When faced with a problem you can stay miserable, tolerate the distress, change how you think and feel about the problem or change the situation. Distress Tolerance Skills help you tolerate unpleasant feelings until you can think clearly and make the best choice to keep you moving toward your goals.
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Distress Tolerance Skills for Improving Happiness and Reducing Wasted Energy
1. Dialectical Behavior Therapy
Techniques
Distress Tolerance
Happiness Isn’t Brain Surgery Additional Resources at DocSnipes.com
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery
Author: Journey to Recovery (2015) & Happiness Isn’t Brain Surgery (2017)
2. Objectives
Define goals of distress tolerance
Discuss why some clients do not choose distress tolerance
Explore a variety of Distress Tolerance and Reality
Acceptance Skills including
STOP
Pros and Cons
TIP
ACCEPTS
Self Soothing
IMPROVE the Moment
Radical Acceptance
Turning the Mind
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3. Goals of Distress Tolerance
The goal of distress tolerance is to accept, find
meaning for and tolerate distress
Pain and distress are part of life. Refusing to
accept this leads to suffering
Any attempts at change will produce distress,
therefore distress tolerance skills are necessary
Change causes crisis and crisis causes change
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4. Distress Tolerance
Distress tolerance is a natural progression from
mindfulness
Accepting, nonjudgmentally, oneself and the situation
Not trying to change the situation, your feelings,
thoughts or urges
Distress tolerance means surviving crises,
accepting life as it is in the moment.
Tolerance and acceptance of reality do not equate with
approval
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5. Distress Intolerant Thoughts
I can’t stand this
It’s unbearable
I hate this feeling
I must stop feeling this
way
I will lose control
I’ll go crazy
This feeling will keep
going on forever
It is wrong to feel this
way
It’s stupid and
unacceptable
It’s weak/bad
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6. Activity
When something bad happens, what are your
distress intolerant thoughts?
Here are some self-statements you can use to
counter your thoughts.
This is agonizing right now, but will get better
I have gone through worse before and survived
I know this cannot last forever
My feelings are designed to protect me.
Come up with other statements to rebut your
personal distress intolerant thoughts.
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7. Proving How Bad It Is
Sometimes people want others to understand how
bad it is, so they focus on the distress instead of
surviving the situation
Short Term Gains (Look what you made me/I had to
do)
Controlling another’s behavior
Going to the hospital and getting attention/break
Remember a time you acted impulsively to try to
get someone to see how bad it was. What were
the results?
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9. Activity
What are your avoidance behaviors?
What is their benefit in the short term?
Do they help resolve the situation at all?
What is the impact on you in the long term?
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10. Summary
The goal of distress tolerance is to accept, find meaning for and
tolerate distress
Once you become mindful (aware) you need to:
Accept, nonjudgmentally, yourself and the situation
Not trying to change the situation, your feelings, thoughts or urges
If you don’t feel like other people understand, or are supportive,
sometimes you may focus on the distress instead of surviving the
situation.
Increase in distress intolerant thoughts
Avoidance or behaviors designed to numb/distract from/eliminate the pain
Recognizing the impact of these behaviors can help you get
motivated to explore distress tolerance skills.
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11. Objectives
Learn about urges and how to deal with them
Identify ways to use your energy to improve the
next moment and help you draw closer to your
goals of Happiness
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12. Distress Tolerance Skills
Different skills work for different people and may
work sometimes but not others
Try various skills until you find the ones that
Help you remain mindful
Reduce vulnerabilities
Accept how you feel in the moment without having to
act on your urges
Help you make wise choices for how you are going to
use your energy.
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14. Urge Surfing
Urges are generally intense for 20-30 minutes
Every time you have an urge think, “I have a choice!”
Surf the urge by opening yourself up to the urge. This
doesn’t mean that you consume yourself in it (which feels
horrible) or fight it and push it away. What you do is
experience the feeling of the urge with acceptance, non-
judgement, being aware that it is there.
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15. Pros and Cons
What are the benefits to acting on impulsive urges?
What are the drawbacks to acting on impulsive
urges?
What are the benefits to not acting on them?
What are the drawbacks to not acting on them?
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16. TIPP Skills
Temperature
Intense Exercise
Paced Breathing
Paired Muscle Relaxation
The act of muscle relaxation is paired with a verbal cue
What reactions do you have that are paired with verbal
cues?
Positive Arousal Unpleasant Arousal
Let’s go to dinner
How would you like to…
Baby laughing
Clear your desks….Quiz time
We need to talk.
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17. STOP Skills
Stop
Take a step back
Observe
Proceed Mindfully
Goals and
Values
Distress and
Suffering
What are your options
that may stop suffering
in the short term but
maintain distress?
What are alternate
thoughts you could
have that help you
feel empowered?
