DBT Distress Tolerance Skills
5/13/2010
KateComtois,PhD,MPH CHAMMP/Harborview UniversityofWashington
Goalsofdistresstoleranceskills TeachingtheSkills •Distraction •SelfǦSoothing •IMPROVEthemoment •ProsandCons
Clinicalapplications •Forclients •Foryourself
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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
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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
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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
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DBT Distress Tolerance Skills
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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
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DBT Distress Tolerance Skills
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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
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DBT Distress Tolerance Skills
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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
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DBT Distress Tolerance Skills
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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
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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
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DBT Distress Tolerance Skills
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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
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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
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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
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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
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DBT Distress Tolerance Skills
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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
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DBT Distress Tolerance Skills
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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.
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