Distress tolerance

Overview of DBT therapy.

The goal is to decrease distress, impulsivity, and to accept reality.

TIPP

Temperature, Intense Exercise, Paced Breathing, Progressive Muscle Relaxation

Temperature: Hold an ice cube, dip your face in cold water, air conditioning, walking outside in the cold air, or aquatic therapy.

Intense exercise: running, jogging, dancing, or swimming.

Paced breathing: Breathe in for 5 seconds, breathe out for 8 seconds.

Progressive muscle relaxation: tense then relax each muscle group down the body.

TIPP skill in DBT.

STOP

Stop, Take a step back, Observe, Proceed Mindfully

Stop what you're doing.

Take a step back to breathe.

Observe and connect with your environment using your 5 senses.

Proceed mindfully by returning to the present moment before responding to the situation.

STOP skill in DBT

Soothe yourself with your 5 senses

What do you: See, hear, smell, taste, can touch

Be mindful of things that please/comfort your senses:

Vision: nature/being outside.

Hearing: music, audio book, others’ voices.

Smell: lavender, lemon, essential oils.

Taste: mint, chocolate, gum.

Touch: putty, squeezy ball, beanbag, ice pack.

Using your 5 senses to soothe yourself.

Distract with ACCEPTS

Activities, Contribution, Comparison, Emotion, Pushing Away, Thinking, and Sensations

Activities: singing, watching TV, talking with friends, dancing/exercising to music.

Contribution: volunteering, walking/playing with animals.

Comparison: remembering that there are people in a similar position but may be "worse off" than you; telling yourself that you are not alone.

Opposite emotion: listen to music/movies with a positive message.

Pushing away: taking a break.

Thoughts: think about something more pleasant.

Sensations: soothing with 5 senses.

ACCEPTS skill in DBT.

Radically accepting reality

Notice reality.

Consider causes.

Practice accepting reality with whole self.

Let go of things you can’t control (anything but your responses).

Learning to accept reality (DBT).

Giving a half-smile and willing hands

Half smile: letting yourself smile enough so you don't fake it, but you are no longer dwelling on the negative emotion.

Willing hands: hands are unclenched, facing up with relaxed fingers.

Half smiling for connecting the body to your emotions.

Unclenched, open hands, facing up to embrace and accept reality.

Turning the mind towards reality

Notice turning from goal.

Make an inner commitment to step toward your goal.

Do it again and again.

Make an effort to turn your mind towards acceptance.

Consider the pros and cons of the situation

List the positive and negative consequences for doing/not doing a behavior.

Pros and cons list during a crisis (DBT).

Emotional regulation skills

The goal is to soothe uncontrollable feelings in the moment.

ABC PLEASE

Accumulate positive emotions, Build mastery, Cope ahead, Physical health, Eat healthy, Avoid mood-altering substances, sleep, and Exercise

Accumulate positive emotions: do things you enjoy doing, such as dancing, sharing stories, playing music, etc.

Build mastery: practice a skill you would like to become competent in, such as running, swimming, singing, or meditation.

Cope ahead: rehearse how you will handle a stressful situation in advance.

Physical health: treat physical injury or illness.

Eat a balanced diet.

Avoid mood-altering substances, such as alcohol.

Sleep 7-9 hours per night.

Exercise at least once a day.

ABC Please skill in DBT.

Acting opposite to the negative emotion

Identify the negative emotion and what you would like to do in this moment (action urge).

Decide to decrease the emotion.

Identify and do the opposite action.

Example: I dread going to physical therapy, but I decide to think of the positives and go anyway.

Opposite to Emotion Action (DBT).

Ride the emotional wave

Experience emotions without judging them or blocking them.

Observe your emotions.

Let them go. Emotions and impulses come and go like waves.

Ride the Wave of emotion like a pro! (DBT).

Core mindfulness

The goal is to increase awareness of the present moment without judgment and decrease cognitive confusion and disassociation.

