Distress Tolerance

Distress Tolerance

Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: Distracting, Self-soothing, Improving the moment, and Thinking of pros and cons. Acceptance skills include Radical Acceptance, Turning the mind toward acceptance, and Willingness versus Willfulness.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Self-soothing

SELF-SOOTHE (AUTO CALMARSE)

A way to remember these skills is to think of soothing each of your

FIVE SENSES 

Vision Notice what you see, find soothing things to look at. (Encontrar cosas calmantes para mirar)

Notice the play of light on a clean wall. Enjoy the richness of colors in the floor tile. Look out the window and watch the grass gently blow in the breeze, the sun dancing on leaves, the graceful movement of the birds, or the smooth movement of passing cars. Close your eyes and notice the textures and light colors behind your eyelids.

Hearing Pay attention to what you can hear around you.

Listen to beautiful or soothing music, or to invigorating and exciting music. Pay at¬tention to sounds of nature (waves, birds, rainfall, leaves rustling). Sing to your favorite songs. Hum a soothing tune. Learn to play an instrument. Be mindful of any sounds that come your way, letting them go in one ear and out the other. Notice how sounds on the unit feel different at various times of day. Quietly notice the sounds of your own breath. See if you can hear the sound of your own circulation.

Smell Be aware of the memories that smell can bring.

Notice the scent of your soap and shampoo while showering. Try to find brands of deodorant, lotion, and other things that have a soothing smell to you. Sit quietly for a few minutes and try to identify all of the smells that you notice. Enjoy the smell of your meals while you are in the dining room. See if you can smell each type of food individually. Savor the smell of popcorn and remember other times in your life when you have enjoyed popcorn.

Taste Carefully savor flavors that the day brings you.

Have a good meal; enjoy your dessert; have a favorite soothing drink such as herbal tea or hot choco¬late. Treat yourself to a favorite snack from the canteen. Suck on a piece of peppermint candy. Chew your favorite gum. Really taste the food you eat; eat one thing mindfully.

Touch Find comfort in touch.

Take a bubble bath. Savor the feeling of crisp, clean sheets on the bed. Soak your feet. Soften your skin with lotion. Put a cold compress on your forehead. Brush your hair for a long time. Place your hand on a smooth, cool surface. Enjoy the feeling of a favorite piece of clothing, or clean clothes. Notice the comforting warmth of clothing that is fresh from the dryer. Experience whatever you are touching; notice touch that is soothing.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Distracting

Distress Tolerance Skills: IMPROVE the moment

Imagery

Use imagery to distract, soothe, bolster courage, and improve confidence. Imagery can make future rewards more salient (a leap of faith). Using imagery, you can create a situation different from the actual one; so, it is like leaving the situation. With imagery, you can go to a place that is safe and secure. Going to an imaginary safe place or room within can be very helpful during flashbacks. For it to be useful, you have to practice this in advance. Your ability to conjure this place must be solid if you are going to use imagery in a crisis. Practice imaging your safe place (when you are not in a crisis) enough times to get it firmly in mind and learned as a skill. An over-learned skill is available under stress.

Meaning

Finding or creating meaning helps many people in crises. Meaning answers the question why? For example, I’m doing this for the good of my family. Problems in life are opportunities to practice skills, this is the idea behind the phrase, “when life gives you lemons, make lemonade.” Suffering, when accepted, enhances empathy, and those who have suffered can reach out and help others.

Prayer

The essence of prayer is the complete opening of oneself to the moment. Ask for strength from a higher power to bear the pain in this moment.

Relaxation

Relaxing changes how the body responds to stress and crises. This skill, like imagery, takes practice. In crisis, some people tense their muscles as if to control the situation by controlling their body. The goal is to accept reality with the body. The body communicates relaxation to the mind promoting psychological acceptance.

One thing at a time

Focusing on one thing in a stressful situation can provide a means to settle down. One-mindfully often has a calming effect. The only pain one has to survive is “just this moment.” Notice how much discomfort increases by ruminating about past stressors or worrying about future problems. Let go of the future and the past. When feeling discomfort, irritation, or anxiety, tell yourself to focus on “just this moment.”

Vacation

Everyone needs a vacation from adulthood occasionally. Plan a timeout to regroup (planning is key to remaining in control and use vacations appropriately). Make it brief, and don’t choose an inappropriate time.

Encouragement

Talk to yourself the way you would talk to someone you care about who is in crisis. Talk to yourself the way you would like others to talk to you.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Thinking of pros and cons

Pros & cons is the skill thinking of advantages and disadvantages of a particular course of action (or doing certain things). Think about the advantages of doing things and the disadvantages of doing them. Then, think about the advantages of not doing things and the disadvantages of not doing things.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Acceptance

Acceptance does not equal approval. Acceptance is the first step toward making a change for the better.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Radical Acceptance

Retrieved from "http://en.wikibooks.org/wiki/Dialectical_Behavioral_Therapy/Distress_Tolerance_Skills/Acceptance"

Subject: Dialectical Behavioral Therapy

Dialectical Behavioral Therapy/Distress Tolerance Skills/Radical Acceptance

Radical Acceptance

Freedom from suffering requires ACCEPTANCE from deep within of what is. Let yourself go completely with what is. Let go of fighting reality. (Para liberarse del sufrimiento requiere ACEPTACIÖN: Dejate ir completamente con lo que es, como es. Dejar de pelear con la realidad).

ACCEPTANCE is the only way out of hell.

Pain creates suffering only when you refuse to ACCEPT the pain.

Deciding to tolerate the moment is ACCEPTANCE.

ACCEPTANCE is acknowledging what is. (Aceptación es reconocer lo que es).

To ACCEPT something is not the same as judging it good. (El aceptar algo no es lo mismo que juzgarlo como bueno)

Dialectical Behavioral Therapy/Distress Tolerance Skills/Turning the mind

Turning the Mind

Acceptance of reality as it is requires an act of CHOICE. It is like coming to a fork in the road. You have to turn your mind toward the acceptance road and away from the “rejecting reality” road.

You have to make an inner COMMITMENT to accept.

The COMMITMENT to accept does not itself equal acceptance. It just turns you toward the path.

You have to turn your mind and commit to acceptance OVER AND OVER AND OVER again. Sometimes, you have to make the commitment many times in the space of a few minutes.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Willingness (Buena voluntad)

 (Buena voluntad ) Willingness is an active form of acceptance. It is accepting the need for action and taking that action. It is not necessarily going along with whatever the therapist or skills trainer thinks is best. Willingness does not demand that reality be something other than what it is. On the other hand willingness does not give up and refuse to take action that could change reality for the better in the future.

Dialectical Behavioral Therapy/Distress Tolerance Skills/Willfulness

Willfulness:

1. voluntariedad
2. testarudez
3. Premeditación

Willfulness (Testarudez) does not accept reality as it is in the moment. Willfulness hopes that by denying reality reality will somehow change or that someone else will take the action to change reality in the desired direction. Willfulness refuses to tolerate unpleasant emotions and insists that whatever causes the unpleasant emotions shouldn't exist.