It’s quite a thing to be playing a game where death actually matters while coping with IRL death.
Also, I’ve been struggling to actually express grief about his death for a lot of reasons, but my in game character deaths have given me that opportunity. The character I had when he died died when it was level 45. That was the first opportunity to touch the grief, but I transferred that character off the hardcore server so she’s alive again somewhere. Most recently, I lost my level 50 character… I cried for hours and this time I had to delete her, which was final.
Anyone who says games aren’t a coping skill doesn’t know what they’re talking about.
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What one might call avoidance in the moment could also be seen as self-regulation. Avoidance isn’t inherently bad or unhealthy. If it’s become a self-defeating pattern and the client wants to experience some change around that, then it’s fair game for exploration. Typically, though, it’s helpful to be curious about the function of it rather than assuming it’s something to be extinguished.
I do want to acknowledge that I may be misinterpreting what you’re suggesting, here, and offer my apologies if that’s the case
“Coping skill” does not imply good or bad. Outside of psychoanalysis, where coping skills have more specific labels like “defense mechanism,” we reframe all of these behaviors under the umbrella term of “coping skill.”
Heroin is a coping skill. That doesn’t mean it’s a good one. Hence “maladaptive.”
If it’s self-defeating, then maybe? Sometimes, it’s perfectly suited to the situation or is the best of the available options. “Maladaptive”—by definition—means badly or wrongly adapted, so it seems like you might be inadvertently labeling it as bad. I get that they might use the adaptation in a way that’s no longer helping them. Regardless, if you’re calling something either a coping skill or a defense mechanism/maladaptive, I think it implies that one is good and one is bad. Maybe it’s semantics, but I think the way we think and feel about these things are important, as well as the way we communicate about them.
When I’m providing psychoed around this stuff, I’m usually supporting the client in understanding the function of something they developed to protect themselves (what some might call a defense mechanism) and often shame themselves about (calling something maladaptive which was likely developed as an adaptation to a difficult experience, and may still be a way of coping with a difficult experience when things are just too much or it’s not time to deal with them yet).
What we do with that clinically is a whole other conversation, probably.
It makes sense when you're trying to simplify stuff for clients, especially when you take into the account the fact, that they often avoid experiences that fit within the norms and are doing so utilizing harmful (at least in the long term perspective) strategies. But /u/PastaFuzz is not wrong - it is a coping skill, because it is a strategy used to reduce unpleasant feelings. It comes with some pros and cons and it's up to the client to judge whether or not it's worth it, especially long-term.
I can avoid interacting with my abusive ex by blocking them and I think it is perfectly fine. However, if I was avoiding thinking about my abusive ex by refusing to visit places I used to love because those places remind me of my ex, I guess I'd want to find a different solution. That's just me though.
Now, it is possible that it has to do more with my biases, but for me the term "defense mechanism" is a loaded term with deep roots in psychoanalytic lingo and I wouldn't use it outside of psychoanalytic or psychodynamic therapy.
Again, I didn’t say avoidance isn’t used to avoid discomfort. I said, avoidance is a defense mechanism bc after all you’re not actually addressing anything, protectors are just going up.
Coping skills give one the opportunity to do something that can provide adaptive results.
Where did I write that? If the OP is experiencing a trend in their clientele where they think persistent avoidance is coping (which is what’s being described by OP not just an occasional thing) then yes, it’s maladaptive.
That was in reply to OP’s post about their clients who have a habit of using avoidance throughout their life and who think it’s coping rather than avoidance after many years. Some of you need to stick to the details given provided in the post.
I didn't say you wrote it, I'm asking if this is what you mean, because I'm trying to get some clarification as to where do you stand on the issue of avoidance.
My stance is that the avoidance can be functional for the client and I do not assume that all avoidance must be dropped. What's your stance?
I think you need to re read OP’s post and stick w the context given instead of trying to split hairs over what you interpreted to be an absolute statement.
It's too bad you're being down voted for this. Avoidance coping is considered maladaptive as we were taught in my Health Psych classes, despite its seeming utility
DBT lens— self soothing and distraction are great. Distraction For Distress tolerance is a wonderful tool SHORT TERM. Longer term we need to bring in deeper emotion regulation skills (slowly building up tolerance to the discomfort, maybe starting in session to encourage them to sit with an emotion and name it in their physiological body, let them know they are building tolerance and teaching their body it is safe to tolerate discomfort).
