On other posts, I’ve talked about how the DBT approach to getting through a crisis and creating the ability to tolerate distress involves several different approaches: distracting yourself, soothing yourself, improving the moment, and analyzing pros and cons. You have a few choices when you’re experiencing a crisis or when you feel unsafe. You can work on problem solving or mindfulness, but sometimes you need to go back to basics and work on distress tolerance.
When you’re in a dark moment or you’re having a really rough time, always ask yourself these questions:
- Is the problem solvable or not? Yes or No. If your answer is No, use your Distress Tolerance tools. If just thinking about the problem is causing total emotional disfunction, causes you to totally apart, then you need to ask someone for help. It’s time to be using your Distress Tolerance skills if you’re in fight or flight mode, if your limbic system is totally activated. See also my posts on emotion regulation skills opposite to emotion action as well as four options to solving problems.
- Is it okay time to solve the problem? Yes or No. Always answer No if it’s the middle of the night. Always answer No if your body’s resources are low. If your answer is No, use your Distress Tolerance skills.
- Am I in Wise Mind enough to solve the problem? Yes or No. Chances are that if you’re having a really rough time, you’re going to need to use distress tolerance before you can get to Wise Mind.
The acronym ACCEPTS can help you remember some of the building blocks for distracting yourself:
Think about physical and mental activities that you can do to distract yourself from the current moment. There’s a range of activities out there – and sometimes they will work for you and sometimes they won’t. It depends upon how much distress you’re in. Sometimes you’ll need to keep it simple and sometimes you’ll be able to do more. It all depends upon the crisis you’re in, how upset you are, how much pain you’re in, how many resources you have. Don’t try to climb Everest when you just need to sit up.
As you get more and more able to manage your emotions and as your pain lessens over time, you’ll be able to use different distress tolerance skills. So go with what you can do right now.
It may be as simple as picking up a magazine and circling every “P” that you find. That may be all you can do at the moment. Maybe you have coloring books that will help distract you. Can you listen to music? What about watching TV? What about going for a walk? What about cooking something? Download some games to your phone or your computer and play for as long as you need to, until the wave of difficult emotion passes. Make a cup of tea.
Put activities into your Distress Tolerance box. That way you don’t have to think of what to do when you’re having a tough time. You can also make a list of activities to put into your Distress Tolerance box to remind you of what you can do for distraction when you need distress tolerance.
Do something nice for someone else. This could be as simple as mustering up a smile to a stranger. Perhaps you can buy an extra can of soup to put into the food bank box at the grocery store. Get out and do some volunteer work. Give someone a compliment. Hold the door for someone. Let someone else have a parking space or perhaps let someone go ahead of you in line.
Contributing to someone else’s life helps distract you from the difficult moments in your life – and it helps to give you positive experiences.
Dig into your memory. How does this current experience, what you are feeling right now, compare to similar experience? Have there been times when you’ve been in a similar dark time and you’ve been less able to deal with the emotion? Show yourself how you have more skill now. Validate yourself – your feelings are completely valid in this moment. It is okay that you are feeling badly. Be gentle with yourself, and know that the wave of emotion will pass. That is why you are using distress tolerance tools, to help you through. That is why you are distracting yourself, to help you through. Using comparison helps us see that we can experience tough times and know that we can come through them again and again, with greater skill. And each time we come through difficult times, we’ve also worked on our emotion regulation skills, which means that we’re getting better and better each time. Watch yourself doing better at managing each painful episode.
Sometimes it helps simply to change the emotion you’re feeling right now. Get into an experience that is the opposite of what you’re feeling now: if you’re exhausted, try listening to rousing music. If you’re sad, trying watching some of your favorite comedians. Listen to calming music or other sounds that calm you. Work on a project that makes you feel good. Watch a funny movie. Watch a scary movie. Putting yourself into a different emotional state through distraction helps you tolerate your distress.
Put the distress on a shelf. Put it in a box. Push it away. This doesn’t mean that you’re going to lock away your pain and throw away the key, but it does mean that you’re going to put it temporarily on hold. Call up the image in your mind’s eye of a deep basement dungeon with lots of shelves. Picture yourself walking down the damp stone steps. Reach inside yourself, pull out all of the darkness and pain and put it up onto the shelves. Tell it to stay there for a while. Then walk out of the dungeon, close the door and climb up the steps. You will come back to it; you will work on it with your therapist. Right now, push it away. This is a way to give yourself a break from the pain until you can return to Wise Mind. A Wise Mind knows that the “24/7 All Pain TV Channel” isn’t going to help you at all. Time to turn off the tv, push it away and wait until you can return to work on it again.
Your mind is pretty good at thoughts, especially when you’re having a really rough time and the despair and anguish is talking up a storm. Using Wise Mind to insert new thoughts into your brain will help distract you from the pain. This is a part of your distress tolerance skill set. Insert new thoughts. Go read a book. Read a newspaper. Fill out a crossword puzzle. Surf Pinterest for inspirational ideas. Think about how you would redo your bedroom if you could. Count to 100. Count down from 100 in multiples of 7. (Good luck with that.) Get your mind to cough up the Five Best Memories of your life. Make your mind think about other things. Distract yourself with thoughts.
Give yourself sensations. Create sensations in your body. Maybe you still are needing physical pain to cope with emotional pain – rather than cut or burn yourself, think about heading to the freezer and holding onto some ice cubes or frozen vegetables. Think about taking a cold shower.
Think about your five senses. Keep something you love to smell in your Distress Box. Go and smell something rotten – that will change your emotional state instantly! Do something vigorous that uses your whole body: go walking, lift weights, move rocks, shovel snow, pull up weeds, bring up a few boxes from your basement to throw out. Take a hot bath. Take a cold shower. Look at the color orange. Look through a kaleidoscope. Taste something you love. If you hate pickles, keep some pickles in the fridge and eat one every time you need to distract yourself. Stimulating your senses will help distract you from the pain of the current moment.
Based on the work of Dr. Marsha Linehan: Dialectical Behavior Therapy.