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DBT Distress Tolerance Skills
DBT Distress Tolerance Skills 5/13/2010 KateComtois,PhD,MPH CHAMMP/Harborview UniversityofWashington Goalsofdistresstoleranceskills TeachingtheSkills •Distraction •SelfǦSoothing •IMPROVEthemoment •ProsandCons Clinicalapplications •Forclients •Foryourself 1 of 19 DBT Distress Tolerance Skills Acrisisiswhenyouhavea seriousproblembutyou can’tsolveit(atleastnot now). Inacrisis,emotionsarehigh sotheproblemisdistressing andhavinghighemotions generallymakesthings worse. Ifyes,SOLVEIT •Stickwithit,don’t takeyoureyeoff theball,anddo whatittakes. 5/13/2010 Inacrisis,thereisapressure tosolvetheproblemanditis difficulttostoptrying. AcrisisisshortǦterm. • Ifitishappeningallthe time,itisn’tacrisis,its’ yourlife! Ifno(ornotrightnow),STOP tryingtosolveit •Tryingtosolvesomethingyou can’twilloftenmakeitworse andsendyouremotions throughtheroof. •Focusondistresstolerance skills duringanunsolvedcrisis. Theseskillstaughtinthis webcastaredesigned justforanunsolved crisis. 2 of 19 DBT Distress Tolerance Skills 5/13/2010 Clients Clinicians facemanystressors facemanystressors • Housing • Money • Drugsandalcohol • Dangerousneighborhoodsor buslines • Troublefindingandkeeping work • Longwaitsforsocialservices • Medicalproblemsandchronic pain • Largecaseloads • Difficultclients • Hearingmanytraumaticstories • Inabilitytohelptheirclients • Lackoftimeorresourcesto helptheirclients • Frustratinginteractionswith socialservices • Unhelpfulrulesorregulations • Paperwork Toleratingdistressisnot solvingtheproblem. •Thereareotherskills forproblemǦsolving. Remember •Don’thityourheadon abrickwallbytryingto solveacrisisthatcan’t besolvednow. •Figureoutanotherway tosolvetheproblem. •Thenpracticedistress tolerance untilthat otherwaycanwork. 3 of 19 DBT Distress Tolerance Skills 5/13/2010 Toleratingdistressisnot removing– orsometimes evenreducing– distress. • Thereareotherskillsfor reducingemotions. Don’texpectdistress toleranceskillstomake you“feelbetter”. • Thefactisthatyouoften mayfeelbetter,butthatis notthepurposeoftheskill. • Theskillsaresoyouwon’t makethesituationworse. • Iftheskillspreventthecrisis gettingworsebutdon’t makeyoufeelbetter, DON’TSTOP!Ifyoudo, thingsmaygetworse. Yellingat someone Givingup onsolving thecrisis altogether Complaining somuchfolks don’twantto talktoyou Howcan youmakea crisis worse? Eatingtoo much Usingdrugs oralcohol “Retail therapy”with moneyyou can’tafford tospend 4 of 19 DBT Distress Tolerance Skills 5/13/2010 So,ifyouuse distresstolerance skills, Themoreyoulearn totolerateacrisis withoutmakingit worse, yousurviveaswell asyoucanbeand “livetofightanother day”onyourcrisis. themorecompetent andconfidentyou willbecome. SowhataretheDistress Toleranceskills •Distract •SelfǦSoothe •IMPROVEthemoment •ProsandCons 5 of 19 DBT Distress Tolerance Skills 5/13/2010 Activities Contributing Remember, wisemind ACCEPTS Comparisons oppositeEmotions Pushingaway Thoughts Sensations Activities Useanactivitythat fitsthemomentor whatyouwouldbe doingifyou weren’tdistressed Sportsorexercise Hobbiesorusing yourtalents Bewithother peopleandDON’T talkaboutthecrisis Watchamovie Gotothezoo, park,beach 6 of 19 DBT Distress Tolerance Skills 5/13/2010 Contributingis doingan