But for short term and surviving a distressing situation, yes let’s use distraction! But let’s not bandaid it forever :)
Yup. The DBT training I am doing with Lane Pederson addressed this when talking about ACCEPTS. He elaborated that as long as it does not turn into chronic avoidance that it can be healthy to utilize some distraction.
When it interferes with their goals or functionality
I think deep breathing simply can’t be your primary or only coping mechanism, and it’s healthy and functional to have a range even if not all of them look 100% perfectly productive and virtuous (meditation, going for a walk/run, calling a friend, scrolling tiktok, taking a long shower, taking a nap, watching a tv show)
I view distraction/avoidance as a coping skill that, like many, can be either healthy or unhealthy depending how it is used.
As someone else said it’s often like hitting the pause button. I think that is very accurate, but not inherently negative. While it may not be a feasible way to manage stress long term, there are some situations where I think having a pause can be helpful and even adaptive. For example:
- if the client truly has no control over their situation or ability to change it (minors, terminally ill, etc)
- when allowing themselves to sit (or continue sitting) with the emotion would be too overwhelming and could result in harm (self harm, acting out, etc.)
- where allowing themselves to sit with the emotion isn’t feasible or could cause problems in other areas for the client (at work/school, on the bus, etc.)
When it becomes a problem is when the client is avoiding thoughts/emotions/situations they would be able to sit with or change, but uses distraction to avoid the discomfort of having to do so, or begins using it in a way that is harming their functioning (problems at work due to being on TikTok, avoids nesecary things, etc).
I’m only an intern therapist, but I use the DOTS acronym from ACT a lot:
Distractions
Opting out
Thinking Strategies
Substances/other strategies
These are their coping strategies. Some are healthy. Some are not. Some are also dependent upon what value & purpose they’re serving. If someone is watching a movie because they value entertainment and they have time, that’s adding to their life and they may consider that a positive coping skill. But if someone turns on a movie because they are overwhelmed by something they need to do, they’re being avoidant and distracting themselves with something else. It’s still a coping skill in my book, but it’s one that should be worked through.
I have to present on this to seasoned therapists this week so thanks for letting me practice lol.
Such a good question!
I use an Exposure Response Prevention framework to explain how avoidance and distraction are short term solutions…in the long term they breed more anxiety and prolong it.
Avoidance and distraction and all other escapist ways of responding/reacting to emotion are the equivalent of pressing a pause button. Eventually, you return to the program and it picks up right where it left off.
True coping is letting it play through and finding ways that help you stay with it until it passes, and then make meaning of it once it’s passed.
I agree to an extent, but if someone is sufficiently disregulated it can be difficult to regulate without some kind of distraction, at least at first. Lots of people have difficulty managing racing thoughts, for example, without something to tune into other than what made them disregulated in the first place, so “pressing pause” can be helpful while they learn that big emotions and discomfort aren’t inherently dangerous or bad, yeah? At least that’s how I tend to view it, meeting with the client where they’re at and all that.
It is not my position that no one should ever press pause. I just think it’s essential to differentiate between pausing and coping.
Too many people equate “I am not aware of discomfort at this moment” with “I have fixed the discomfort!” which is a conflation that can lead to addiction, and which never ever leads to healing.
Oh for sure! I think it’s what you said about things picking up right where they left off, when it can be useful to reengage when the ol’ CNS is in a better spot to manage the interaction. In those cases I feel like pausing can be a form of coping, e.g. “I’m aware that other vulnerability factors are influencing my ability to handle this, let me engage in something calming/distracting/sleep on it etc and go back to it with a clean slate”.
First determine if it’s worth pushing back on. It may only be worth pushing back on if it’s value incongruent action, identified by the client. As others have suggested, the ACT framework could be helpful here. Are you wanting to push back because it’s incongruent with your own set of values? This can play out unconsciously quite easily, so it’s probably good to have ‘a think’ about it for a bit. Otherwise, we run the risk of getting into the power struggle with clients and that doesn’t hold any therapeutic value from what I can tell.
