3 Core Distress Tolerance Skills

The following is a synopsis of a weekly Dialectical Behavior Therapy (DBT) group lesson, based on the work of Marsha Linehan out of the University of Washington. This week’s lesson is actually outside of the normal DBT content, it is solely based on the codependency literature, specifically the work of a wonderful fellowship called CODA.

New Disclaimer: I LOVE doing this, I think it is desperately needed, and I WANT to do it. However, I have zero time to do it so, while I am committed to giving it my all, I may fall behind or skip a week or two. I apologize in advance for that, and for the fact that I will not be spell checking, fixing formatting, or doing a read through before I post. No offense, but I gotta draw the line somewhere!

Distress Tolerance Skills Module: 3 Core Distress Tolerance Skills

Ok, so I didn’t actually write a blog last week and, truthfully, I can’t do one next week either so this blog covers all 3 weeks. But this is really truly ok because, these DT skills are the 3 most concrete, obvious, and clear skills in DBT. These skills are Distracting, Self Soothing and Improving the Moment. There are just a few major points to make about these skills.

Distracting: All 3 sets of skills have easy ways to remember them so that in a really difficult situation, we can be more likely to know what to do. The pneumonic for Distracting skills is “Wise Mind ACCEPTS”.

Activities: ANY activity can be a distracting skill, as long as it is chosen purposefully and done mindfully, to distract from pain, crisis, urges, etc. Examples are games, chores, journaling, reading, watching TV, etc.

Comparisons: Comparing ourselves to those doing better than us can make us feel inspired. Comparing to those doing worse than us can make us feel grateful. Comparing our past selves to our past selves can give us hope and pride. People sometimes feel guilty or angry about using this skill, but of course, it is all a matter of perspective. If you feel guilty about other’s pain, distract from THAT, too.

Contributing: Helping around the house, checking in on a friend who’s been struggling, volunteering at a shelter, etc. are all ways to give back to the world. These activities enhance our lives, give us a feeling of connectedness to the world, and give us something to do that can take us outside of our own selves and troubles.

Emotions: ANY other emotions are ok. If you want to distract from sadness, read a scary book. If you want to distract from anxiety watch a funny movie. As long as we are purposefully and mindfully choosing what emotions we want and an activity that is likely to cause that emotion, this will work to distract.

Pushing away: This can be either imaginal or “in vivo”. We can push away our problems by telling ourselves that we will think about them later. We can push away obsessive thoughts by putting them in an imaginary box and putting them up on a high shelf in our mind. Or, we can make a “worry box”, decorating it and putting our worries on slips of paper that go in the box. AND STAY THERE!!

Thoughts: Like other emotions, other thoughts that can distract us are helpful for reducing obsessions or fears. Choosing an activity that requires some sustained mental effort (ex. reading mindfully, doing a challenging puzzle, counting colors in a painting, etc.) can really distract from distressing thinking.

Sensations: Finally, other physical sensations are helpful for distracting from anything, but mainly self harm urges. Squeezing a rubber ball very hard, taking a hard, hot shower, or holding ice in our hands can distract from physical urges to harm, which by the way, pass within 20 minutes, as a rule (Marlatt).

With all of the distracting skills, the most important points are to do them mindfully (or they won’t work), and to do them minimally! We cannot go through life distracting from our problems, as this leads to way bigger problems. We must distract when we can’t do anything about a situation at all, when we have problem solved but can’t do anything more right now, or when we really need to avoid attending to a problem for the time being. Monitor how much you are using distress tolerance skills, in order to avoid over use.

Self Soothing: The way to remember your self soothing skills is that they are tied into our 5 senses.

Soothing with Vision: Anything that is pleasurable to look at counts, such as a pretty picture, a hot picture, a beautiful landscape, etc.

Soothing with Taste: Yummy, comfort foods, soothing teas, tasty coffees, candies or gum that can make tastes linger, etc  Tastes are very satisfying and very pleasant.

Soothing with Touch: All kinds of things feel very soothing, such as petting an animal, putting a warm towel on your face, or rubbing a piece of your favorite fabric while in a stressful situation.

Soothing with Sound: Music is a very popular coping skill, but other sounds can be very soothing such as waves crashing, rain falling, or wind chimes chiming.

Soothing with Smell: Scents, like tastes can be very pleasant to smell, including candles or lotions with familiar smells that can be calming and soothing.

Self soothing is the opposite of distracting, in that we need to do these on a regular basis, several times a day. We do have to be careful not to over soothe with things like food or sex, but in most cases, we are not soothing enough, and even if we do over-soothe, we need to focus on finding a healthy balance. Most of us, especially women, have many belief obstacles that get in our way of self soothing, such as believing that others should soothe us, thinking self soothing is wasteful or too time consuming, or getting frustrated that it doesn’t help us enough. Exploring what myths get in the way of our frequent self soothing is important in helping us use self soothing to bring quality to our lives.

Finally, Improving the Moment is our last Core skill set, with the acronym “IMPROVE” These skills are meant to make a bad situation just a little more bearable.

Imagery: Like pushing away (Distracting skill), imagery can be very useful for taking us out of our worries. Imagining a happy place, a fantasy world, or a time when things will be better, will make the moment a little nicer.

Meaning: Finding meaning in the pain is essential for getting through true crisis, and often we cannot find the meaning until the crisis passes. But remembering that there is a reason for everything can help us have faith that there is meaning in pain, even if we are not sure what the meaning is.

Prayer: Even if we are not religious, praying to the universe, chanting, or just using prayer as a sort of self talk will make the moment better.

Relaxation: There are lots of ways to relax, using deep breathing, meditation, muscle tensing, etc. Let’s face it,  giving ourselves a break and our bodies and minds a rest will help with most things.

One thing in the Moment: Like one mindfully (Mindfulness), doing any one thing and only that, helps reduce overwhelm and stress.

Vacation: Taking a mental vacation can be a 5 minute thing (like pulling the covers over your head). Taking a day to get lost on a long drive, or renting a hotel room for a night or weekend is distracting, self soothing, and improving the moment.

Encouragement: Positive self talk, cheerleading, and being our own best friend are essential skills for making our lives more pleasant.

Like any skill we teach in DBT, it’s all about balance. Having as many coping skills as possible helps, since some of them won’t help at times, so you can always try others. Over using any skill will make it ineffective, and sometimes it will make our lives worse, so strive for variety, mindful execution of skills, and BALANCE!

One comment on “3 Core Distress Tolerance Skills

  1. Suzanne Robison says:

    It’s usually worry thoughts and anxiety that distracts us from the moment. Read the blogs on mindfulness, we have to ground ourselves in whatever we are doing by fully attending to it. If you’re eating, eat, if you’re running, run, if you’re worrying, worry….fully and completely. When your mind wanders, you notice it, and bring it back…again and again and again…it also helps to put your finger on the words and say them out loud if needed….

    thanks for the questions!!!

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