Distress Tolerance – Part One (Distracting – A.C.C.E.P.T.S)

The second module I am going to look at is that of Distress Tolerance.

Allow me to quote Marsha Linehan, “DBT emphasises learning to bear pain skillfully. The ability to tolerate and accept distress is an essential mental health goal for at least two reasons. First, pain and distress are a part of life; they cannot be entirely avoided or removed. The inability to accept this immutable fact itself leads to increased pain and suffering. Second, distress tolerance, at least over the short run, is part and parcel of any attempt to change oneself; otherwise, impulsive actions will interfere with efforts to establish desired changes.ā€

Distress tolerance is about accepting reality, events as they happen, but this does not mean you approve of them. It is very important to observe the difference between acceptance and approval. Acceptance is an example of using non-judgmental stance and describing. This will help you to tolerate crisis and distress, reacting to it in a safer and more manageable manner.

There are four skills taught within this module;

  • Distracting
  • Self Soothing
  • Improving the moment
  • Pro’s and con’s

These skills should help you to accept situations, and ‘sit with them’. I think I am going to find this really useful. When I find myself in a stressful or painful situation, my immediate reaction is to self harm, or to dissociate. This is because I cannot deal with ‘sitting with’ the emotional pain and therefore need to find an escape. This, is believe is because I am lacking the distress tolerance skills that I am hopefully about to learn.

Within the first skill of distracting, there are four ‘sub skills’ and these can be remembered using the acronym that a Wise Mind ACCEPTS things as they are rather than trying to hide or run away from them;

A.C.C.E.P.T.S

  • Distract with Activities – Go for a walk, go for a run, sing, swim, train the dog, watch videos on youtube, blog, watch films, watch TV, draw, paint, write poetry, play with photoshop, take pictures (The list goes on. Do what ever you need to do to distract you from the distress you are feeling. Be one-mindful in whatever you do).
  • Distract with Contributing – Do nice for someone, help someone out. This will take your attention from your own pain and allow you to concentrate on concern for someone else. (An example of this would be the little box of goodies and video I made for Jen recently. I forgot my own problems and concentrated on doing something for her that would make her happy.)
  • Distract with Comparisons – Some people think this works, others don’t, so you need to make your own mind up on this one. Compare yourself to how you were when you were in even more distress and observe how far you have come, and how much better you are dealing with things. Compare yourself to other people in the same situation and observe the way they are dealing with things. Watch dramas and documentaries and compare your situation with one that is much worse.
  • Distract with Opposite Emotions – Whatever you are feeling, do something to promote the complete opposite emotion. If you are feeling down, watch a comedy and find yourself laughing out loud. If you are feeling manic, watch a drama that will make you cry. The theory is that promoting the opposite reaction shakes up your emotions and releases you from the emotion you have become trapped in.
  • Distract by Pushing Away – Imagine yourself pushing the stressful situation away from yourself as hard as you can, and then building a wall around yourself. Imagine putting the emotional pain in a box, with a lock, on a shelf. When the thought tries to return, refuse to let it. Direct your concentration to other, more positive thoughts. Note: This method doesn’t resolve the problem, but it gives you temporary respite from the distress
  • Distract with Other Thoughts – In an emergency situation, the quickest and simplest way to use this method is to count things; tiles, stairs, marks, stars – anything that you can concentrate on, and stop yourself from thinking of the stressful situation you are in. Where there is less urgency, you can use books, meditation, writing poetry; anything to keep your thoughts away from the emotional pain.
  • Distract with Other Sensations – A strong sensation has the ability to jog your emotions and break the connection between yourself and your emotional pain – enough to allow you to then distract using the methods discussed above. Examples of strong sensations could be snapping an elastic band on your wrist (this could be used for other reasons but that’s a whole other blog post! I have found Thought Stoppers to be effective for this) ice cubes on your skin, cold water, putting your head out of a moving car window in the wind (be careful with this!!!).

Please see here for a list of distraction activities for times of distress. (Please feel free to contribute!)

Here is a link to the distress tolerance handouts included in the Skills Training Manual for Borderline Personality Disorder by Marsha Linehan (courtesy of Borderline Chat).

Here are some ways to manage distress immediately (Courtesy of Seth Alexrod)

Click here and here for downloadable worksheets to help using these skills.

Click here for a downloadable worksheet to use using ‘opposite emotions’

References

Skills Manual for treating Borderline Personality Disorder (Marsha Linehan)

DBT Self Help

DBT Handouts, Protocols & Client Learning Resources

Get Self Help

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6 comments

  1. […] Distress Tolerance — Part 1 (Distracting — A.C.C.E.P.T.S.)@Living with BPD […]

  2. […] decision to tolerate the distress, which can be done using other distress tolerance methods such as distracting, improving the moment or self soothing. Try this for yourself when you find yourself with a […]

  3. […] number of the worksheets can be found on this page, or linked to from […]

  4. Thank you for your work here, on this subject! I was in the process of posting this very information on my own blog, instead, I will just link my readers here! Well done and thank you!

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