CARESS is a coping strategy that helps us regain our sense of emotional and physical control. This three-step process, developed by Lisa Ferentz, incorporates both the right and left hemispheres of the brain, helping us to more fully understand and remember information. CARESS also reinforces self-efficacy, the belief that we are capable and can succeed in a specific situation. Ultimately, CARESS is a wonderful reminder that the tools we need to calm ourselves are within us.
When we feel emotionally wobbly or unsteady, it is important to keep in mind that our mix-ups made sense at some point in our lives. We misread people’s intentions and respond too little or too much, not because we are broken or crazy, but because we are reenacting with old and outdated coping strategies. Rage may have been the only way we could defend ourselves. Losing our footing, falling down, falling short, or laying low may have been the strategies required to keep ourselves safe in childhood. Cutting off our noses to spite our faces may have been the only avenue we had to express our indignation.
These once appropriate, now outmoded, ways of defending ourselves can be costly, and part of therapy is figuring out better alternatives. In support of growing and learning, it is imperative that we appreciate how far we have come to get to where we are, reminding ourselves that we have already peeled away many layers of the onion. Holding compassion for ourselves is critically important to healing. As Ferentz so aptly expresses: “Punitive, harmful acts [to ourselves or others] are a form of metacommunication and the destructive behaviors are presentative of pain narratives.” In other words, we are reenacting and re-story-ing other prior traumatic experiences in a (maladaptive) effort to heal.
CARESS helps us change our state of mind and body when we are triggered and stuck in negative and destructive reactivity. When hyper- or hypo-aroused, we have difficulty accessing the resources we need most—to think clearly; to strategize; and to mentalize, which is the capacity to imagine what the other person is thinking and feeling while simultaneously being aware of feeling your own thoughts and feelings. Isolation and alienation are, unfortunately, part of the legacy of trauma. (See Triggering and the Window of Tolerance.)
What follows is a brief explanation for each step in CARESS, followed by the actual activity which is bolded and bulleted for your convenience. It is important that you follow the three steps of CARESS in order and set a timer to help you keep approximate track of the time. (It is possible, in a pinch, though not optimal, to run through the steps in five- to ten-minute segments.) By the end of the cycle, 30 to 45 minutes total, you will have hopefully shifted into a different emotional, mental, and/or physical state.
1. CA in CARESS stands for Communicate Alternatively
(for 10 – 15 minutes)
Because the raw emotion of trauma is stored in the body, acting it out can be a way to communicate unresolved needs, thoughts, and feelings. We can be relieved of a traumatic memory, lessening its power to overtake us, by simply naming it and knowing the objective specifics and the narrative sequence of how it happened, without interpretation. Talking to a reliable witness to the event that upset you may be helpful to help ground you and recall what actually happened—thereby better managing the consequences.
In this first activity, you will try to look at the trauma narrative through a different lens by involving the right side of the brain. Rather than acting out the panic, this step will help you process negative and intense feelings in alternative ways: visually, aurally, and through language.
Safe ways to express and understand your feelings might include:
drawing, painting,or collaging the feeling
writing a poem or song about the feeling
dictating/recording your voice talking about the feeling
writing yourself a letter or an email
playing a musical instrument that expresses the feeling
2. RE in CARESS stands for Release Endorphins (for 10 – 15 minutes)
Endorphins occur naturally and act on the opiate receptors in our brains to reduce pain and boost pleasure. Endorphins can be released by pleasurable activities like a burst of exercise, big laughs, hugging, and sex, as well as through less healthy outlets which include compulsive behavior like gambling, shopping, cutting, YouTubing, gaming, over-eating, or food-deprivation.
Some healthy ways to release endorphins that facilitate relief and restore a sense of well-being include exercise and aerobic activity. Additionally, exercise helps us feel competent and strong.
Safe ways to release endorphins include:
running up and down the stairs; doing jumping jacks
going on a fast walk or jog
getting on an elliptical, bicycle, or treadmill
belly-laughs: watching stand-up comedy or babies laughing or animal tricks
hugging a pillow, a pet, a stuffed animal (a tree !)
3. SS in CARESS stands for Self Soothe (for 10 – 15 minutes)
Self-care is often treated like a luxury when, in fact, it is essential to managing anxiety and protecting ourselves from triggering events. If we are having trouble with emotional regulation and clear thinking, we probably need some reminders about how to self-soothe and maybe some planning ahead to believe it will even work.
Self-soothing might include:
rocking in a rocking chair wrapped in a blanket
taking a candle-lit bath
giving yourself a hand massage with lotion
listening to soothing music, a podcast, or relaxation exercise
drinking a cup of tea
getting out in nature to look at the trees and sky, listen to birds.
CARESS involves changing our mental and emotional states in order to center ourselves and restore better cognitive discernment and emotional regulation. Through creative and alternative perspectives, body work, and self-soothing we can not only manage but transcend past challenges.
(For more coping strategies, also see Emotional Grounding and Emotional Range and Emotional Regulation.)
Resource:
Treating Self-Destructive Behaviors in Trauma Survivors: A Clinician’s Guide, Lisa Ferentz