Distress Tolerance Skills: Crisis or Bad Day?

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: Crisis or Bad Day?

This week marked the beginning of the Distress Tolerance Skills Module, the shortest and pretty much the simplest of all of the Modules. Mindfulness, the last module, is the most complex, abstract, and difficult module to execute. This module is the dialectical opposite! Distress Tolerance is very concrete, direct, and easy to use, up until the last 2 weeks when we discuss Willingness and Radical Acceptance.

Distress Tolerance skills were specifically designed to help us get through a true crisis situation. You can use them to get through urges, bad days, or stressful situations, but you have to be very careful about doing so (which will be discussed over the next few weeks). So this module has to start with defining a crisis.

How many crises do we go through in a lifetime? One group member did a great job explaining crises and how they evolve developmentally, at certain phases across the lifespan. While some individuals go through more crises than others, we can anticipate that we may go through about a 5-10 true crises in the average lifetime. Crisis is something:

a. Over and above the stressors of every day life. We all have bad days, bad weeks, bad things happen, etc. But a CRISIS is a situation that knocks us down emotionally, comes out of the blue or without too much warning, or just forces a huge change in our life.

b. Temporary. This is a big concept. Crisis is temporary, it is not ongoing. If I lose my job today, I am not still in crisis a year from now. A crisis is only for now, until we adapt, adjust, move on, etc. A true crisis is recent, takes some time to adjust to, grieve, etc.; but then the crisis has passed. If we feel we are in crisis every day, we are not. This is our life, not a crisis.

c. We cannot resolve right now. A true crisis is not going to fix itself, and we cannot do anything to fix it in the moment. This is another important thing to consider, as we sometimes don’t do enough to solve our own problems, even when we can. If we can resolve a problem, we need to resolve it. In a true crisis however, we are powerless to fix it in the moment. Even if that moment lasts an hour, this is an hour that we are in crisis.

d. We don’t want to make worse. I am a big believer that no one wants to be miserable. Sometimes people get accused of that, they are told that they want to be unhappy or choose their misery. When it comes right down to it, we all choose our own emotions, lives, etc. We all choose things that are not good for us, or choose not to better ourselves in some ways. But none of us want to be in pain. Some of us might wallow in self pity sometimes, avoid things that we know will make ourselves feel better, etc., but in a true crisis, we don’t want to make it worse because it already feels so bloody awful.

So these are the criteria for a true crisis, in which we have 5 options:

a. Problem solve as much as possible. Even in a true crisis, we can problem solve as much as possible to make it slightly better. We may not be able to fix it right now, but we can make a plan to attempt to fix it, or a plan to cope with it, or take steps to move toward acceptance. For example, if a very special person dies, we can make the burial arrangements. If a teacher gives me an “F” on a Friday, I can call him first thing Monday morning. 

b. Change your perspective on it. Accepting our realities is something I talk to everyone I see about. It is the most difficult, and most important of all of the DBT skills to master, and something we review at the end of this module. If we have a true crisis, we can view it as an opportunity, a forced change that we needed forced upon us, and a new beginning, rather than viewing it as the sky falling. 

c. Stay Miserable. Many of us view misery as something that takes us against our will, but we are in charge of this. We can stay miserable, wallow in self pity, and make our situation worse with self-destructive behaviors. That is our right, and our choice. But if we don’t want to make the situation worse, than we need to do anything we can to ease our burden.

d. Use our Distress Tolerance Skills. The skills in this module are very practical, useful coping skills that we can use anytime. But as mentioned before, we need to use them with caution, and we need to use them anytime we are in a true crisis. There are 3 core sets of distress tolerance skills; Distracting, Self soothing and Improving the Moment.

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