activitythat primarily servesothers Volunteer Usuallymore distracting thanan activityfor yourself Write someone whoislonely aletter Bakesomeone cookies Getattentionofthe crisisbutthinkingabout othercrisesthatare worsethanyours Someoneorpeoplewho aresufferingmorethan you Listento someone else’s problems Atimeinyourlifewhen youweredoingworse Remember– yourpainis stillvalidbutputitona continuumfromeasiest tohardesttobearand focusattentiononthe harder 7 of 19 DBT Distress Tolerance Skills 5/13/2010 Whenweare distressed,one ortwonegative emotions dominatethe scene Figureoutanemotion differentfromthenegative oneyouarefeelingandtryand bringiton •Ifangry,watchacomedy •Ifscared,watchsomeone daring •Ifsad,listentoupbeatmusic This means deciding that something cannot be dealt with now and putting it out of your mind Imagine puttingitona shelf,ina timeǦrelease safe,in anotherroom Imaginea Lucitewall betweenyou andthe problemso youmaybe awareofit butyouare cutoff Imaginethe “volume”of theproblem beingturned down 8 of 19 DBT Distress Tolerance Skills 5/13/2010 Theideaistofillyourbrainwithother thoughts,sothereisnoroomforthecrisis •Singsonglyricsyoudon’tquiteremember •Dothetimestablestoanumberyouhave tocalculate •Decidewhatprofessioneveryoneonthe busdoes •Imaginedecoratingyourfuturehome Thisis THEBEST strategyto getunstuck whenyouare very distressed Mobilizeyourbodyanditwillbring yourmindandemotionswithit •Putyourfaceinicewaterorhold ice •Runupanddownstairs •Takecoldshower •Ifyouareinsidegotoutsideorif youareoutsidegoinside 9 of 19 DBT Distress Tolerance Skills 5/13/2010 Whatwouldyoudoifyoulivedwith alovedonegoingthroughacrisis? Howwouldyousoothethem? Thatiswhatyouwanttodofor yourself Don’tmakeasituationharderby beingmoreuncomfortablethan required For instance, don’t wear tight shoes to the dentist Vision Decorateyourspace,go somewhereinspiring Sound Music,soothingvoices,nature sounds Smell Cooking,lavender,thebeach Touch Comfortableclothes,pet animal,footmassage Taste Favoritefood,hardcandyor mint,goodcupofcoffee 10 of 19 DBT Distress Tolerance Skills 5/13/2010 Imagery Meaning Skillsto acceptpain andreduce suffering Prayer Relaxation Onethinginthemoment Vacation Encouragement Picturea placeyou feel Happy abeach,a hike,with friends Safe placefar away,place withlocks Relief likewhen thecrisiswill besolved Relaxed onawarm, comfortable couch 11 of 19 DBT Distress Tolerance Skills 5/13/2010 Whatcanthiscrisis ortoleratingthis crisisdoforyou? Whatwillyouget outofthis? “Whatdoesn’tkill youmakesyou stronger” Whatareyourcore beliefsorreligious traditions? “Goddoesn’tgive memorethanIcan handle” “Thistooshall pass” Useandconnecttothereligiousorspiritual traditionsthataremeaningfultoyou Examples SerenityPrayer ǦǦǦ MayIbefilledwithlovingkindness. MayIbewell. MayIbepeacefulandatease. MayIbehappy. AncientTibetanBuddhistmeditation 12 of 19 DBT Distress Tolerance Skills Thegoal isto reduce suffering by removing physical stress fromthe body 5/13/2010 Progressiverelaxation •Tighteneachpartofyourbodyfullyfor5 secondsandthencompletelyrelaxit •Startattoesandworkthroughfullbody Walk,yoga,otherexercisethat relaxesyourmuscles Bringallofyourattentiontowhatis happeningrightinthismoment Alotofdistress isnotinthepresent – itisinthepastor isanticipatedfor