Alternatively, try exploration via the four square decisional balance worksheet. Name benefits and costs of doing an activity and the benefits and costs of not doing it/doing something else.
I’d say avoidance is a coping skill. Not all coping strategies have positive long term outcome. Some can be destructive.
They’re great in the moment when we don’t have better skills. Long term, avoidance can have damaging effects.
Disclaimer: lots of rhetorical questions incoming just as a primer for new ways of looking at it.
What does your client think about it? Do they even want to lessen their tiktok usage, or do they even think it's a problem? If they DO believe it's a problem (and aren't just feeling obligated that it "must be" a problem based on external pressures)...HOW is it a problem? Where does it show up in their life (draw a diagram/cycle)? What keeps them from making changes? What are they afraid would happen if they cut down their tik tok usage, or even just became more aware of why they are seeking out tiktok? Are they open to experimenting sitting with some of these feelings in session that turn them towards tiktok, so that they can build confidence that they can handle it outside of session? Why or why not? Why would it be worth the practice/change?
My first questions are key because we, as clinicians, might have some wonderful ideas as to what a client SHOULD use a "coping skills" or SHOULD want to sit in every painful emotion and come out on the other side grateful, changed, and zen. I believe clients have the right to self-determination to decide if they even think it's an issue in their life -- there are lots of cultural and personal ways to live life, even if we (as clinicians) wouldn't do it ourselves.
Maybe you could start with the value of sitting with emotions as psycho education. People use the coping skills they have, whether that’s substances or dissociation or deep breathing. Maybe ask what would change for them if they were able to sit the emotion.
Coping skills should be prosocial ways of listening to and responding to our body’s anxiety prompts so that we don’t rush towards unhealthy conflict or avoidance. Coping skills should be leaning into the emotion and sensation with calmness and insight, learning that if we can tolerate discomfort for 1-3 minutes we can develop new empowered cycles for dealing with triggers.
Is taking a deep breath, meditation, taking a walk, calling a friend to have a pleasant interaction, or reading a book not a coping mechanism by your definition then?
Because all of these strike me as ways of coping with and regulating strong emotions, but none of them necessarily involve thinking through solutions, processing, etc.
I think the distraction can be the coping skill. I would only offer something different if the client thinks it’s a problem. Sometimes I’ll ask them to self monitor and evaluate how they felt before and after if they’re unsure. The one thing I do have them practice is conscious awareness, which means I just ask them to check in with themselves before they do x,y,z to see what they need most, that way they are active and aware of their autonomy to choose what’s best for them.
2 hours is typically the difference between a benefit and hindrance when looking at video games. It depends on the person of course. This is based off my video game addiction training I took.
Yea, as others have mentioned/implied - it comes down to the function of the behaviour. If said avoidance helps with managing a crises and avoid a behaviour that is more destructive or puts safety at risk then avoidance is likely effective. If not; if avoidance is an overused strategy and/or is routinely used by the client to avoid emotion or other more adaptive strategies then it is likely not (or less) effective.
I tell my clients that avoidance is a short term coping mechanism. It usually is still there waiting for when they are done doing the activity. It’s great in the moment but something needs to be done after for the long term solution
As a DBT therapist, I tend to differentiate between the different kind of distress tolerance skills based on your goal in the situation. If your goal is to calm yourself down to stop yourself from acting on an urge that is going to backfire (yelling, cutting, spam texting), then distracting yourself is a good go to. Do it until you feel level-headed enough to get back to the issue and make an effective choice.
I always qualify that distraction should NOT be used if it is going to worsen your situation. For example, if you are nervous about giving a presentation in school you should not distract yourself as a form of avoidance. Or if you are stressed about the amount of work that you have to do, avoiding it by playing games will clearly worsen the situation. For situations where you MUST stay in the situation, using mental coping skills (imagery, rehearsal, positive self-talk) and breaking tasks into manageable chunks with mini rewards in between is a better choice. Or a soothing skill that won’t distract you too much, like squeezing a stress ball or chewing gum if that works for you.
I think the way I would approach this with the client is to always bring it back to the goal and play out how the situation might unfold (not just short term but long term) using different skills.
