Distress Tolerance strategies

In DBT, there are four categories of Distress Tolerance strategies. These are:

Distracting

Self-Soothing

Improving the Moment

Focusing on the Pros and Cons

These are strategies that short circuit or help you to cope with overwhelming negative emotions or intolerable situations. They take a lot of practice, but as you get the hang of using some of these techniques, you will see your relationship to the negative emotions and intolerable feelings change. (This was the most amazing thing about DBT for me, that things I though could never change or that I could never learn to deal with did become better.) It takes time and practice, and so I urge you to give the techniques plenty of practice. You will find some things work better than others for you. And you will find that some things don't work at first, but over time and practice you will see some results.

Self-Soothing Techniques

Some of us may recognize these techniques as things that we already use. But many of us have never learned how to self-soothe, how to do those often simple things that makes us feel better. These are mostly very physical techniques, that use different body senses. Some of us have never had the feeling that we could do things to make ourselves feel better, calmer, feel relaxation or pleasure. I urge you to experiment with these techniques until you find some that are comfortable and helpful for you. And when you find these, practice them. Use them when you are feeling distressed, when emotions feel overwhelming, when situations feel like you can't stand them any more. Instead of doing something that hurts you, try something that gives you pleasure and comfort,SELF-SOOTHING has to do with comforting, nurturing and being kind to yourself. One way to think of this is to think of ways of soothing each of your five senses:

Vision

Hearing

Smell

Taste

Touch

VISION:Walk in a pretty part of town. Look at the nature around you. Go to a museum with beautiful art. Buy a flower and put it where you can see it. Sit in a garden. Watch the snowflakes decorate the trees during a snowfall. Light a candle and watch the flame. Look at a book with beautiful scenery or beautiful art. Watch a travel movie or video.HEARING:Listen to beautiful or soothing music, or to tapes of the ocean or other sounds of nature. Listen to a baby gurgling or a small animal. Sit by a waterfall. Listen to someone chopping wood. When you are listening, be mindful, letting the sounds come and go.SMELL:Smell breakfast being cooked at home or in a restaurant. Notice all the different smells around you. Walk in a garden or in the woods, maybe just after a rain, and breathe in the smells of nature. Light a scented candle or incense. Bake some bread or a cake, and take in all the smells.TASTE:Have a special treat, and eat it slowly, savoring each bite. Cook a favorite meal. Drink a soothing drink like herbal tea or hot chocolate. Let the taste run over your tongue and slowly down your throat. Go to a potluck, and eat a little bit of each dish, mindfully tasting each new thing.TOUCH:Take a bubble bath. Pet your dog or cat or cuddle a baby. Put on a silk shirt shirt or blouse, and feel its softness and smoothness. Sink into a really comfortable bed. Float or swim in a pool, and feel the water caress your body.

Discussion

Many of us may feel like we don't deserve these comforts, and may find it hard to give pleasure to ourselves in this way. Do you have these feelings?Some of may also expect this soothing to come from other people, or not wantto do it for ourselves. Have you experienced this feeling?You may feel guilty about pleasuring yourself in this way. It may take some practice to allow yourself to experience these pleasures. These are really simple human pleasures that everyone has a right to, and that will give us some good tools to use when we are feeling bad.

Exercises

Try at least one of these self-soothing exercises this week. You may want to choose a whole group of things, say all the visual things, or you may want to choose a single thing to try. As you do what you have chosen, do it mindfully. Breathe gently, and try to be fully in the experience, whether it is walking in the woods or watching a flower or taking a bubble bath or smelling some fresh-baked bread.As you begin to overcome your feelings that perhaps you do not deserve this, or guilt, and start to enjoy one or more of these activities, you will be learning very useful tools to help you deal with negative feelings and difficult situations.

Improve the Moment: One Thing in the Moment

One thing in the moment is the same thing as One-mindfully, or Mindfulness, which we talked about when we discussed the Core Mindfulness skills. It means focusing on the one thing that you are doing right now, in the present moment. This can be very helpful if you are in a distressing situation or a crisis. It can give you some time to settle down and calm down.Often our suffering is made more intense by remembering past suffering and worrying about future suffering. If we can stay in the moment and focus on what is happening in the here and now, our suffering will be greatly reduced.Mindfulness or one thing in the moment is a skill that can be practiced. Later in this lesson there will be some simple exercises that you can use to practice mindfulness, and then a little later on, we will have some more breathing and awareness exercises.

Awareness Exercises

You might try this exercise, suggested by Marsha Linehan in the manual. Close your eyes and get in touch with some current discomfort or anxiety - one that you are experiencing right now. Notice your level of discomfort. Now start thinking about times in the past that you have had to endure such feelings, and think about how many more times you are going to have to endure such feelings. Notice your level of discomfort. Now let your mind refocus on this moment, letting all the past and future thoughts and feelings go. Take some time to focus again just on this present moment. Notice your level of discomfort. What do you notice? Share with the list if you are comfortable doing so.To get a sense of what "in the moment" or mindfulness feels like, try the following exercises. Just breathe slowly and gently through each exercise, and concentrate fully on what you are doing right then.

Breathing Awareness

Close your eyes, put your right hand on your abdomen, right at the waistline, and put your left hand on the center of your chest.Without trying to change your breathing, notice how you are breathing. Which hand rises most as you inhale, the hand on your chest or the hand on your belly?If your abdomen expands, then you are breathing from your abdomen or diaphragm. If your belly doesn't move, or moves less than your chest, then you are breathing from your chest.The trick to shifting from chest to abdominal breathing is to make one or two full exhalations that push out the air from the bottom of your lungs. This will create a vacuum that will pull in a deep diaphragmatic or abdominal breath the next time you breathe in.Focus on your breathing in this way for a few minutes.

