DISTRESS TOLERANCE: CRISIS SURVIVAL STRATEGIES

DBT teaches us four sets of skills for tolerating (dealing with, getting through, accepting) the distressing events and activities in our lives.


      1.  Distracting - Wise Mind ACCEPTS


      2.  Self-Soothing


      3.  Improving the Moment


      4.  Thinking of Pros and Cons

Look at p. 165, Distress Tolerance Handout 1. This lists all the skills. Also look at page 96 in the manual. and p. 166, the second part of Distress Tolerance Handout 1.

A useful way to remember these skills is by the acronym, "Wise Mind A C C E P T S"

Distract with A ctivities:

                 
                 Do hobbies, watch a video, go for a walk, play a sport,
                 cook, garden, go fishing, go shopping.


                 What other activities can you think of that you can get
                 involved in and distract yourself from your distress?


                 Make a list of your activities and put it up on your
                 refrigerator, so you can find it in a hurry.

Distract with C ontributing:


                 Contribute.  Do volunteer work.  Babysit so a friend can
                 go out.  Do something nice or surprising for someone.


                 What have you done this week to contribute?


                 What can you do next week to contribute?  Plan something in
                 advance.  This takes you away from your pain and puts your
                 attention on your concern for someone else.

Distract with C omparisons:


                Compare yourself to people coping the same as or less well
                than you.  If you are doing better than you were a year or
                two or five years ago, make that comparison.
                The manual suggests that you compare yourself to others'
                suffering, watch weepy soap operas, read about disasters.
                Some people find this helpful, others don't.  Just do what
                works for you.

Distract with opposite E motions


               Read emotional books, go to emotional movies, listen to
               emotional music.  For this to work, you need to read or
               watch or listen to things that have an emotion opposite
               to one you are feeling.
               If you are sad, watch a comedy.  Watch a scary moviie.
               Listen to silly music.

Distract with A ctivities

Distract with C ontributing

Distract with C omparisons

Distract with opposite E motions

There are four groups of crisis survival streategies: Distraction, Self-Soothing, Improving the Moment, Pros and Cons. All of these are strategies that help us to get though difficult feelings and situations, to tolerate (deal with, get through, sit with, accept) the things that we can't immediately change. This is one of the keys to DBT skill usage, to find some of these skills and techniques that work for you, to practice them until they are part of your everyday life and you can call them up whenever you need them.

In DBT, there are four categories of Distress Tolerance strategues. These are:


      1.  Distracting
      2.  Self-Soothing
      3.  Improving the Moment
      4.  Focusing on the Pros and Cons

These are strategies that short circuit or help you to cope with overwhelming negative emotions or intolerable situations. They take a lot of practice, but as you get the hang of using some of these techniques, you will see your relationship to the negative emotions and intolerable feelings change.

SELF-SOOTHING TECHNIQUES

Some of us may recognize these techniques as things that we already use. But many of us have never learned how to self-soothe, how to do those often simple things that makes us feel better. These are mostly very physical techniques, that use different body senses. Some of us have never had the feeling that we could do things to make ourselves feel better, calme r, feel relaxation or pleasure. Use them when you are feeling distressed, when emotions feel overwhelming, when situations feel like you can't stand them any more. Instead of doing something that hurts you, try something that gives you pleasure and comfort.

SELF-SOOTHING has to do with comforting, nurturing and being kind to yourself. One way to think of this is to think of ways of soothing each of your five senses:


                    Vision
                    Hearing
                    Smell
                    Taste
                    Touch

Check p. 167 in the manual, Distress Tolerance Handout 1, for lots of suggestions of things that you can do to soothe and pleasure your five senses.

A few examples:

With VISION:

Walk in a pretty part of town. Look at the nature around you. Go to a museum with beautiful art. Buy a flower and put it where you can see it. Sit in a garden. Watch the snowflakes decorate the trees during a snowfall. Light a candle and watch the flame. Look at a book with beautiful scenery or beautiful art. Watch a travel movie or video.

With HEARING:

Listen to beautiful or soothing music, or to tapes of the ocean or other sounds of nature. Listen to a baby gurgling or a small animal. Sit by a waterfall. Listen to someone chopping wood. When you are listening, be mindful, letting the sounds come and go.

With SMELL:

Smell breakfast being cooked at home or in a restaurant. Notice all the different smells around you. Walk in a garden or in the woods, maybe just after a rain, and breathe in the smells of nature. Light a scented candle or incense. Bake some bread or a cake, and take in all the smells.

With TASTE:

Have a special treat, and eat it slowly, savoring each bite. Cook a favorite meal. Drink a soothing drink like herbal tea or hot chocolate. Let the taste run over your tongue and slowly down your throat. Go to a potluck, and eat a little bit of each dish, mindfully tasting each new thing.

With TOUCH:

Take a bubble bath. Pet your dog or cat or cuddle a baby. Put on a silk shirt shirt or blouse, and feel its softness and smoothness. Sink into a really comfortable bed. Float or swim in a pool, and feel the water caress your body.

Many of us may feel like we don't deserve these comforts, and may find it hard to give pleasure to ourselves in this way. Some of may also expect this soothing to come from other people, or not want to do it for ourselves.

You may feel guilty about pleasuring yourself in this way. It may take some practice to allow yourself to experience these pleasures. These are really simple human pleasures that everyone has a right to, and that will give us some good tools to use when we are feeling bad.

Do these skills mindfully. Breathe gently, and try to be fully in the experience, whether it is walking in the woods or watching a flower or taking a bubble bath or smelling some fresh-baked bread.

As you begin to overcome your feelings that perhaps you do not deserve this, or guilt, and start to enjoy one or more of these activities, you will be learning very useful tools to help you deal with negative feelings and difficult situations.

Distress Tolerance Lesson 5a - Improving the Moment



DBT Skills Discussion List Work Linehan's DBT skills to cope with BPD. This list can be very helpful but is not designed as a replacement for (not is it) therapy. It is a moderated peer-support list that facilitates the dicussion and working of Linehan's DBT Skills.



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The Borderpd List is one for anyone who has Borderline Personality. It is a list that offers support, it is those with BPD supporting each other. From time to time we do have people in relationships with Borderlines (non-borderlines) who join the list and from time to time, professionals who join as well. So, while the list is open to all with an interest in Borderline Personality Disorder, it is first and foremostly for those with BPD.


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as of October 29, 2003



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  • Last up-dated January 14, 2006