1
Distress Tolerance
A) Crisis Survival Skills – 4 Skills
1.
2.
3.
4.
Distress Tolerance
Focusing on Pros/Cons
Self-Soothing – 5 Senses
Improve the moment – “IMPROVE”
Distracting – “Wise Mind Accepts”
≤
B) Reality Acceptance – 3 Skills
1. Radical Acceptance
2. Turning the mind
3. Willingness VS. Willfulness
A) Crisis Survival Skills:
1. Focusing on pros/cons:
a.
b.
c.
d.
e.
f.
g.
Both short term and long term
Accepting reality VS. rejecting reality
Do it in advance and use it during crisis
Keep it accessible
Urges +/- drugs/act out – Using not using
Common difficulties: commitment and looking at pros and cons
Use a wise mind / Emotional Reasonable mind
2. Self- Soothing:
a. Comfort, Nurture, Gentle, and kind. Use 5 senses
b. When cannot escape reality
a. Vision – Painting, sunset, flower
b. Hearing – Music, Ocean, Thunder, Birds, Children Laughing
c. Smell – Chocolate, Perfume
d. Touch – Fabric, Fur, Pet, Hot bath, gentle stroking of your arm
e. Orient – Validate – Provide Examples – Acknowledge a skill may or may not
work
3. Improve the moment
a.
b.
c.
d.
Replacing negative thoughts and emotions with positive ones.
Changing how one thinks about one self or situations.
Changing bodily response to events – Relaxations – meaning
Accepting and letting go – Prayer and focusing on one thing in the moment.
2
Distress Tolerance
I
M
P
R
Imagery – Practice effective coping in imaginations
O
One thing in the moment – Just this moment focus attention to just one thing in the
moment
V
E
Vacation – Stop activity managing your life, moments to days.
Meaning
Prayer – Attitude of acceptance, openness and willingness
Relaxation – Quit the mind and calm body. Your body commute to your mind
Encouragement
Distraction:
Reduce contact with emotional stimuli. Mindful is a distraction.
“Wise Mind Accepts”
A - Activity – Sports, Cleaning, Watching movie, crafts, listening to music – to get the mind off
the current situation.
C - Contributing – Doing for others. Sense of purpose.
C - Comparisons – Less fortunate or capable
E - Opposite Emotions – Engage in activity that generate opposite emotions. Depressionwatching a comedy movie, or dancing. Lonely- Attend a group function or phone a friend.
P - Pushing Away – Leave the situation physically (wall) or block it out of your mind. Box up in
the shell.
T – Thoughts- Other thoughts unrelated to current moment of distress. Adaptive Denial Counting to ten- Names of objects in the room- increase mental demand of your thoughts. 1A2B
S – Intense Sensations – Holding an ice cube
B) Reality Acceptance:
3 Skills
3
Distress Tolerance
1.
Radical Acceptance: – Broader perspective, stop fighting reality, Accept pain but not
suffering. Practicing burning bridges, letting go of “why” full contact with reality, willingly
(open-heartedly) to accept reality.
A) Reality as it is – Pain is unavoidable – Suffering is avoidable.
B) Everything has a cause – but you don’t know what it is
C) Life can be worth living even if there is a pain.
Guidelines or exercises
a. Awareness – sense of connecting with your surroundings.
b. Half Smiling
c. Observing your breath
2. Turning the mind: – turning to acceptance. Stop suffering or frustrating by
accepting.
a) Notice you are not accepting
b) Make inner commitment to accept
c) Do it again and over and over again.
3. Willingness VS. Willfulness:
a) Accepting the world as it is.
b) Responding with acceptable behavior.