Distress Tolerance Skills for Improving Happiness and Reducing Wasted Energy

Dialectical Behavior Therapy
Techniques
Distress Tolerance
Happiness Isn’t Brain Surgery Additional Resources at DocSnipes.com
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery
Author: Journey to Recovery (2015) & Happiness Isn’t Brain Surgery (2017)

Objectives
 Define goals of distress tolerance
 Discuss why some clients do not choose distress tolerance
 Explore a variety of Distress Tolerance and Reality
Acceptance Skills including
 STOP
 Pros and Cons
 TIP
 ACCEPTS
 Self Soothing
 IMPROVE the Moment
 Radical Acceptance
 Turning the Mind

Goals of Distress Tolerance
 The goal of distress tolerance is to accept, find
meaning for and tolerate distress
 Pain and distress are part of life. Refusing to
accept this leads to suffering
 Any attempts at change will produce distress,
therefore distress tolerance skills are necessary
Change causes crisis and crisis causes change

Distress Tolerance
 Distress tolerance is a natural progression from
mindfulness
 Accepting, nonjudgmentally, oneself and the situation
 Not trying to change the situation, your feelings,
thoughts or urges
 Distress tolerance means surviving crises,
accepting life as it is in the moment.
Tolerance and acceptance of reality do not equate with
approval

Distress Intolerant Thoughts
 I can’t stand this
 It’s unbearable
 I hate this feeling
 I must stop feeling this
way
 I will lose control
 I’ll go crazy
 This feeling will keep
going on forever
 It is wrong to feel this
way
 It’s stupid and
unacceptable
 It’s weak/bad

Activity
 When something bad happens, what are your
distress intolerant thoughts?
 Here are some self-statements you can use to
counter your thoughts.
 This is agonizing right now, but will get better
 I have gone through worse before and survived
 I know this cannot last forever
 My feelings are designed to protect me.
 Come up with other statements to rebut your
personal distress intolerant thoughts.

Proving How Bad It Is
 Sometimes people want others to understand how
bad it is, so they focus on the distress instead of
surviving the situation
 Short Term Gains (Look what you made me/I had to
do)
Controlling another’s behavior
Going to the hospital and getting attention/break
 Remember a time you acted impulsively to try to
get someone to see how bad it was. What were
the results?

Avoidance Behaviors

Activity
 What are your avoidance behaviors?
 What is their benefit in the short term?
 Do they help resolve the situation at all?
 What is the impact on you in the long term?

Summary
 The goal of distress tolerance is to accept, find meaning for and
tolerate distress
 Once you become mindful (aware) you need to:
 Accept, nonjudgmentally, yourself and the situation
 Not trying to change the situation, your feelings, thoughts or urges
 If you don’t feel like other people understand, or are supportive,
sometimes you may focus on the distress instead of surviving the
situation.
 Increase in distress intolerant thoughts
 Avoidance or behaviors designed to numb/distract from/eliminate the pain
 Recognizing the impact of these behaviors can help you get
motivated to explore distress tolerance skills.

Objectives
 Learn about urges and how to deal with them
 Identify ways to use your energy to improve the
next moment and help you draw closer to your
goals of Happiness

Distress Tolerance Skills
 Different skills work for different people and may
work sometimes but not others
 Try various skills until you find the ones that
 Help you remain mindful
 Reduce vulnerabilities
 Accept how you feel in the moment without having to
act on your urges
 Help you make wise choices for how you are going to
use your energy.

Urges

Urge Surfing
 Urges are generally intense for 20-30 minutes
 Every time you have an urge think, “I have a choice!”
 Surf the urge by opening yourself up to the urge. This
doesn’t mean that you consume yourself in it (which feels
horrible) or fight it and push it away. What you do is
experience the feeling of the urge with acceptance, non-
judgement, being aware that it is there.

Pros and Cons
 What are the benefits to acting on impulsive urges?
 What are the drawbacks to acting on impulsive
urges?
 What are the benefits to not acting on them?
 What are the drawbacks to not acting on them?

TIPP Skills
 Temperature
 Intense Exercise
 Paced Breathing
 Paired Muscle Relaxation
 The act of muscle relaxation is paired with a verbal cue
 What reactions do you have that are paired with verbal
cues?
Positive Arousal Unpleasant Arousal
Let’s go to dinner
How would you like to…
Baby laughing
Clear your desks….Quiz time
We need to talk.

STOP Skills
 Stop
 Take a step back
 Observe
 Proceed Mindfully
Goals and
Values
Distress and
Suffering
What are your options
that may stop suffering
in the short term but
maintain distress?
What are alternate
thoughts you could
have that help you
feel empowered?
What are your
options that can
help you reach your
goals?
What thoughts and
feelings are you having
that are increasing
your distress?