Body Scanning

Close your eyes, and starting with toes and moving slowly up your body, ask yourself "Where am I tense?" When you discover a tense area, exaggerate it slightly, so you can become aware of it. Be aware of the muscles in your body that are tense. Then, for example, say to yourself, "I am tensing my neck muscles...I am creating tension in my body." At this point, be aware of anything that is creating tension in your body and what you might do to change it.

Everyday Awareness

Use your breath in helping you to become more aware in your everyday life. Cue into the process of mindful breathing in all different situations - waiting for the bus, watching the sunset, sitting in church, eating an ice cream cone, playing with your dog, listening to your favorite music.

Ask what is my body doing?

Where are my thoughts taking me?

Who is the person I'm talking with?

What does this food feel like in my mouth?

Why is my shoulder feeling so tight?

This awareness is the verbalized appreciation of the way things are - the experience of "just being with" the flower, the other person, the movement of your body as you dance. You are in the moment, enjoying and appreciating what is.

Awareness of Sound

Close your eyes and stand very still. Listen carefully. What is the furthest sound you can hear? Concentrate on that one. Hear it with the "ear" of every cell of your body.

Stand very close to a tree or bush. Listen only for the sound of the wind playing with the leaves or branches. Experience yourself as a tree. Listen for what the wind does to your body.

Locate a source of running water - a river, a stream, a waterfall. Close your eyes and allow the sound of moving water to fill you. Try to attend to nothing else. Hear the water with your whole body. Imagine that it is running through you - the channel. Allow it to cleanse and refresh you. Become a part of the water.

Most large buildings have an air-conditioning system or heating system which makes a continual background noise. Close your eyes and listen for this sound. Use the sound to relax yourself. Tangerine/Orange Meditation

Sit at a table with a tangerine or an orange in front of you. (You may also use a grape.) Look at the tangerine. Look at the color and the shape. Notice any markings. See the dimple at the center. Is it exactly round? Hold the tangerine in your hands. Feel the skin. Smell the skin. Imagine the grove where the tangerine grew, and see it hanging on the tree. See the other trees in the grove. Now begin to peel the tangerine. Feel the oiliness of the skin. Notice the inside of the peel. Notice the color and shape of the section. See the white strings on the section of tangerine. Hold it to your nose and smell its fragrance. Bite into the tangerine. Feel its texture. Notice its taste. Are there seeds? Is it juicy? Does the juice run down your chin or get on your fingers? Continue to eat the pieces of tangerine - how many slices are there? Notice how you feel after eating the tangerine. How was the experience of really taking notice of how it looked, smelled, tasted? This is mindful eating.Try eating some other foods in this way, really paying attention to the food and the experience of eating it.

Improve the Moment: Relaxation

Use of relaxation and stress reduction exercises is an excellent way to help ourselves feel better in the moment. Many of us are tense, and become more tense when we are in distress. Relaxing changes that response. The goal is to accept reality with the body, not to fight against it or try to push it away. The body and the mind are closely linked. Relaxing the body also relaxes the mind.Some of the relaxation techniques that you might try are listening to a relaxation tape (can be found in book stores, health food stores, sometimes gift shops), exercising hard (think of how relaxed you feel after a good run or swim or a long walk), taking a hot bath, massaging your neck and scalp, legs and feet, breathing deeply, drinking some hot milk, cocoa or herbal tea, sitting in a hot or cold tub until the water becomes tepid, listening to music.Can you think of some other relaxing things? Each of you probably has some special thing.

Exercises

Note: All of these exercises involve breathing, most of them deep breathing. Some people find that this causes panic. A couple of people have suggested to me that reversing the sequence, that is, breathing out first and then in, instead of in and then out, does not cause the same panic. So give that a try. If it does not help, then just go ahead with the rest of the exercise.Try to learn and practice these exercises when you are feeling good. This way you will be better able to use them when you are in distress.

Breathing Awareness

Lie down on the floor with your legs flat or bent at the knees, your arms at your sides, palms up, and your eyes closed. Breathe through your nose if you can. Focus on your breathing. Place your hand on the place that seems to rise and fall the most as you breathe. If this place is on your chest, you need to practice breathing more deeply so that your abdomen rises and falls most noticeably. When you are nervous or anxious you tend to breathe short, shallow breaths in the upper chest. Now place both hands on your abdomen and notice how your abdomen rises and falls with each breath. Notice if your chest is moving in harmony with your abdomen. Continue to do this for several minutes. Get up slowly. This is something you can do during a break at work. If you can't lie down you can do it sitting in a chair.

Deep Breathing

This exercise can be practiced in a variety of positions. However it is most effective if you can do it lying down with your knees bent and your spine straight. After lying down, scan your body for tension. Place one hand on your abdomen and one hand on your chest. Inhale slowly and deeply through your nose into your abdomen to push up your hand as much as feels comfortable. Your chest should only move a little in response to the movement in your abdomen. When you feel at ease with your breathing, inhale through your nose and exhale through your mouth, making a relaxing whooshing sound as you gently blow out. This will relax your mouth, tongue and jaw. Continue taking long, slow deep breaths which raise and lower your abdomen. As you become more and more relaxed, focus on the sound and feeling of your breathing. Continue this deep breathing for five or ten minutes at a time, once or twice a day. At the end of each session, scan your body for tension. As you become used to this exercise, you can practice it wherever you happen to be, in a standing, sitting or lying position. Use it whenever you feel tense.