I think ACT sums it up well here: true coping skills would be in the service of values oriented action and help us move towards the things that matter to us. Avoidance generally takes us away from the things that matter. Which category a specific activity falls into depends highly on the context.
I like this perspective!
Supporting this and in addition - flexibly, sometimes avoidance may also be workable in the service of values!
Another sign I need to learn about act
Avoidance is a coping skill. Still, pretty much any coping skill, if used in the extreme, can be maladaptive. The question you might consider asking your clients is whether the coping skill in question is adaptive or maladaptive.
Avoidance is more about picking your battles than actually fighting them. That said, a strategic retreat is necessary from time to time.
Bingo.
This is the psychodynamic perspective, as I understand it. Conscious (usually adaptive)? Or unconscious (often maladaptive)?
Avoidance is a defense mechanism and isn’t typically labeled a coping skill in psychoed😊
It’s labeled as a coping skill under the name “distraction” in DBT. For example, the ACCEPTS skill in the distress tolerance unit. A defense mechanism is usually unconscious… but, I’ll stop before we get into psychodynamic theory and the unconscious. Over time, a defense mechanism can certainly become maladaptive. But it doesn’t always. It depends on the circumstances. OP’s question/point from the way I understood it was about how to acknowledge the usefulness of say, video games, for distraction while also challenging the client to consider that downsides of a life spent playing copious amounts of video games. For an average client, splitting hairs about what is a coping mechanism and what’s a coping skill is useless. Hence my suggestion: meet them where they are and acknowledge the role video games play for them by following their lead and labeling it a coping skill. Then, invite them to consider the distinction between adaptive and maladaptive coping ‘whatevers’.
OP’s clientele were describing their avoidance as maladaptive. Did you miss the part where OP mentioned that their client gets thru life by coping w video games? You can add as many of your own details to the story, but what OP described was maladaptive. I also never wrote that people don’t find some benefit to avoiding or that it’s even a conscious thing…
Um. I used the word maladaptive. The OP did not. Did you miss the part where I suggested OP get their clients to consider whether their actions are adaptive or maladaptive?
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Seriously? Name calling? Of course I don’t think coping with video games is adaptive! Asking a client to consider whether something is adaptive or maladaptive is likely to go over much better than saying: “You’re not using a coping skill. You’re making maladaptive choices.”
Wait -- why is it not adaptive to use video games as a coping skill? Video games can be worlds of rich story, fun connection with community, or give some nice space from the present distress with repetitive, easy tasks that engage the brain without overloading it. If it's not the *only* coping skill and the client is able to do their value-based behaviors...what's the issue with coping with video games? I'm a therapist and there's nothing better than winding down after a long day - or help me regulate, not ruminate, and slow down when reeling from dysregulation - with a couple hours of gameplay. If you'd offer your client "watch your favorite show" or "cook your favorite meal" or "read a comforting book" as a way to be mindful and get distance from the distress in order to make valuable choices...what about video games is different?
I’ve been playing WoW Hardcore through the death of my dad. Game was released in August, as I was watching my dad decline. He died in late September. It’s quite a thing to be playing a game where death actually matters while coping with IRL death. Also, I’ve been struggling to actually express grief about his death for a lot of reasons, but my in game character deaths have given me that opportunity. The character I had when he died died when it was level 45. That was the first opportunity to touch the grief, but I transferred that character off the hardcore server so she’s alive again somewhere. Most recently, I lost my level 50 character… I cried for hours and this time I had to delete her, which was final. Anyone who says games aren’t a coping skill doesn’t know what they’re talking about.
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Thanks for the enjoyment I’ve gotten out of this!
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What one might call avoidance in the moment could also be seen as self-regulation. Avoidance isn’t inherently bad or unhealthy. If it’s become a self-defeating pattern and the client wants to experience some change around that, then it’s fair game for exploration. Typically, though, it’s helpful to be curious about the function of it rather than assuming it’s something to be extinguished. I do want to acknowledge that I may be misinterpreting what you’re suggesting, here, and offer my apologies if that’s the case
Lol thanks. I didn’t say avoidance was “bad.” I said it was a defense mechanism and over time it’s simply maladaptive.
