DBT Distress Tolerance Skills - uwaims.orguwaims.org/webinars/slides/AIMS_MHIP_Distress_Tolerance_Skills... · Goals of distress tolerance skills Teaching the Skills ... Sports or

Kate Comtois, PhD, MPHCHAMMP/HarborviewUniversity of Washington

Goals of distress tolerance skillsGoals of distress tolerance skills

Teaching the SkillsTeaching the SkillsDistractionSelf SoothingIMPROVE the momentPros and Cons

Clinical applicationsClinical applicationsFor clientsFor yourself

DBT Distress Tolerance Skills 5/13/2010

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A crisis is when you have aserious problem but youcant solve it (at least not

now).

In a crisis, there is a pressureto solve the problem and it is

difficult to stop trying.

In a crisis, emotions are highso the problem is distressingand having high emotionsgenerally makes things

worse.

A crisis is short term. If it is happening all thetime, it isnt a crisis, itsyour life!

If yes, SOLVE IT

Stick with it, donttake your eye offthe ball, and dowhat it takes.

Stick with it, donttake your eye offthe ball, and dowhat it takes.

If no (or not right now), STOPtrying to solve it

Trying to solve something youcant will often make it worseand send your emotionsthrough the roof.

Focus on distress toleranceskills during an unsolved crisis.

Trying to solve something youcant will often make it worseand send your emotionsthrough the roof.

Focus on distress toleranceskills during an unsolved crisis.

These skills taught in thisThese skills taught in thiswebcast are designedjust for an unsolved

crisis.


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Clientsface many stressors

Housing Money Drugs and alcohol Dangerous neighborhoods orbus lines

Trouble finding and keepingwork

Long waits for social services Medical problems and chronicpain

Housing Money Drugs and alcohol Dangerous neighborhoods orbus lines

Trouble finding and keepingwork

Long waits for social services Medical problems and chronicpain

Cliniciansface many stressors

Large caseloads Difficult clients Hearing many traumatic stories Inability to help their clients Lack of time or resources tohelp their clients

Frustrating interactions withsocial services

Unhelpful rules or regulations Paperwork

Large caseloads Difficult clients Hearing many traumatic stories Inability to help their clients Lack of time or resources tohelp their clients

Frustrating interactions withsocial services

Unhelpful rules or regulations Paperwork

Tolerating distress is notsolving the problem.

There are other skillsfor problem solving.

There are other skillsfor problem solving.

Remember

Dont hit your head ona brick wall by trying tosolve a crisis that cantbe solved now.

Figure out another wayto solve the problem.

Then practice distresstolerance until thatother way can work.

Dont hit your head ona brick wall by trying tosolve a crisis that cantbe solved now.

Figure out another wayto solve the problem.

Then practice distresstolerance until thatother way can work.


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Tolerating distress is notremoving or sometimeseven reducing distress.

There are other skills forreducing emotions.

There are other skills forreducing emotions.

Dont expect distresstolerance skills to make

you feel better.

The fact is that you oftenmay feel better, but that isnot the purpose of the skill.

The skills are so you wontmake the situation worse.

If the skills prevent the crisisgetting worse but dontmake you feel better,DONT STOP! If you do,things may get worse.

The fact is that you oftenmay feel better, but that isnot the purpose of the skill.

The skills are so you wontmake the situation worse.

If the skills prevent the crisisgetting worse but dontmake you feel better,DONT STOP! If you do,things may get worse.

How canyou make a

crisisworse?

Yelling atsomeone

Using drugsor alcohol

Retailtherapy withmoney youcant affordto spend

Eating toomuch

Complainingso much folksdont want totalk to you

Giving upon solvingthe crisisaltogether


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you survive as wellas you can be and

live to fight anotherday on your crisis.

So, if you usedistress tolerance

skills,

the more competentand confident you

will become.

The more you learnto tolerate a crisiswithout making it

worse,

So what are the DistressTolerance skillsSo what are the DistressTolerance skills

DistractSelf SootheIMPROVE the momentPros and Cons


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Remember,wise mindACCEPTS

ActivitiesActivities

ContributingContributing

ComparisonsComparisons

opposite Emotionsopposite Emotions

Pushing awayPushing away

ThoughtsThoughts

SensationsSensations

Use an activity thatfits the moment orwhat you would be

doing if youwerent distressed

Use an activity thatfits the moment orwhat you would be

doing if youwerent distressed

Sports or exerciseSports or exercise Hobbies or usingyour talentsHobbies or using

your talents

Be with otherpeople and DONTtalk about the crisis

Be with otherpeople and DONTtalk about the crisis

Watch a movieWatch a movie Go to the zoo,park, beachGo to the zoo,park, beach

ActivitiesActivities


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Usually moredistractingthan an

