Dialectical behaviour therapy (DBT) distress tolerance skills
address the tendency of some individuals to experience negative
emotions as overwhelming and unbearable.
People with a low tolerance for distress can become
overwhelmed at relatively mild levels of stress, and may react with
negative behaviours.
Many traditional treatment approaches focus on avoiding painful
situations, but in the distress tolerance module of DBT, clients learn
that there will be times when pain is unavoidable and the best
course is to learn to accept and tolerate distress.
A key ingredient of distress tolerance is the concept of radical
acceptance.
This refers to experiencing the situation and accepting the reality of it
when it is something the person cannot change.
By practicing radical acceptance without being judgmental or trying to
fight reality, the client will be less vulnerable to intense and prolonged
negative feelings.
Within the distress tolerance module, there are four skill categories:
1)Distracting
2)Self-soothing
3)Improving the moment
4)Focusing on pros and cons
SKILL NO. 1: DISTRACTING
The first skill, distracting, helps clients change their focus from upsetting
thoughts and emotions to more enjoyable or neutral activities.
SKILL NO. 2: SELF-SOOTHING
The second skill in distress tolerance is self-soothing; clients can use the five
senses to nurture themselves in a variety of ways:
Vision: look at beautiful things such as flowers, art, a landscape, or an
artistic performance.
Hearing: listen to music, lively or soft, or enjoy the sounds of nature such as
birds chirping and waves crashing. Savour the voice of a relative or friend.
Smell: use a favourite lotion or perfume, light a scented candle, notice the
scents of nature, or bake an aromatic recipe.
Taste: enjoy a hearty meal or indulge in decadent dessert. Experiment
with a new flavour or texture, and focus on the food’s flavours.
Touch: pet an animal or give someone a hug. Have a massage, rub on
lotion, or snuggle up in a soft blanket.
SKILL NO. 3: Improving the moment
In the third distress tolerance skill, the goal is to use positive mental
imagery to improve one’s current situation.
SKILL NO. 4: Focusing on pros and cons
In focusing on pros and cons, the individual is asked to list
the pros and cons of tolerating the distress and of not
tolerating the stress (Coping through self-destructive
behaviours). It can be helpful to remember the past
consequences of not tolerating distress, and to imagine
how it will feel to successfully tolerate the current distress
and avoid negative behaviours. Through evaluating the
short-term and long-term pros and cons, clients can
understand the benefits of tolerating pain and distress,
and thereby reduce impulsive reactions.

Distract yourself from self-destructive behaviours

Distract yourself with pleasurable ativities

Distract yourself by paying attention to somebody else

Distract your thoughts

Distract yourself by leaving

Distract yourself by counting


One of the most important purposes of
dialectical behavior therapy is to help
you stop engaging in self-destructive
behaviors, such as cutting, burning,
scratching, and mutilating yourself.
When you hurt yourself, a natural
painkiller called endorphins are
released in your body which temporarily
relieves a person from his painful
feelings.

Hold an ice cube in one hand and squeeze it.

Write on yourself with a red felt-tip marker instead of
cutting.

Draw faces of people you hate on balloons and then pop
them.

Cry or Scream as loud as you can into a pillow.

Write letters to people you hate or to people who have
hurt you.

Throw pillows against the wall as hard as you can.

Sometimes doing something that makes you feel good is the best way
to distract yourself from painful emotions.

You need to engage in pleasurable
activites in a regular basis as this
will make us feel good.

It is also necessary to do exercise
as it is good for our overall health
and it makes us feel good by
releasing endorphins.

Talk to a friend on the telephone.

Go for a long walk in a park or
someplace else that’s peaceful.

Watch a funny movie.

Sleep or take a nap.

Go outside and watch the birds and
other

animals.

Go shopping.

Take photographs.

Do something for someone else.

Take your attention off yourself.

Think of someone you care about.
 It’s
impossible not to think about your problem.
 In fact, the harder you try not to think about it, the
more power you give to the image and the more
your brain keeps bringing it into your thoughts.
 It’s almost as if the harder you try to forget
something, the harder your brain tries to remember
it. This is why forcing yourself to forget about
something that happened to you is impossible.
 It’s also why you can’t simply force yourself to get rid
of emotions that you don’t want.