"What skills"

Observe: just notice your experience or attend to your senses, without labeling the experience.

Describe: use words to describe observations and sensations.

Participate: become one with the experience by interacting with the world around you.

"What" skills (DBT).

"How skills"

Non-judgmentally: replace judgments of “good” or “bad” with facts.

One mindfully: attend to one thing in the moment.

Effectively: identify goals and focus on what works (act skillfully).

Wise Mind: attend to inner wisdom and balance thoughts/reason with feelings/values to find a grounded certainty.

Wise-mind.

Interpersonal effectiveness

The goal is to increase interpersonal chaos.

Ways to practice interpersonal skills to work together with others and to get what you need.

DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate)

To meet an objective or to say “no”.

Describe the situation.

Express how you feel.

Assert yourself.

Reinforce why getting your way would satisfy both parties.

Be Mindful and focus on the conversation at hand - don’t get distracted.

Appear confident.

Negotiate with the other person.

DEAR MAN (how to get what you want), DBT.

GIVE (Gentle, Interest, Validate, Easy manner)

To maintain a relationship.

Gentle when talking to the other person.

Remain Interested in understanding the other person’s side.

Validate their feelings the way you want them to validate yours.

Have an Easy manner no matter what the other person says: don't be aggressive or unkind.

The GIVE skill in DBT can be used to repair broken relationships.

FAST

Fair, Assert, Stick to values, and remain Truthful

To maintain self-respect.

Be Fair.

Don't overwhelm the person with Apologies.

Stay true to your values.

Be Truthful about how you feel and what you deserve.

FAST is about being fair but insuring self-respect (DBT).

Validation

Validation is the ability to find the kernel of truth in another person’s perspective.

Giving and receiving validation is necessary for us to connect and grow.

Anger management

Skills for working through reactive, destructive anger. Feeling angry is a natural and understandable emotion, but it must be regulated to avoid damaging yourself or others.

Conquering anxiety

1) Taking action: Working towards a resolution to your problem using achievable baby-steps.

An example of taking action against anxiety is making steps to improve financial troubles.

2) Keeping things in perspective: Examine how important your issues are and how they impact your life.

If your worries are ultimately insignificant, remember that it is not the end of the world.

If they are more significant, you can ask for help or find the resources you need.

It's necessary to consider the bigger picture to avoid putting yourself through unnecessary pain and suffering.

Don't be overwhelmed by the small things. As long as you keep moving along, you can overcome the struggles you face.

3) Focus on a calming activity.

Here are a handful of daily activities to manage overwhelming anxiety.

Steps for tackling depression: One day at a time

These guidelines can complement doctors' recommendations to reset your brain and reclaim your life.

Learning to focus with and without AD(H)D medication

Start a new focusing routine with these easy steps.

Brainstorming ideas for organizing and simplifying the often "scattered minds" of those with AD(H)D.

Strategies from Cognitive Behavioral Therapy (CBT)

Automatic Negative Thoughts (ANTs):

Different types of ANTs.

ANTs take the form of:
1) Should statements.
2) Disregarding the positive.

To overcome ANTs, catch them, write them down, think deeply about the evidence to the contrary, and reframe your thoughts using the new positive evidence.

Working through ANTs.

Cognitive restructuring: Replacing destructive distortions with neutral or positive facts

Cognitive restructuring (or reframing) involves identifying ANTS and distortions, challenging them, and replace the distortions with neutral and positive facts.

Exposure therapy

Exposure therapy is used under the supervision of a CBT specialist to gradually face a fear in order to lessen the overwhelming reaction.

The technique is not always practical, especially for those suffering from a psychotic disorder, suicidal ideation, or disassociation.

Exposure therapy is useful for more than just phobias. Many conditions can be improved with exposure over time.

Processes improved by exposure therapy.

Exposure therapy can be utilized through various methodologies, not just through physical touch.

Kristen Woods

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