Distract with Wise Mind ACCEPTS
 Activities (pleasant)
 Contributing
 Comparisons
 Emotions (opposite)
 Pushing Away
 Think about something totally different
 4 3 2 1

Self-Soothing
 Body Scan Meditation
 Self-Soothing Using the 5 Senses
 Sight
 Smell
 Hearing
 Touch
 Taste

IMPROVE the Moment
 Imagery
 Safe place
 Successfully dealing with this
 A force field
 A coach/fairy godmother/angel
 Feelings and thoughts are clouds in the sky
 An unstoppable train
 Meaning
 Changing how you think about yourself and your situation
 Make lemonade. Find the silver lining.
 Prayer
 Relaxation

IMPROVE the Moment
 One thing in the Moment
 Focus on one thing you are doing right now
 Sitting in a chair
 Driving
 Weeding
 Vacation
 Mental vacation
 Take a short break
 Leave stress at work
 Encouragement
 Be your best friend
 Create a mental coach

Summary
 Urges come and go
 Surfing your urges keep you from doing something
impulsively that could cause you distress
 TIPP skills can help you get through the urge
 ACCEPTS activities can help you unhook/distance
from powerful urges and feelings
 IMPROVE skills help you take positive steps toward
your goals

Objectives
 Define and explore Radical Acceptance
 Explore additional tools

Reality Acceptance
 Radical Acceptance
 Complete and total acceptance of the facts of reality
 You don’t have to like or condone it, just accept that in
THIS moment, it is what it is.

Reality Acceptance
 Seeing Emotions Differently
 Fear and anger kick in when there is a threat
 Sadness kicks in when you lose something important to
you in some way, If you didn’t feel sadness when these
things occurred, it would mean that nothing was
important.
Unpleasant emotions are important to survival,
rather than something to be feared and avoided
at all costs

Reality Acceptance
 Willingness vs. Willfulness
 Willfulness forgets, ignores or actively tries to change,
master, direct, control or manipulate what is
 Willingness is a surrendering to a process in which one
is already a part and figuring out what to do to change
the next moment

Reality Acceptance
 Turning the mind—Willingness (changing what will be)
 Mentally looking to the other side to focus on how you can
best use your energy to improve or cope with the situation.
Car Accident
Going to Jail
Break Up

Reality Acceptance—Emotions & Thoughts
 Half Smiling and Willing Hands
 Emotions are partially controlled by facial expressions.
 Half smiling with lips slightly upturned
 Hands are unclenched, palms up, fingers relaxed
 Mindfulness of current thoughts
 Recognize that thoughts are just neural firing in the
brain, not facts about the world
 Allow the thoughts to come and fade

Additional Tools for Addictions
 Clear Mind
 Addicted Mind is governed by impulsive behaviors
designed to make the pain go away quickly.
How is addicted mind similar to the emotional mind?
 Clean Mind (Pink Cloud) forgets that relapse is possible
How is the clean mind similar to the rational mind?
 Clear mind is not engaging in addictive behaviors but
remains aware that relapse is possible.
How is the clear mind similar to the wise mind?

Activity
Addicted Mind Clean Mind (Pink
Cloud)
Clear Mind
Ex. Defeated, hopeless
Ex. Angry, bitter
Ex. Untouchable,
infallible
Ex. Exuberant,
compassionate
Ex. Cautiously
optimistic
Ex. Compassionate but
careful
How do you think, feel and behave in each state of mind?

Additional Tools
 Burning Bridges and Building New
 Actively eliminate triggers/vulnerabilities
 Find physical and emotional sensations and create
mental images that compete with the urge to use

Activity
 Find physical and emotional sensations and create
mental images that compete with the urge to use.
 Laughter
 Love
 Happiness
 What is more important than using? Or what
brings you greater peace than using?
 Picture album
 Mental Images (draw, narrate, record)
 Sunshine

Additional Tools
 Alternate Rebellion
 Finding alternative ways to act out which are safer
Harm reduction
Sublimation
TIPP (Temperature, Intense Exercise)
Loud music
What can you do?

Important Questions
 When choosing distress tolerance skills, evaluate
 How does [this technique] make you feel?
 How does it impact your feelings in the moment?
 How does it affect how you handle the problem?

Emotional Comebacks
 Sometimes emotions, thoughts, urges reappear
 Notice them without negative judgement.
 Deal tolerate the distress
 Problem solve

Summary
 Remember that you feel how you feel
 Feelings can cause you to have urges
 Urges are generally designed to escape the feeling,
but often do nothing to change the situation
 Urges subside within 20-30 minutes
 Find techniques that can help you let the urge pass.
 Use STOP skills to identify options to improve the
next moment
 Start improving…

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