Distress Tolerance Skills

Pain and distress are part of life and cannot be entirely avoided or removed
... learning to tolerate stress, surviving crises and accepting life as it is in
the moment ... that does not mean that you have to like it, but accepting it is
the key. Listed here are some suggestions to help you through that painful
event and emotions when you cannot make things better right away ...
































Distracting

With Activities: Engage in exercise or hobbies; do cleaning; go to events;
call or visit a friend; play computer games; go walking; work; play sports; go
out for a meal, have decaf coffee or tea; go fishing; chop wood, do
gardening; play pinball.

With Contributing: Contribute to someone; do volunteer work; give
something to someone else; make something nice for someone else; do a
surprising, thankful thing; random acts of kindness.
With Comparisons: Compare yourself to individuals copping the same as
you or less well than you; compare yourself to those less fortunate than
you; watch soap operas; read about disasters that offer you insight into
other's suffering.

With Opposite Emotions: Read emotional books or stories, old letters; go
to emotional movies; listen to emotional music. Be sure the event will create
a different emotion that what you are currently experiencing. Ideas would be
scary movies, joke books, comedies, funny records, religious music,
marching songs, "I am Woman" (Helen Reddy); going to a store and
reading funny greeting cards.

With Pushing Away: Push the situation away by leaving it for a while.
Leave the situation mentally. Build an imaginary wall between yourself and
the painful situation. Or push the situation away by blocking it out of your
mind. Censor ruminating. Refuse to think about the painful aspects of the
situation. Put the pain on a shelf or lock box ... and put it away for a while
until you are at a better place to pull it out and look at it.

With Other Thoughts: Count to 10; notice colors in a painting or tree,
windows, anything; work puzzles; do needlecraft projects; watch TV; read.
With Intense Other Sensations: Hold ice in your hand; squeeze a rubber
ball very hard; stand under a very hard and hot shower; listen to very loud
music; sex; put rubber band on wrist, pull out, and let go

Self-Sooth the Five Senses

With Vision: Buy one beautiful flower; make one space in a room pretty;
light a candle and watch the flame. Set a pretty place at a table, using your
best things, for a meal. Go to a museum with beautiful art. Go sit in the
lobby of a beautiful old hotel. Look at nature around you. Go out in the
middle of the night and watch the stars. Walk in a pretty part of town. Fix
your nails so they look pretty. Look at beautiful pictures in a book. Go to a
ballet or other dance performance, or watch one on TV. Be mindful of each
sight that passes in front of you, not lingering on any.

With Hearing: Listen to beautiful or soothing music, or to invigorating and
exciting music. Pay attention to sounds of nature (waves, birds, rainfall,
leaves rustling). Sing to your favorite songs. Hum a soothing tune. Learn to
play an instrument. Call 800 or other information numbers to hear a human
voice. Be mindful of any sounds that come your way, letting them go in one
ear and out the other.

With Smell: Use your favorite perfume or lotions, or try them on in the
store; spray fragrance in the air; light a scented candle. Put lemon oil on
your furniture. Put potpourri in a bowl in your room. Boil cinnamon; bake
cookies, cake, or bread. Smell the roses. Walk in a wooded area and
mindfully breathe in the fresh smells of nature.

With Taste: Have a good meal; have a favorite soothing drink such as
herbal tea or hot chocolate (no alcohol); treat yourself to a dessert. Put
whipped cream on your coffee. Sample flavors in an ice cream store. Suck
on a piece of peppermint candy. Chew your favorite gum. Get a little bit of a
special food you don't usually spend the money on, such as
fresh-squeezed orange juice. Really taste the food you eat; eat one thing
mindfully.

With Touch: Take a bubble bath; put clean sheets on the bed. Pet your
dog or cat. Have a massage; soak your feet. Put creamy lotion on your
whole body. Put a cold compress on your forehead. Sink into a really
comfortable chair in your home, or find one in a luxurious hotel lobby. Put
on a silly blouse, dress, or scarf. Try on fur-lined gloves or fur coats in a
department store. Brush your hair for a long time. Hug someone.
Experience whatever you are touching; notice touch that is soothing.

Improve the Moment

With Imagery: Imagine very relaxing scenes (others may need to imagine
very challenging and dramatic scenes). Imagine a secret room-within
yourself, seeing how it is decorated. Go into the room whenever you feel
very threatened. Close the door on anything that can hurt you. Imagine
everything going well. Imagine coping well. Make up a fantasy world that is
calming and beautiful and let your mind go with it. Imagine hurtful emotions
draining out of you like water out of a pipe.

With Meaning: Find or create some purpose, meaning, or value in the
pain. Remember, listen to, or read about spiritual values. Focus on
whatever positive aspects of a painful situation you can find. Repeat them
over and over in your mind. Make lemonade out of lemons.
With Prayer or Meditation: Open your heart to a supreme being, greater
wisdom, God, your own wise mind. Ask for strength to bear the pain in this
moment. Turn things over to God or a Higher Power.
With Relaxation: Try muscle relaxing by tensing and relaxing each large
muscle group, starting with your ands and arms, going to the top of your
head, and then working down; listen to a relaxation tape; exercise hard;
take a hot bath or sit in a hot tub; drink hot milk or hot chocolate; massage
your neck and scalp, your calves and feet. Get in a tub filled with very cold
or hot water and stay in it until the water is tepid. Breathe deeply; half-smile;
change facial expressions.

With One Thing in the Moment: Focus your entire attention on just what
you are doing right now. Keep yourself in the very moment you are in; put
your mind in the present. Focus your entire attention on physical
sensations that accompany nonmental tasks (e.g., walking, washing, doing
dishes, cleaning, fixing). Be aware of how your body moves during each
task. Do awareness exercises.

With a Brief Vacation: Give yourself a brief vacation. Get in bed and pull
the covers up over your head for 20 minutes. Rent a motel room at the
beach or in the woods for a day or two; drop your towels on the floor after
you use them. Ask your partner or roommate to bring you coffee in bed or
make you dinner (offer to reciprocate). Get a schlocky magazine or
newspaper at the grocery store, get in bed with chocolates, and read it.
Make yourself milk toast or hot chocolate and cinnamon toast, bundle up in
a chair, and eat it slowly. Take a blanket to the park and sit on it for a whole
afternoon. Unplug your phone for a day, or let your answering machine
screen your calls. Take a one-hour breather from hard work that must be
done.

With Encouragement: Cheerlead yourself. Repeat over and over: "I can
stand it," "It won't last forever," "I will make it out of this," "I am doing the
best I can do."

Thinking of Pros and Cons

Make a list of the pros and cons of tolerating the distress. Make another list
of the pros and cons of not tolerating the distress - that is, of coping by
hurting yourself, abusing alcohol or drugs, or doing something else
impulsive.

Focus on the long-term goals, the light at the end of the tunnel. Remember
when there was no pain.

Think of the positive consequences of tolerating the distress. Imagine in
your mind how good you will feel if you achieve your goals, if you do not act
impulsively. If you just stay in the moment ... without judgment.

Think of all the negative consequences of not tolerating your current
distress. Remember what has happened in the past when you have acted
impulsively to escape the moment ... how might you do it differently this
time?





(Resource: Skills Training Manual for Treating Borderline
Personality Disorder by Marsha Linehan, 1993, Guilford Press)