DBT Distress Tolerance Skills II

Let’s take a look at how we can cope with overwhelming negative emotions and seemingly intolerable situations in Part II of Distress Tolerance Skills.

Again, I underscore the fact that we must not be tempted to think they are all we need to sail through life. No, there are times, many in fact, when we have to go about with figuring out how to Change situations. We’ll learn Change strategies after we learned (and practiced, practiced, practiced) the Acceptance Strategies in the Mindfulness and Distress Tolerance Modules.

If this sounds like a lot…it is. You may recall that in learning how to be a DBT therapist, I committed to learning and practicing using the knowledge in my own life over the course of a year. Once you too have done that, they will stick and become part of your way of being in the world.

As has been said, distress tolerance behaviors are concerned with tolerating and surviving crisis situations and accepting life as it is in the moment. Four sets of crisis survival strategies are taught:

• distracting (with activities, doing things that contribute, comparing oneself with people less well off, engaging in opposite emotions to the ones you are feeling, pushing away painful situations, other thoughts and intense other sensations)

• self-soothing (via vision, smell, taste, touch and hearing)

• improving the moment (with imagery, meaning, prayer, focusing on one thing in the moment, self-encouragement, and taking a vacation or

  a break in responsibilities/a change of scene no matter how seemingly small)

• thinking of pros and cons

All of those strategies begin with Radical Acceptance. That is not always easy. We have to turn our minds toward accepting the reality of the situation. We have to remind ourselves to be Willing to do this even in the face of feeling Unwilling because we think it implies acceptance of the situation, the person who we view as having created the situation, or all the other people who consider this particular situation “right.”

There are more than 20 individual skills you could use. Will you find all of them equally useful? The answer is probably not but the only way to find out is to try each one.

Remember in the Mindfulness Module we spoke about Wise Mind (the state of balanced thinking combining both emotional and rational/logical perspectives)? Here is a phrase which will help you recall the 7 distracting skills: “Wise Mind ACCEPTS”

• Activities (which elicit emotions opposite what you are feeling)

• Contributing (refocuses attention from self to others with concrete behaviors)

• Comparing (considering others who are in a worse situation)

• Emotions (generating less negative emotions than what you are feeling)

• Pushing away (actually leaving a situation or blocking dwelling on it in one’s mind)

• Thoughts (thinking about more pleasurable things)

• Sensations (holding ice cubes, for example, when feeling red hot with rage)

Self-soothing behaviors are the most straight-forward (in my opinion). The various means are based on individual preference. Going into nature is soothing for many and combines sight, smell, and hearing. Akin to that for me is placing the essence of hinoki into a diffuser and taking in the aroma. Some enjoy being on a beach smelling the salt air, hearing the waves and sea birds, feeling the sand underfoot, watching the ocean and whatever is in/on it is soothing. Sitting at home listening to music is something many do. I’m quite certain you know what there is available to you to draw upon.

Improving the Moment is replacing the immediate negative events with more positive ones. A way to help remember those 7 skills is the word “IMPROVE”:

• Imagery ( taking yourself in your mind to another place which is more peaceful to distract, soothe)

• Meaning (consider the purpose of your life)

• Prayer

• Relax (try to un-tense your body by progressive muscle relaxation)

• One thing in the moment (remind yourself the goal is to get through one moment at a time rather than look at the next 16 hours)

• Vacation from some of your adult activities (for example a night of fast-food rather than a several course meal or sitting around and doing absolutely nothing for a few hours)

• Encouragement (aka cheerleading yourself by talking to yourself as you would a dear friend)

Finally, the last skill is Pros and Cons. Specifically it is thinking about and making a list of the positive and negative aspects of tolerating the distress and a list of the positive and negative aspects of not tolerating your distress. Sometimes people forget they are to do both the pros and cons for each stance. Here’s an easy example. If you have a puppy who naturally wants to hang around the table as people are eating and who begins to beg for food, what are the pros and cons of acquiescing to the little cutie and giving some handouts and the pros and cons of not indulging the begging behavior by not allowing the dog to come to the table.

I know the above is a lot to take in. It certainly will require more than a week to try out those skills to discover what is most useful. Just take it easy. Start using the ones you already find helpful. I included an image of a woman gardening because I myself find that pleasureable but it may not at all be something you care about. Another thing to keep in mind is that we change…what we once enjoyed may not hold the same meaning or enjoyment. Please look at all of this as an exploration. We are all works in progress.

Next week let’s give ourselves the gift of thinking about other topics. If you have some ideas (I know you have lots), let us know. And if you have questions about Distress Tolerance Skills, please ask.

See you next week, Dear Friends.