The Child, Adolescent & Family Recovery Center
DISTRESS TOLERANCE
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Distress Tolerance
2
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We use this skill when we are having
impulse control problems.
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Problem Solving Strategies
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This skills offers Crisis Survival
strategies.
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It is also used as an attempt to accept
reality.
The Child, Adolescent & Family Recovery Center
Distress Tolerance
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Pros and Cons
Crisis Survival Network (CSN)
K.I.I.P.
Half Smiling
OBJECTIVES
SPECIFIC PATHS
DISTRACT with “Wise Mind ACCEPTS”
SELF-SOOTHE  The Five Senses
IMPROVE the moment
Observe Breathing
Radical Acceptance
Distract with “Wise Mind ACCEPTS”
4
The Child, Adolescent & Family Recovery Center
Observe Your Breathing
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Inhale while counting to five
slowly
Let the breath out while
counting to five slowly
Repeat
Take a deep breath while
taking one long stride
Let out deep breath while
taking one long stride.
Repeat
“These exercise is
designed to help you
deal with crisis,
stress and/or
difficulties…”
Getting grounded
with you breathing is
something you can
do anywhere and in
any situation
Self-Soothe the Five Senses
6
Smell
Create a SelfSoothe 1st Aid Kit
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IMPROVE the Moment
7
Imagery
Meaning
Prayer
Relaxation
One thing at a time
Vacation
Encouragement
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Pros and Cons
8
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Make one list of pros and cons of tolerating distress and
another list of pros and cons of not tolerating the
distress.
Focus on long term goals “the light at the end of the
tunnel.”
Think of the positive consequences of tolerating the
distress- Imagine in your mind how good you will feel if
you achieve your goals and don’t act impulsively.
Think of the negative consequences of not tolerating
your current distress.
The Child, Adolescent & Family Recovery Center
Pros and Cons
Pros of Having Drama and Stress
Cons of NOT having Drama and Stress
Cons of having Drama and Stress
Pros of NOT having Drama and Stress
Crisis Survival Network (CSN)

This is a list of people
who support you in the
middle of a crisis or a
problem.
 Mentors
 Family
members
 Non-using friends
 Sponsor
 Teacher
 Therapist
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Support Groups that
you can attend
 12-step
 ANAD
 CAFRC
Half-Smile
“By having a small genuine smile on your face, you are
less tense in your face, neck and shoulders.”
Try and find something to smile about, even in an
extremely difficult situation.
Finding at least one little thing to have a small and
genuine smile about.
Having BALANCE!
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When things are difficult, think about when things are easy
When you don’t get your way, think about a time that you did
“Hold this ‘half-smile’ with the stress and difficulty you
are currently experiencing.”
SPECIFIC PATHS
What is my upreme Concern?
ractice my skills
Focus my nergy and Concentration
can be effective
Have aith
Figure out what is mportant
Have ourage and atience
Pay
ttention
Complete asks
Be umble and have ensitivity
“This acronym
is designed to
help you stay
on the path to
building the
life you want
for yourself”
(Moonshine)
OBJECTIVES
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ne thing at a time
e effective
“You can
effectively deal
with difficult
experiences by
using this
acronym. It helps
to practice using
the acronym
BEFORE you
really need it”
(Moonshine)
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Avoid udgments
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Cope with motions
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Consider onsequences
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Take ime
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Use ntrospection
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Act consistently with alues
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Focus on desired ndings
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Balance hort-term and long term goals
14
“All the things you think you should have
done that you did not do, and all of the
things that you should not have done,
accept them. You did (or did not) do
them. That's reality. That's happened.
No changing the past.”
~Peter McWilliams
The Child, Adolescent & Family Recovery Center
Accepting Reality
15
“Some people confuse acceptance with apathy,
but there is all the difference in the world.
Apathy fails to distinguish between what can
and what cannot be helped; acceptance
makes that distinction. Apathy paralyzes the
will-to-action; acceptance frees it by relieving it
of impossible burdens.”
~Arthur Gordon
The Child, Adolescent & Family Recovery Center
Radical Acceptance
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Freedom from suffering requires ACCEPTANCE from
deep within of WHAT is
ACCEPTANCE is acknowledging WHAT is
To ACCEPT something is NOT the same as judging
good.
The Child, Adolescent & Family Recovery Center
Willingness versus Willfulness
17
Cultivate a WILLING response to each situation
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Willingness is doing just what is needed in each
situation, in an unpretentious way. It is focusing on
effectiveness
Willingness is listening very carefully to your WISE
MIND, acting from your inner self
Willingness is ALLOWING into awareness your
connection to the universe- to the earth to the floor
you are standing upon, to the person you are
interacting with
The Child, Adolescent & Family Recovery Center
Willingness versus Willfulness
18
Replace WILLFULNESS with WILLINGNESS
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Willfulness is sitting on your hands when action is
needed, refusing to make changes that are needed
Willfulness is giving up
Willfulness is the opposite of “doing what works,” or
being effective
Willfulness is trying to fix every situation
Willfulness is refusing to tolerate the moment
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Keep It In Perspective (K.I.I.P.)
If you don’t know what’s important 
Then everything is important
If everything is important 
Then you try to do everything 
If you are attempting to do everything 
Then people expect you do do everything 
And in trying to please everybody 
Then you don’t have time to determine 
What is important to you
Behavioral Chain Analysis
Problem Bx
Vulnerability Factor
Chain of Events
Consequences
of the Problem
Behavior
Skills that could have been
used during the chain of
event
Consequences of
using the skills