Archive for the ‘Distress Tolerance’ Category

Distress Tolerance

Distress Tolerance


I often tell clients that Distress Tolerance is about “getting through a crappy moment without doing something to make it worse.” Most of the self destructive behaviors associated with BPD or chemical dependency are an effort to escape from severe emotional pain. Acknowledging that it will take time before clients learn to effectively reduce the intensity of this pain, DBT offers a large collection of ways to distract attention that are more positive than planning suicide attempts, taking street drugs, or jumping into abusive relationships.

The basic idea is to focus awareness on something other than the hurtful thoughts and emotions. Here is a short list of distraction techniques taken mostly from Marsha Linehan’s Skills Training Manual:

Activities; Get involved in exercise or hobbies, do puzzles, clean the house in a mindful way, call a friend, play computer games, surf the web.

Contribute; Do volunteer work, do something nice for someone else.

Generate Opposite Emotions; Watch comedies on TV, read joke books or funny greeting cards, listen to emotional music (of a different emotion than you’re feeling).

Think about something else; Count to 10, count backwards by 7’s from 100, count the colors (or shades of the same color) in the room or a picture, read detective novels, watch the fish in an aquarium.

Generate strong sensations; Hold ice or a synthetic ice pack (even colder!) in hand, squeeze a rubber ball really hard, stand under a hard, hot shower, listen to very loud music.

Take a brief vacation; Get in bed and pull the covers over your head for 20 minutes, buy a shlocky magazine and eat chocolates while you read it in bed (okay, maybe this is fattening, but it’s better than some things people do when upset).

What makes these distractions work is mindful focus –- being really aware of the sensations involved. Clients who continue to ruminate about their problems and hurt feelings while doing these techniques will experience less benefit. Pick something you can get into, pay attention to the details of it, and bring your focus back if your mind wanders.

Radical Acceptance

The distraction techniques above offer the opportunity to change our experience for a least a brief respite from emotional pain, while we rebuild our strength. The dialectical balance to this emphasis on change is a powerful statement of the idea of acceptance as a way out of extreme distress. The concept of Radical Acceptance suggests that we suffer less if we let go of struggling with what is occurring. This does not mean that we endorse as “good” what is going on, or that we never try to make changes in the long run. Radical Acceptance suggests that in this moment, what is happening is happening, whether we like it or not. Screaming about it in our mind will not help, but merely exhaust us. Acceptance mode is the fastest way out of pain; we save our strength until we can find a way to change the situation.

Pros and Cons

In this technique, we look at our options about dealing with a “crappy day”, and think about whether falling into old habits will really help or “make it worse” in the long run. Do we really want to return to the self-harm behavior, or try (as many times as it takes) more positive distraction techniques, even if they don’t work as fast or dramatically as what we’ve employed in the past? The trick here is to think beyond the immediate moment, beyond the temporary relief offered by the destructive habits, to the guilty, hung-over and set-further-back consequences that always follow those habits. In addition to thinking about these usual consequences, we can also anticipate how good it may feel to have been able to avoid destructive behaviors by trying something else more productive.