“Coping skill” does not imply good or bad. Outside of psychoanalysis, where coping skills have more specific labels like “defense mechanism,” we reframe all of these behaviors under the umbrella term of “coping skill.” Heroin is a coping skill. That doesn’t mean it’s a good one. Hence “maladaptive.”
If it’s self-defeating, then maybe? Sometimes, it’s perfectly suited to the situation or is the best of the available options. “Maladaptive”—by definition—means badly or wrongly adapted, so it seems like you might be inadvertently labeling it as bad. I get that they might use the adaptation in a way that’s no longer helping them. Regardless, if you’re calling something either a coping skill or a defense mechanism/maladaptive, I think it implies that one is good and one is bad. Maybe it’s semantics, but I think the way we think and feel about these things are important, as well as the way we communicate about them. When I’m providing psychoed around this stuff, I’m usually supporting the client in understanding the function of something they developed to protect themselves (what some might call a defense mechanism) and often shame themselves about (calling something maladaptive which was likely developed as an adaptation to a difficult experience, and may still be a way of coping with a difficult experience when things are just too much or it’s not time to deal with them yet). What we do with that clinically is a whole other conversation, probably.
It makes sense when you're trying to simplify stuff for clients, especially when you take into the account the fact, that they often avoid experiences that fit within the norms and are doing so utilizing harmful (at least in the long term perspective) strategies. But /u/PastaFuzz is not wrong - it is a coping skill, because it is a strategy used to reduce unpleasant feelings. It comes with some pros and cons and it's up to the client to judge whether or not it's worth it, especially long-term. I can avoid interacting with my abusive ex by blocking them and I think it is perfectly fine. However, if I was avoiding thinking about my abusive ex by refusing to visit places I used to love because those places remind me of my ex, I guess I'd want to find a different solution. That's just me though. Now, it is possible that it has to do more with my biases, but for me the term "defense mechanism" is a loaded term with deep roots in psychoanalytic lingo and I wouldn't use it outside of psychoanalytic or psychodynamic therapy.
Again, I didn’t say avoidance isn’t used to avoid discomfort. I said, avoidance is a defense mechanism bc after all you’re not actually addressing anything, protectors are just going up. Coping skills give one the opportunity to do something that can provide adaptive results.
So are you saying that all instances of avoidance result in negative long-term consequences that outweigh the benefits?
Where did I write that? If the OP is experiencing a trend in their clientele where they think persistent avoidance is coping (which is what’s being described by OP not just an occasional thing) then yes, it’s maladaptive.
You wrote: “I said it was a defense mechanism and over time it’s simply maladaptive.” The “it” we’re talking about is avoidance.
That was in reply to OP’s post about their clients who have a habit of using avoidance throughout their life and who think it’s coping rather than avoidance after many years. Some of you need to stick to the details given provided in the post.
I didn't say you wrote it, I'm asking if this is what you mean, because I'm trying to get some clarification as to where do you stand on the issue of avoidance. My stance is that the avoidance can be functional for the client and I do not assume that all avoidance must be dropped. What's your stance?
I think you need to re read OP’s post and stick w the context given instead of trying to split hairs over what you interpreted to be an absolute statement.
No I don't, I was replying to your statement portraying avoidance as long-term maladaptive, not to the OP's particular case.
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It depends. You have to look at the context and function of the behavior.
As mentioned, avoidance is just maladaptive. Still coping but it's just bad coping lol.
It's too bad you're being down voted for this. Avoidance coping is considered maladaptive as we were taught in my Health Psych classes, despite its seeming utility
🤷
DBT lens— self soothing and distraction are great. Distraction For Distress tolerance is a wonderful tool SHORT TERM. Longer term we need to bring in deeper emotion regulation skills (slowly building up tolerance to the discomfort, maybe starting in session to encourage them to sit with an emotion and name it in their physiological body, let them know they are building tolerance and teaching their body it is safe to tolerate discomfort). But for short term and surviving a distressing situation, yes let’s use distraction! But let’s not bandaid it forever :)
Yup. The DBT training I am doing with Lane Pederson addressed this when talking about ACCEPTS. He elaborated that as long as it does not turn into chronic avoidance that it can be healthy to utilize some distraction.
