Distress Tolerancedialectical Behavioral Training

Dialectical behavior therapy, or DBT, is a type of psychotherapy that utilizes a cognitive-behavioral approach to emphasize the psychosocial aspects of treatment. In the next couple of blogs, we’ll be exploring the four different components of DBT, and breaking them down to understand their respective roles within the treatment protocol. Our first blog in the series covered the component at the core of DBT: Mindfulness. From there we move onto Distress Tolerance – what is it, why is it important, and how is it used in DBT protocol?

What is Distress Tolerance?

In dialectical behavior therapy, distress tolerance skills are taught to address the tendency of individuals who experience negative emotions as overwhelming and unbearable. Those who have a low tolerance for distress can become overwhelmed at what others may perceive as relatively mild levels of stress, and therefore may react with negative behaviors. Other traditional therapeutic approaches for this issue focus on avoiding painful situations, but in the distress tolerance module of DBT, clients learn that there will be times when pain is unavoidable, and the best course is to learn to accept and tolerate distress.

Distress

Why is Distress Tolerance Important?

Unfortunately, suffering and pain are part of life – we experience a variety of stressful events whether it’s the end of a relationship, the death of a loved one, or loss of a job. As previously mentioned, some individuals, especially people with borderline personality disorder feel the pain and discomfort of these situations more intensely than others. If people with BPD haven’t learned to use healthy coping skills to tolerate the distress they feel, they may resort to unhealthy behaviors like self-harm, substance use, or other impulsive behaviors that may seem like an immediate “fix”, but in the long-term these behaviors can make the pain worse. Distress tolerance helps these highly sensitive people learn to navigate uncomfortable or painful situations and manage urges to engage in harmful behaviors, in order to maintain balance in the face of crises, and to accept and cope with it in healthier ways.

The dialectical behavior therapy skills in ACCEPTS help you tolerate your distress until the appropriate time to resolve the situation. Once you’re ready and able to address the problem head on, other skills, such as DBT interpersonal effectiveness, can help you get your needs met. Dialectical behavior therapy is a type of treatment that teaches patients how to regulate their emotions and respond to distress through skills training. Distress tolerance skills have proved to be especially effective in people struggling with self-harm and other self-destructive, maladaptive behavior. 2-1 Introduction to Distress Tolerance 2-2 PRO/CON 2-3 TIPP 2-4 STOPP 2-2 ACCEPTS 2-5 IMROVE the Moment 2-8 Willingness vs. Willfulness 2-9 (1) Willing Hands 2-9 (2) Half Smile 2-10 Reality Acceptance 2-11 Radical Acceptance 2-12 Turning the Mind 2-13 Self-Soothing.

How Is Distress Tolerance Used in DBT?

Distress

What, then, do these skills entail? Distress tolerance skills are a type of intervention in DBT where clients learn to manage distress in a healthy way and learn to manage their response in a situation where they may not feel in control. A key ingredient of distress tolerance is the concept of radical acceptance – experiencing the situation and accepting the reality that it is out of your control and cannot be changed. By practicing radical acceptance without trying to fight reality, the client will be less vulnerable to intense and prolonged negative feelings. Within the distress tolerance module, there are four skill categories: Distracting, Self-soothing, Improving the moment, and Focusing on pros and cons. The first skill, distracting, helps clients change their focus from upsetting thoughts and emotions to more enjoyable or neutral activities. Self-soothing then teaches clients to utilize their senses to nurture themselves in a variety of ways. In improving the moment, the goal is to use positive mental imagery to improve one’s current situation. Finally, focusing on pros and cons, the individual is forced to evaluate the short-term and long-term pros and cons to understand the benefits of tolerating pain and distress in the moment, based on past experience.

Distress Tolerancedialectical Behavioral Training

Dialectical Behavioral Therapy Pdf

Because these skills are so critical to one’s mental well-being in times of extreme distress, they should be taught accordingly by someone with the proper qualifications. Meredith O’Brien is a Licensed Clinical Social Worker in New Jersey with advanced training certificate in Dialectical Behavior Therapy. Following the DBT treatment module, Meredith and her team provide individual therapy sessions in a nurturing environment to help clients to achieve treatment goals, as well as offer DBT Skills Groups to strengthen treatment. To schedule your appointment with Meredith today, visit www.meredithobrienlcsw.com.

Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy originally developed by Dr. Marsha Linehan to treat chronically suicidal adults diagnosed with Borderline Personality Disorder. Although DBT was developed for the treatment of severely suicidal patients, DBT skills can be very useful for anyone who is trying to manage stressful, painful, or challenging situations in their lives.

Behavioral

A core component of DBT is radical acceptance. Radical acceptance means that we are able to acknowledge situations in our lives that we have no control over and fully accept them as reality, rather than fighting against them by denying that they exist or complaining that they are unfair. Radically accepting these situations in our lives, without judgement can often help in shifting our focus from how things “should be” to accepting things as they are. This slight, but powerful shift in perspective is often the first step in learning to manage emotions and tolerate distress.

In addition to radical acceptance, DBT teaches several distress tolerance skills that are helpful in tolerating painful emotions without making the situation worse. These skills are not meant to solve your problems (again, you may be facing problems that you have no power to change). Instead, they are designed to help you overcome overwhelming emotions that can often times emerge when we are faced with obstacles in our lives.

Tolerancedialectical

The five skills categories for Distress Tolerance are:

  1. Distract with “Wise Mind ACCEPTS”
  2. Self-SOOTHE with Six Senses
  3. IMPROVE the Moment
  4. PROS and CONS
  5. TIPP

Each skill focuses on a different way in which you can help manage stressful emotions and tolerate distress. Here, we will focus on how to use “Wise Mind ACCEPTS”:

Distract with “Wise Mind ACCEPTS”

Activities: Engage in some kind of healthy activity and shifting your attention to that activity. Examples include calling a friend, baking cookies, and going for a bike ride.

Contributing: Contribute to someone else. Surprise someone with a thoughtful gesture or volunteer. Doing things for other people causes us to feel better.

Comparisons: Compare yourself to those less fortunate than you or to yourself at a time when things were worse. Try to come up with a list of things you feel grateful for that others may not have. Your pain is still valid, but the focus here is to put it in perspective for the moment so you can tolerate what you are feeling now in the crisis.

Emotions: Create a different emotional experience by listening to something that usually makes you laugh or feel happy. Listen to your favorite upbeat song or put a funny video.

Distress Tolerancedialectical Behavioral Training Techniques

Pushing Away: For the moment, decide that you will put thinking about the crisis on the backburner and chose to think about something else. This does not mean we ignore our problems, it means we decide to come back to it at a time when we are more able to handle it.

Thoughts: Replace your thoughts with any other thoughts that are neutral and unrelated to the situation. If you fill your head with other thoughts, there will be less room for thoughts related to the problem. You can do brain teasers, sing songs, imagine positive memories.

Distress Tolerance Skills

Sensations: Distract yourself with physical senses. Our bodies are designed to focus on new or intense sensations. If you engage your body in a sensory experience, such as putting your face in cold water, holding an ice cube, soaking your feet in hot water, your thoughts will follow and focus on the experience.

Distress Tolerance Activities

Like any skill, the more you practice the better you will be at using Wise Mind ACCEPTS. Also keep in mind that you may try to use one of the ACCEPT skills and not find it helpful immediately. That does not mean you should give up! If you have given the skill a chance and it really does not seem to help regulate your emotions, move on to the next skill.