Distress Tolerance

Stress is a normal part of life however sometimes we can become overwhelmed and distressed.  If we don’t have helpful coping strategies to manage this distress, we can sometimes turn to substance use to get us through. Using substances can actually make us feel worse and continue the cycle! Distress tolerance skills are alternative, healthy ways to survive the moment of distress, or crisis, without making it worse.

These skills will not solve the problem and should only be used in the short term to help get us through, until we can get back into wise mind. Once we are in wise mind we can use other DBT problem solving strategies to effectively resolve the situation.

ACCEPTSIMPROVESelf SoothePros and ConsUrge SurfingAcceptance Skills

ACCEPTS

ACCEPTS is a distraction skill. Remember, none of these distractions should make the situation worse.
Activities Take time out to do something else For example; walk the dog, draw, etc.
Comparison Compare yourself to someone else to gain perspective Try comparisons with role models, people doing it tough, or even yourself at different times of your life
Contribution Do something for others; it often makes you feel better too For example; help mow the lawn, give someone a compliment etc.
Emotions What would you be doing if you felt good? Go do it! Try to generate a helpful emotion For example; watch a comedy, listen to music that makes you feel good etc.
Pushing Away Leave the situation or mentally check out
Thoughts Fill your short term memory with alternate thoughts For example; recite song lyrics, read your favourite saying over and over, read a book etc.
Sensations Engage your 5 senses to make yourself feel better For example; have a relaxing shower when tense, exercise when lethargic etc.

IMPROVE

IMPROVE is a distraction skill. Remember, none of these distractions should make the situation worse.
Imagery Use visualisation to imagine a good outcome, or imagine coping effectively.
Meaning Connect with your goals and values.
Prayer Connect with your sense of purpose and spirituality. Take comfort in the fact that we can't control everything but we do have some control.
Relaxation Take time to relax your body and mind.
One thing in the moment Focus on one task at a time. Try putting all of your energy and concentration into that one task.
Vacation Give yourself a break. If you can't physically get away, imagine yourself where you are able to have time out.
Encouragement Cheerlead yourself and mean it!

Self Soothe

Self soothe is a distraction skill. Remember, none of these distractions should make the situation worse. Comfort and be kind to yourself. Engage your 5 senses; smell, taste, see, hear and touch.   Tip! Create your own virtual self soothe kit by signing up to pinterest and saving pictures, videos and music to a secret pinboard. When you are feeling distressed, simply sign in and view the things that comfort you. You could also do this with a real self soothe box in your room; place photos, perfumes, CD's, lollies, stress balls or whatever works for you, into a box and have it close by for when you feel distressed.  

Pros and Cons

When we are distressed we often act on impulsive urges that will make us feel better in the short-term. To encourage deliberate reflection on short and long term outcomes, use a 4 column pros and cons list to identify the positives and negatives of acting on the urge. Remember to use your mindfulness skills to objectively describe the situation, the urge and the potential outcomes.

Urge Surfing

It is important to remember that emotions and urges do not last forever; they swell, crest and subside. Typically, substance use cravings last less than 30 minutes. Use your mindfulness skills to 'ride the wave' without judging, countering or acting on the craving. Experiencing urges without acting on them will retrain your brain and weaken the connection between triggers and relapse. Arguing with, or trying very hard to suppress urges, on the other hand, tends to only make them stronger.

Acceptance Skills

These skills can help us to cope with major trauma and pain, and they give us another option when problem solving strategies aren't working.   Sometimes it can be helpful to accept life as it is in the moment. Fighting or struggling against something that has happened, does not change it. It does however, take up emotional and mental energy or 'head space' and it often increases our suffering. Accepting does not mean giving up, or approving or agreeing with your circumstances; instead it is about reducing your suffering and increasing your freedom.   Tips for acceptance
  • Try radical acceptance; this means accepting something 100% and opening yourself to the reality of the moment. Imagine yourself accepting the moment and then practice acting as if you have already accepted it! Allow yourself to feel emotions such as disappointment, grief and sadness but acknowledge that life can be worth living even when it is painful.
  • Acceptance is a choice and you will need to turn your mind to accepting something over and over again.
  • Be willing; do what works and throw yourself into it wholeheartedly. Let go of pride, bitterness and ego. Being stubborn can be a barrier to acceptance.
  • Try relaxing your posture, open your hands and half-smile so that your body reflects your minds turn towards acceptance.