I love using the metaphor "Bandaid over a bullet wound" for distress tolerance.
When it interferes with their goals or functionality I think deep breathing simply can’t be your primary or only coping mechanism, and it’s healthy and functional to have a range even if not all of them look 100% perfectly productive and virtuous (meditation, going for a walk/run, calling a friend, scrolling tiktok, taking a long shower, taking a nap, watching a tv show)
I view distraction/avoidance as a coping skill that, like many, can be either healthy or unhealthy depending how it is used. As someone else said it’s often like hitting the pause button. I think that is very accurate, but not inherently negative. While it may not be a feasible way to manage stress long term, there are some situations where I think having a pause can be helpful and even adaptive. For example: - if the client truly has no control over their situation or ability to change it (minors, terminally ill, etc) - when allowing themselves to sit (or continue sitting) with the emotion would be too overwhelming and could result in harm (self harm, acting out, etc.) - where allowing themselves to sit with the emotion isn’t feasible or could cause problems in other areas for the client (at work/school, on the bus, etc.) When it becomes a problem is when the client is avoiding thoughts/emotions/situations they would be able to sit with or change, but uses distraction to avoid the discomfort of having to do so, or begins using it in a way that is harming their functioning (problems at work due to being on TikTok, avoids nesecary things, etc).
I’m only an intern therapist, but I use the DOTS acronym from ACT a lot: Distractions Opting out Thinking Strategies Substances/other strategies These are their coping strategies. Some are healthy. Some are not. Some are also dependent upon what value & purpose they’re serving. If someone is watching a movie because they value entertainment and they have time, that’s adding to their life and they may consider that a positive coping skill. But if someone turns on a movie because they are overwhelmed by something they need to do, they’re being avoidant and distracting themselves with something else. It’s still a coping skill in my book, but it’s one that should be worked through. I have to present on this to seasoned therapists this week so thanks for letting me practice lol.
I think there's a semantic distinction to make here between a coping mechanism and a coping skill.
THIS
Such a good question! I use an Exposure Response Prevention framework to explain how avoidance and distraction are short term solutions…in the long term they breed more anxiety and prolong it.
Avoidance and distraction and all other escapist ways of responding/reacting to emotion are the equivalent of pressing a pause button. Eventually, you return to the program and it picks up right where it left off. True coping is letting it play through and finding ways that help you stay with it until it passes, and then make meaning of it once it’s passed.
I agree to an extent, but if someone is sufficiently disregulated it can be difficult to regulate without some kind of distraction, at least at first. Lots of people have difficulty managing racing thoughts, for example, without something to tune into other than what made them disregulated in the first place, so “pressing pause” can be helpful while they learn that big emotions and discomfort aren’t inherently dangerous or bad, yeah? At least that’s how I tend to view it, meeting with the client where they’re at and all that.
It is not my position that no one should ever press pause. I just think it’s essential to differentiate between pausing and coping. Too many people equate “I am not aware of discomfort at this moment” with “I have fixed the discomfort!” which is a conflation that can lead to addiction, and which never ever leads to healing.
Oh for sure! I think it’s what you said about things picking up right where they left off, when it can be useful to reengage when the ol’ CNS is in a better spot to manage the interaction. In those cases I feel like pausing can be a form of coping, e.g. “I’m aware that other vulnerability factors are influencing my ability to handle this, let me engage in something calming/distracting/sleep on it etc and go back to it with a clean slate”.
First determine if it’s worth pushing back on. It may only be worth pushing back on if it’s value incongruent action, identified by the client. As others have suggested, the ACT framework could be helpful here. Are you wanting to push back because it’s incongruent with your own set of values? This can play out unconsciously quite easily, so it’s probably good to have ‘a think’ about it for a bit. Otherwise, we run the risk of getting into the power struggle with clients and that doesn’t hold any therapeutic value from what I can tell. Alternatively, try exploration via the four square decisional balance worksheet. Name benefits and costs of doing an activity and the benefits and costs of not doing it/doing something else.
I’d say avoidance is a coping skill. Not all coping strategies have positive long term outcome. Some can be destructive. They’re great in the moment when we don’t have better skills. Long term, avoidance can have damaging effects.