activity foryourself

Usually moredistractingthan an

activity foryourself

Bake someonecookies

Bake someonecookies

Listen tosomeoneelses

problems

Listen tosomeoneelses

problems

Writesomeone

who is lonelya letter

Writesomeone

who is lonelya letter

VolunteerVolunteer

Contributing isdoing an

activity thatprimarily

serves others

Get attention of thecrisis but thinking about

other crises that areworse than yours

Someone or people whoare suffering more than

you

Get attention of thecrisis but thinking about

other crises that areworse than yours

Someone or people whoare suffering more than

you

A time in your life whenyou were doing worseRemember your pain isstill valid but put it on acontinuum from easiestto hardest to bear andfocus attention on theharder

A time in your life whenyou were doing worseRemember your pain isstill valid but put it on acontinuum from easiestto hardest to bear andfocus attention on theharder


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Figure out an emotiondifferent from the negative

one you are feeling and try andbring it on

If angry, watch a comedyIf scared, watch someonedaring

If sad, listen to upbeat music

If angry, watch a comedyIf scared, watch someonedaring

If sad, listen to upbeat music

When we aredistressed, oneor two negative

emotionsdominate the

scene

Imagineputting it on ashelf, in atime releasesafe, inanother room

Imagine aLucite wallbetween youand theproblem soyou may beaware of itbut you arecut off

Imagine thevolume ofthe problembeing turneddown

This means deciding that something cannot be dealt with now and putting it out of your mind


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The idea is to fill your brain with otherthoughts, so there is no room for the crisis

Sing song lyrics you dont quite rememberDo the times tables to a number you haveto calculate

Decide what profession everyone on thebus does

Imagine decorating your future home

Sing song lyrics you dont quite rememberDo the times tables to a number you haveto calculate

Decide what profession everyone on thebus does

Imagine decorating your future home

Mobilize your body and it will bringyour mind and emotions with it

Put your face in ice water or holdice

Run up and down stairsTake cold showerIf you are inside got outside or ifyou are outside go inside

Put your face in ice water or holdice

Run up and down stairsTake cold showerIf you are inside got outside or ifyou are outside go inside

This isTHE BESTstrategy toget unstuckwhen you are

verydistressed


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What would you do if you lived witha loved one going through a crisis?

How would you soothe them?

That is what you want to do foryourself

Dont make a situation harder bybeing more uncomfortable thanrequired

For instance, dont wear tight shoes to the dentist

Vision Decorate your space, gosomewhere inspiringDecorate your space, gosomewhere inspiring

Sound Music, soothing voices, naturesoundsMusic, soothing voices, nature

sounds

Smell Cooking, lavender, the beachCooking, lavender, the beach

Touch Comfortable clothes, petanimal, foot massageComfortable clothes, petanimal, foot massage

Taste Favorite food, hard candy ormint, good cup of coffeeFavorite food, hard candy ormint, good cup of coffee


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Skills toaccept painand reducesuffering

Imagery

Meaning

Prayer

Relaxation

One thing in the moment

Vacation

Encouragement

Happya beach, ahike, withfriends

Happya beach, ahike, withfriends

Safeplace far

away, placewith locks

Safeplace far

away, placewith locks

Relieflike when

the crisis willbe solved

Relieflike when

the crisis willbe solved

Relaxedon a warm,comfortable

couch

Relaxedon a warm,comfortable

couch

Picture aplace you

feel


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What can this crisisor tolerating thiscrisis do for you?What will you get

out of this?

What can this crisisor tolerating thiscrisis do for you?What will you get

out of this?

What are your corebeliefs or religious

traditions?

What are your corebeliefs or religious

traditions?

What doesnt killyou makes you

stronger

What doesnt killyou makes you

stronger

God doesnt giveme more than I can

handle

God doesnt giveme more than I can

handle

This too shallpass

This too shallpass

Examples

Serenity Prayer

May I be filled with loving kindness.May I be well.

May I be peaceful and at ease.May I be happy.

Ancient Tibetan Buddhist meditation

Use and connect to the religious or spiritualtraditions that are meaningful to you


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Progressive relaxationTighten each part of your body fully for 5seconds and then completely relax it

Start at toes and work through full body

Progressive relaxationTighten each part of your body fully for 5seconds and then completely relax it

Start at toes and work through full body

Walk, yoga, other exercise thatrelaxes your musclesWalk, yoga, other exercise thatrelaxes your muscles

The goalis to

reducesuffering

byremovingphysicalstress

from thebody

Bring all of your attention to what ishappening right in this momentBring all of your attention to what ishappening right in this moment

Let go of thoughts about the past andfutureLet go of thoughts about the past andfuture

Describe (in your mind, out loud, inwriting) what you notice in this momentto bring your attention just to now

Describe (in your mind, out loud, inwriting) what you notice in this momentto bring your attention just to now

A lot of distressA lot of distressis not in the present it is in the past oris anticipated for

the future


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Take a small vacation totolerate the distress

Dont talk to anyone for anhour

Go to bed and forget the restof the day

Decide everyone can dowithout you for a while

Get take out rather than cook

Dont talk to anyone for anhour

Go to bed and forget the restof the day

Decide everyone can dowithout you for a while

Get take out rather than cook

Key, as with all vacations, isplan it ahead of time andhave a return ticket

Otherwise you are runningaway!