thefuture Letgoofthoughtsaboutthepastand future Describe(inyourmind,outloud,in writing)whatyounoticeinthismoment tobringyourattentionjusttonow 13 of 19 DBT Distress Tolerance Skills 5/13/2010 Avacationiswhenyoudeliberatelystepaway fromyourlifetodosomethingmorerelaxing,fun, orpeaceful Takeasmallvacationto toleratethedistress • Don’ttalktoanyoneforan hour • Gotobedandforgettherest oftheday • Decideeveryonecando withoutyouforawhile • Gettakeoutratherthancook Goalisnotto be“Pollyanna” aboutyour troublesbut encourage yourselfto stickwithit andtell yourselfyou willsucceed Key,aswithallvacations,is planitaheadoftimeand havea“returnticket” • Otherwiseyouarerunning away! Beyourown cheerleader • “Icandoit” • “Only3moredays…2 more…1more…” • “Ihavebeenthroughworse andIcandothistoo” SimilartopositiveselfǦtalk 14 of 19 DBT Distress Tolerance Skills 5/13/2010 Pros Cons Pros Cons Makingitworseby: ____________ Toleratingdistress by: ____________ Makingitworseby: Ǧgettorelax Ǧwon’thaveto gettingdrunk thinkaboutit Toleratingdistress Ǧgetsome relaxation by: Ǧwillbeclear selfǦsoothing minded tomorrow Ǧwon’tbeableto function tomorrowwhen havetocallguy back Ǧwillbeworriedall night Ǧprobablywon’t sleep 15 of 19 DBT Distress Tolerance Skills 5/13/2010 Pros Cons ǦselfǦfulfilling Makingitworseby: Ǧdon’thaveto focuswhentired prophesy justgothroughthe Ǧdon’tgetmy Ǧpersonwillthink motions Toleratingdistress by: IMPROVEwith meaning,prayer, andencouragement Dowithclient orcolleague orfriend hopesup youdon’tcare Ǧfeelproudofthe qualityofmy work Ǧhavehope Ǧtreatmentmore likelytowork Ǧtakesalotof effort Ǧmaybe disappointed (again) Afterwards, copytheCons ofmakingit worseandthe Prosof tolerating distressonto onelist Keepthe listwhere youneedit most! Ifyouareatyourdarkestmoment,youwillnotbeableto seetheprosandconsatallclearly 16 of 19 DBT Distress Tolerance Skills 5/13/2010 Makesurethedistresstoleranceskillisclose totheintensityofthedistress • Ifyouhavetheurgetodie,ironingisprobablynotgoing tohelp! Makesurethetimingoftheskillmatches thesituation • DistractingwithSensationsisagreatwaytogetstarted butdoesn’tlast;soifcrisisislong,pairwithActivitiesor Contributing • DistractingwithThoughtslastsforminutestomaybean hour– goodforthebus,traffic,staffmeetings,orthe lineattheDMV • Takea“vacation”foraslongastimeallows 17 of 19 DBT Distress Tolerance Skills 5/13/2010 AnyDistressToleranceskillsoverusedcan makethingsworse • Soothingbytasteisnotagoodideaifyouarea compulsiveeateroraregainingweight • Taketoomanyvacations,youdon’tgetanythingdone • DistractingbywatchingaDVDTVseriesorreading novelscantakeoveryourlife AvoidDistractionwhenitisavoidance • OftenpeopleseedistractionǦ gettingyourmindoffitǦ as theonlywaytocopewhenyoucan’tdoanythingabout theproblem • Sometimesyouneedtostaywiththeproblemsuchas stayinginclassorontheworksiteorwithyourchildren (orwithyourclients) • BesuretolearnSelfǦSoothingandIMPROVEasmuchas Distractforthis Doeachskill onpurpose (evenifitis something youdoallthe time) Observe whatyoudo whentheskill doesn’twork Thisis whatto coach clientsto use Observehow yougoabout usingtheskill Practiceeach skilltillyou aregoodatit Challenge yourselfto usetheskills whenyour distressis high 18 of 19 DBT Distress Tolerance Skills 5/13/2010 Thankyou. 19 of 19