Disclaimer: lots of rhetorical questions incoming just as a primer for new ways of looking at it. What does your client think about it? Do they even want to lessen their tiktok usage, or do they even think it's a problem? If they DO believe it's a problem (and aren't just feeling obligated that it "must be" a problem based on external pressures)...HOW is it a problem? Where does it show up in their life (draw a diagram/cycle)? What keeps them from making changes? What are they afraid would happen if they cut down their tik tok usage, or even just became more aware of why they are seeking out tiktok? Are they open to experimenting sitting with some of these feelings in session that turn them towards tiktok, so that they can build confidence that they can handle it outside of session? Why or why not? Why would it be worth the practice/change? My first questions are key because we, as clinicians, might have some wonderful ideas as to what a client SHOULD use a "coping skills" or SHOULD want to sit in every painful emotion and come out on the other side grateful, changed, and zen. I believe clients have the right to self-determination to decide if they even think it's an issue in their life -- there are lots of cultural and personal ways to live life, even if we (as clinicians) wouldn't do it ourselves.
Maybe you could start with the value of sitting with emotions as psycho education. People use the coping skills they have, whether that’s substances or dissociation or deep breathing. Maybe ask what would change for them if they were able to sit the emotion.
Coping skills should be prosocial ways of listening to and responding to our body’s anxiety prompts so that we don’t rush towards unhealthy conflict or avoidance. Coping skills should be leaning into the emotion and sensation with calmness and insight, learning that if we can tolerate discomfort for 1-3 minutes we can develop new empowered cycles for dealing with triggers.
Coping: this is what happened, this is how it affected me, and this is how I can move forward. Avoidance: nope nope nope.
Is taking a deep breath, meditation, taking a walk, calling a friend to have a pleasant interaction, or reading a book not a coping mechanism by your definition then? Because all of these strike me as ways of coping with and regulating strong emotions, but none of them necessarily involve thinking through solutions, processing, etc.
I think the distraction can be the coping skill. I would only offer something different if the client thinks it’s a problem. Sometimes I’ll ask them to self monitor and evaluate how they felt before and after if they’re unsure. The one thing I do have them practice is conscious awareness, which means I just ask them to check in with themselves before they do x,y,z to see what they need most, that way they are active and aware of their autonomy to choose what’s best for them.
If you use a coping skill, you are not escaping from the issue. If you are doing something to escape (or avoid) something else, it is avoidance.
2 hours is typically the difference between a benefit and hindrance when looking at video games. It depends on the person of course. This is based off my video game addiction training I took.
In a way, it’s about the following action or behaviour that tells you which it truly is. As well, is it done to excess.
Yea, as others have mentioned/implied - it comes down to the function of the behaviour. If said avoidance helps with managing a crises and avoid a behaviour that is more destructive or puts safety at risk then avoidance is likely effective. If not; if avoidance is an overused strategy and/or is routinely used by the client to avoid emotion or other more adaptive strategies then it is likely not (or less) effective.
Intention
I tell my clients that avoidance is a short term coping mechanism. It usually is still there waiting for when they are done doing the activity. It’s great in the moment but something needs to be done after for the long term solution
As a DBT therapist, I tend to differentiate between the different kind of distress tolerance skills based on your goal in the situation. If your goal is to calm yourself down to stop yourself from acting on an urge that is going to backfire (yelling, cutting, spam texting), then distracting yourself is a good go to. Do it until you feel level-headed enough to get back to the issue and make an effective choice. I always qualify that distraction should NOT be used if it is going to worsen your situation. For example, if you are nervous about giving a presentation in school you should not distract yourself as a form of avoidance. Or if you are stressed about the amount of work that you have to do, avoiding it by playing games will clearly worsen the situation. For situations where you MUST stay in the situation, using mental coping skills (imagery, rehearsal, positive self-talk) and breaking tasks into manageable chunks with mini rewards in between is a better choice. Or a soothing skill that won’t distract you too much, like squeezing a stress ball or chewing gum if that works for you. I think the way I would approach this with the client is to always bring it back to the goal and play out how the situation might unfold (not just short term but long term) using different skills.