DISTRESS TOLERANCE SKILLS: PROS & CONS & OTHER TIPS

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: Pros & Cons & Other Tips

Along with the 3 core sets of Distress Tolerance skills, there are some other add-on skills worth mentioning in this module. Included is the concept of Behaviorism and how important it is for other skills to be effective.

Pros & Cons

Personally, I don’t love this skill being here, I think it should be in the emotion regulation module. However, it is a very important skill to have and hone, as good problem solving is essential for daily living. In DBT, the idea is to use the skill of weighing out the pros and cons of using self-destructive behaviors, vs. not using them. I don’t think this is a good idea for handling urges, as I don’t think you can think very clearly in the midst of an urge, and you are likely to talk yourself into, not out of self-destructive behaviors. I also think using 4 quadrants is too confusing and overwhelming for people, so instead I recommend doing this only if you are with someone who is able to objectively help you develop your list, or to do it outside of an urge to evaluate acting on the next urge. I also recommend using only one set of pros and one set of cons, and weighing each on a simple  3 point scale which determines the decision.

For example, say that you are trying to decide whether or not to adopt a dog. You would list all of the good things about the decision in the “pro” column, and all of the down sides of the decision in the “con” column. In addition, it is important to weigh the importance of each item on a scale of “1” (not very important) “2” (kind of important) and “3” (Super important). The total weighted number ,not the total number of items, determines the outcome:

Pros

Cons

Something to help me be accountable…………………………………….3 Something to be responsible for…………2
Something to calm me down……………3 Something that takes up my time and energy………………………………………………2
Something to cuddle………………………..2 Something expensive…………………….…..3
Something fun…………………………………1 Something messy/destructive……………2
Can help me be more social………………1 My apartment is small……………………….3
TOTAL:   ……………………………………….10 TOTAL:   ………………………………………….12

TIPPING THE TEMPERATURE

The TIPPING the TEMPERATURE skill can be very helpful for stoping a panic attack, lowering intense anxiety, or calming anger. By triggering the Dive response, our bodies will send blood to different areas and reduce the stress we are feeling in the moment. Holding your breath while dipping your face in very cold water, or while holding a ziploc bag of very cold water or ice on our face triggers this response, and can be very useful for stopping an urge to self harm.

Body Scan & Grounding Techniques

Doing any type of meditation, relaxation exercise, or physical movement can help reduce urges and stress as well. Being mindful of how each small part of our body, from our tippy toes to the top of our head, helps take the focus off of obsessive thoughts and destructive urges. Similarly, grounding techniques can help us regroup, orienting ourselves to the present moment and keeping us from dissociating from the moment. Grounding techniques can be audio, visual, tactile, olfactory, or things we taste, and should be chosen based on what grounds us the most in the moment. Some examples include, feeling the texture of the chair we are sitting on, imagining that we are held down by the weight of a huge warm blanket, etc:

Body Scan & Grounding Techniques

Doing any type of meditation, relaxation exercise, or physical movement can help reduce urges and stress as well. Being mindful of how each small part of our body, from our tippy toes to the top of our head, helps take the focus off of obsessive thoughts and destructive urges. Similarly, grounding techniques can help us regroup, orienting ourselves to the present moment and keeping us from dissociating from the moment. Grounding techniques can be audio, visual, tactile, olfactory, or things we taste, and should be chosen based on what grounds us the most in the moment. Some examples include, feeling the texture of the chair we are sitting on, imagining that we are held down by the weight of a huge warm blanket, etc:

Behaviorism 

The final concept discussed in this module so far is the concept of behaviorism. This refers to the sequence of events before and after a  behavior that motivate this behavior. It’s an important concept to take note of because, whether we intend to or not, we keep ourselves stuck in self destructive cycles due to our own undoing of our progress. This concept goes back to shortly after the turn of the century, when Psychologists were just beginning to uncover the brain and how it operates. Beahviorists like Skinner, Watson, and Pavolov were studying rats, cats, and pigeons in an effort to understand how we can change our behaviors. Ivan Pavlov, for example, gave his dogs meat powder, and took note of the natural consequence of doing so….salivation. Next, he started to ring a bell before giving the dogs meat powder, to see if he could pair the bell with the anticipation of food. After a while, he took the meat powder away, and found that the dogs started to salivate in response to the bell, rather than the food itself.

Like Pavlov, we can shape our own behaviors to be either how we want them to be, or to be self-sabatoging. For example, we can use a behavioral strategy called contingency management to shape our behavior. This means that a reward (reinforcement) is contingent upon a behavior change that I am trying to achieve. So, if my ice cream cone is contingent upon my finishing my housework, I am using contingency management to motivate me to do my housework.

Behavioral principals are so important because they either help us achieve our goals, or hinder us from achieving them. For example, if I let myself get that ice cream before I finish my housework, I am sabotaging myself by taking my motivation away. Then, lets say I feel guilty (a natural consequence of going against my goals) about eating the ice cream when I didn’t earn it. Guilt then acts as punishment, which can motivate me in the future, because I will want to avoid that guilt. But research shows that punishment is not as effective in chaining behavior as reinforcement is. In fact, punishment puts me in a shame cycle, where I feel ashamed of eating the ice cream, then i feel hopeless helpless and angry, leading me to more unhealthy behavior.

Instead, I could encourage myself by saying “Wow I am halfway done my housework and already I’m exhausted. I am going to get my ice cream and set a new goal to finish this housework before I watch any TV.” Setting a new goal shapes my behavior toward what I want it to be still holds me accountable to do what I set out to do, and motivates me intrinsically (by telling myself nice things about myself), and extrinsically (by getting myself an ice cream). Instead of being kind to ourselves, many of us are very invalidating of ourselves, taking away the progress we have made and treating ourselves as if we are bad human beings. We deserve kindness, compassion, and empathy even from ourselves, and operating out of self hate, shame, and invalidation will surely NOT motivate positive change.

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