What are your
options that can
help you reach your
goals?
What thoughts and
feelings are you having
that are increasing
your distress?
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18. Distract with Wise Mind ACCEPTS
Activities (pleasant)
Contributing
Comparisons
Emotions (opposite)
Pushing Away
Think about something totally different
4 3 2 1
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19. Self-Soothing
Body Scan Meditation
Self-Soothing Using the 5 Senses
Sight
Smell
Hearing
Touch
Taste
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20. IMPROVE the Moment
Imagery
Safe place
Successfully dealing with this
A force field
A coach/fairy godmother/angel
Feelings and thoughts are clouds in the sky
An unstoppable train
Meaning
Changing how you think about yourself and your situation
Make lemonade. Find the silver lining.
Prayer
Relaxation
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21. IMPROVE the Moment
One thing in the Moment
Focus on one thing you are doing right now
Sitting in a chair
Driving
Weeding
Vacation
Mental vacation
Take a short break
Leave stress at work
Encouragement
Be your best friend
Create a mental coach
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22. Summary
Urges come and go
Surfing your urges keep you from doing something
impulsively that could cause you distress
TIPP skills can help you get through the urge
ACCEPTS activities can help you unhook/distance
from powerful urges and feelings
IMPROVE skills help you take positive steps toward
your goals
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23. Objectives
Define and explore Radical Acceptance
Explore additional tools
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24. Reality Acceptance
Radical Acceptance
Complete and total acceptance of the facts of reality
You don’t have to like or condone it, just accept that in
THIS moment, it is what it is.
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25. Reality Acceptance
Seeing Emotions Differently
Fear and anger kick in when there is a threat
Sadness kicks in when you lose something important to
you in some way, If you didn’t feel sadness when these
things occurred, it would mean that nothing was
important.
Unpleasant emotions are important to survival,
rather than something to be feared and avoided
at all costs
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26. Reality Acceptance
Willingness vs. Willfulness
Willfulness forgets, ignores or actively tries to change,
master, direct, control or manipulate what is
Willingness is a surrendering to a process in which one
is already a part and figuring out what to do to change
the next moment
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27. Reality Acceptance
Turning the mind—Willingness (changing what will be)
Mentally looking to the other side to focus on how you can
best use your energy to improve or cope with the situation.
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Car Accident
Going to Jail
Break Up
28. Reality Acceptance—Emotions & Thoughts
Half Smiling and Willing Hands
Emotions are partially controlled by facial expressions.
Half smiling with lips slightly upturned
Hands are unclenched, palms up, fingers relaxed
Mindfulness of current thoughts
Recognize that thoughts are just neural firing in the
brain, not facts about the world
Allow the thoughts to come and fade
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29. Additional Tools for Addictions
Clear Mind
Addicted Mind is governed by impulsive behaviors
designed to make the pain go away quickly.
How is addicted mind similar to the emotional mind?
Clean Mind (Pink Cloud) forgets that relapse is possible
How is the clean mind similar to the rational mind?
Clear mind is not engaging in addictive behaviors but
remains aware that relapse is possible.
How is the clear mind similar to the wise mind?
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30. Activity
Addicted Mind Clean Mind (Pink
Cloud)
Clear Mind
Ex. Defeated, hopeless
Ex. Angry, bitter
Ex. Untouchable,
infallible
Ex. Exuberant,
compassionate
Ex. Cautiously
optimistic
Ex. Compassionate but
careful
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How do you think, feel and behave in each state of mind?
31. Additional Tools
Burning Bridges and Building New
Actively eliminate triggers/vulnerabilities
Find physical and emotional sensations and create
mental images that compete with the urge to use
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32. Activity
Find physical and emotional sensations and create
mental images that compete with the urge to use.
Laughter
Love
Happiness
What is more important than using? Or what
brings you greater peace than using?
Picture album
Mental Images (draw, narrate, record)
Sunshine
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33. Additional Tools
Alternate Rebellion
Finding alternative ways to act out which are safer
Harm reduction
Sublimation
TIPP (Temperature, Intense Exercise)
Loud music
What can you do?
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34. Important Questions
When choosing distress tolerance skills, evaluate
How does [this technique] make you feel?
How does it impact your feelings in the moment?
How does it affect how you handle the problem?
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35. Emotional Comebacks
Sometimes emotions, thoughts, urges reappear
Notice them without negative judgement.
Deal tolerate the distress
Problem solve
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36. Summary
Remember that you feel how you feel
Feelings can cause you to have urges
Urges are generally designed to escape the feeling,
but often do nothing to change the situation
Urges subside within 20-30 minutes
Find techniques that can help you let the urge pass.
Use STOP skills to identify options to improve the
next moment
Start improving…
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