Remember events from your past that
were pleasant, fun, or exciting.

Look outside at the natural world
around you.

Imagine yourself as a hero or heroine correcting some past or future
event in your life.

Imagine yourself getting praise from someone whose opinion matters to
you.

Keep a copy of your favorite prayer or favorite saying with you.

Sometimes the best thing that you can do is leave.

If you’re in a very painful situation with someone and you
recognize that your emotions are going to overwhelm you
and possibly make the situation worse than it is already, then
often it’s best to just leave.

If you’re overwhelmed by your emotions, it will be harder for
you to think of a healthy resolution to your problem.

It is best to put some distance between you and the
situation in order to give yourself time to calm your emotions
and think of what to do next.

Counting is a simple skill that can really
keep your mind busy and help you focus
on something other than your pain.

Count your breaths.

Count anything else.

Count or subtract by increments of
seven.
Activity !!!!
Since
we don’t know
each of your dominant
sense, we thought of a
activity that can stimulate
all the FIVE senses
FOOD!!!!!!!!!!!!!!!!!
Concentrate on;
The way the food
looks
 How it feels
 How their skin
responds to its
manipulation

Its smell
 Its taste
 And listen to our
soothing voices

Are You Feeling Any Better???

Rate how you are feeling after the activity
Focusing on a single object that is desirable is meant to bring
the participant’s mind off the problem , to what is right in front
of them as well as something more pleasant.
Food for thought
Always having chocolate
with you helps reduce
significant amounts of
distress
Uses
Of
Distress Tolerance
Teaches patience to find ways to
distract themselves from troubling
thoughts and feeling patterns that are
self destructive.
Patients will be taught to know about their
bodies and how their bodies will react to
certain emotional states.
Patients will be taught to examine their own
beliefs and assumptions about the stressful
situations, thereby helping the patients to
reduce / prevent maladaptive responses to
such situations.
Helps to improve problem solving skills
Eg; weighing pros and cons
Patients will learn that there are times when
pain is unavoidable and the best course is
to learn to accept and tolerate distress.
Eg: Radical Acceptance
Clients / Patients will learn to change
their focus from upsetting thoughts
and emotions to more enjoyable or
neutral activities
Patients will learn to use
positive mental imagery to
improve one’s current
situation

Distress tolerance skills training is a core feature of
Dialectical Behavior Therapy for borderline personality
disorder (BPD)

The distress tolerance skills are meant to reduce
impulsive behavior which can often result from an
inability to tolerate strong emotions.
Why Are Distress Tolerance Skills Important?
One of the most destructive symptoms of borderline personality
disorder is impulsive behavior
Many people with BPD have problems with

substance abuse,

alcohol abuse,

spending,

reckless driving,

physical violence, and

impulsive sex.
In many cases, all of these impulsive behaviors are preceded by strong
emotions.
Here’s how this works:
You have a strong emotion that is triggered by some event
(e.g., rejection by a loved one.)
You feel and believe that the emotion is intolerable
(e.g., “I cannot stand this feeling.”)
You engage in an impulsive behavior in order to reduce the
seemingly intolerable emotion
(e.g., drink alcohol)
The behavior is reinforced because it works in the short term
(e.g., you feel better temporarily).
Once the temporary effects of the impulsive behavior
have worn off, you feel worse because:
(a) the thing that was causing you to feel bad in the first place
hasn’t gone away; and
(b) now you feel shameful about the impulsive behavior and its
destructive consequences.
As you can see, impulsive behaviors are a
pretty unhealthy way to deal with strong
emotions, because
While they sometimes “work” in the short
term (e.g., reduce distress), in the long
term they actually make things worse.
So, distress tolerance skills are an alternative to
this cycle.
These skills help you get through the emotional
pain without doing anything impulsive.
In the long run, these skills lead to a healthier
pattern and reduce emotional pain (because
you are not engaging in so many destructive
acts).
Thank you