Otherwise you are runningaway!

A vacation is when you deliberately step awayfrom your life to do something more relaxing, fun,

or peaceful

A vacation is when you deliberately step awayfrom your life to do something more relaxing, fun,

or peaceful

Be your owncheerleaderI can do itOnly 3 more days 2more1 more

I have been through worseand I can do this too

Similar to positive self talk

Be your owncheerleaderI can do itOnly 3 more days 2more1 more

I have been through worseand I can do this too

Similar to positive self talk

Goal is not tobe Pollyannaabout yourtroubles butencourageyourself tostick with itand tell

yourself youwill succeed


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Pros Cons

Making it worse by:____________

Tolerating distressby:____________

Pros Cons

Making it worse by:getting drunk

get to relaxwont have tothink about it

wont be able tofunctiontomorrow whenhave to call guyback

Tolerating distressby:self soothing

get somerelaxationwill be clearmindedtomorrow

will be worried allnightprobably wontsleep


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Pros Cons

Making it worse by:just go through themotions

dont have tofocus when tireddont get myhopes up

self fulfillingprophesyperson will thinkyou dont care

Tolerating distressby:IMPROVE withmeaning, prayer,and encouragement

feel proud of thequality of myworkhave hopetreatment morelikely to work

takes a lot ofeffortmay bedisappointed(again)

Do with clientor colleagueor friend

Do with clientor colleagueor friend

Afterwards,copy the Consof making it

worse and thePros of

toleratingdistress onto

one list

Afterwards,copy the Consof making it

worse and thePros of

toleratingdistress onto

one list

Keep thelist whereyou need it

most!

Keep thelist whereyou need it

most!

If you are at your darkest moment, you will not be able tosee the pros and cons at all clearly

If you are at your darkest moment, you will not be able tosee the pros and cons at all clearly


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If you have the urge to die, ironing is probably not goingto help!

If you have the urge to die, ironing is probably not goingto help!

Make sure the distress tolerance skill is closeto the intensity of the distress

Distracting with Sensations is a great way to get startedbut doesnt last; so if crisis is long, pair with Activities orContributing

Distracting with Thoughts lasts for minutes to maybe anhour good for the bus, traffic, staff meetings, or theline at the DMV

Take a vacation for as long as time allows

Distracting with Sensations is a great way to get startedbut doesnt last; so if crisis is long, pair with Activities orContributing

Distracting with Thoughts lasts for minutes to maybe anhour good for the bus, traffic, staff meetings, or theline at the DMV

Take a vacation for as long as time allows

Make sure the timing of the skill matchesthe situation


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Soothing by taste is not a good idea if you are acompulsive eater or are gaining weight

Take too many vacations, you dont get anything doneDistracting by watching a DVD TV series or readingnovels can take over your life

Soothing by taste is not a good idea if you are acompulsive eater or are gaining weight

Take too many vacations, you dont get anything doneDistracting by watching a DVD TV series or readingnovels can take over your life

Any Distress Tolerance skills overused canmake things worse

Often people see distraction getting your mind off it asthe only way to cope when you cant do anything aboutthe problem

Sometimes you need to stay with the problem such asstaying in class or on the worksite or with your children(or with your clients)

Be sure to learn Self Soothing and IMPROVE as much asDistract for this

Often people see distraction getting your mind off it asthe only way to cope when you cant do anything aboutthe problem

Sometimes you need to stay with the problem such asstaying in class or on the worksite or with your children(or with your clients)

Be sure to learn Self Soothing and IMPROVE as much asDistract for this

Avoid Distraction when it is avoidance

Do each skillon purpose(even if it issomething

you do all thetime)

Practice eachskill till you

are good at it

Challengeyourself touse the skillswhen yourdistress is

high

Observe howyou go aboutusing the skill

Observewhat you dowhen the skilldoesnt work

This iswhat tocoach

clients touse


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Thank you.


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Documents

DBT Distress Tolerance Skills - uwaims.orguwaims.org/webinars/slides/AIMS_MHIP_Distress_Tolerance_Skills... · Goals of distress tolerance skills Teaching the Skills ... Sports or