Just as a little re-cap as it has been a while since I have done one of these, distress tolerance is the art of accepting the moment as it is, without trying to change it. Life will always contain distress in many different forms (emotional pain, stress) and this cannot be changed or avoided – being unwilling to accept this simply causes further pain. The distress tolerance module gives ways of dealing with this distress to enable you to continue functioning normally.
Note: Accepting the situation does not necessarily mean you approve of it, it just means you have accepted things as they are when you are unable to improve a situation. Being able to tolerate distress means you are less likely to resort to self destructive behaviours.
The third part of distress tolerance I am going to alk about is improving the moment, which involves replacing negative aspects of a situation with more positive ones, to enable distress to be tolerated. which is split into seven parts, making up the word IMPROVE:
- (Create) Meaning
- One thing in the moment
ImageryWe can use imagery to create a different situation to the one we are actually in. It involves imaging you are in a safe place, for example, I imagine a meadow full of flowers, daisies in fact. It is helpful to imagine the smells, the textures, the sounds. It is worth practicing this in a non-distressing environment first, until you get the hang of it, but be careful to make sure you are in control of the imagery, rather than becoming confused with being dissociated.
When you become distressed, you can take yourself to this place and allow it to soothe you. You can also imagine yourself, whether it is from the safe place or not, being able to deal with the current distressing situation – if you imagine it, you are more that likely to be able to do it.
To Practice (courtesy of dbtselfhelp):
Picture a place in your mind where you feel good and safe. Look at what is around you. This may be a cozy room, an outdoor spot, a place with a friend. When you feel distressed this week, picture this place. Hold on to the image. Feel yourself there, safe and comfortable. Stay there as long as you need to.
How does it make you feel?
How does it affect your feelings in the moment?
If you are having a problem or conflict, picture yourself dealing with it effectively. Tell yourself that you can handle the situation.
How does this affect how you actually handle the problem, or conflict?
These skills need to practiced when you are not in a crisis, in order to be effective during a crisis. Try to practice for at least a few minutes each day.
This is a cognitive technique, which means you are changing the way you feel about yourself or a situation, rather than trying to distract yourself or remove yourself from it. Finding the meaning in a situation can sometimes be very soothing during a painful time, but it must be noted that sometimes things happen which for meaning cannot be found. Life works that way, and unfortunately it can be cruel. Using Marsha Linehans’ metaphor (is that even the right word?), finding meaning in a situation is like making lemonade out of lemons – you are taking the bitter lemons, and making a sweety and tasty drink by changing or adding something.
This took me quite a while to get my head round, as it is a strange concept. Surely what meaning can be taken from feeling depressed? Well this is what I came up with – some meanings taken from difficult situations;
- Feeling depressed or going through a difficult time = made me a stronger person, and more empathic towards other people
- Offer fell through on my new house = found an even nicer, perfect one
- Thinking Tom had cancer = brought us closer together and strengthened our friendship
To practice (courtesy of dbtselfhelp):
(This picture hasn’t got anything to do with anything, I just liked it!)
I thought I was going to be sceptical about this one because I am not religious at all, but it turns out the prayer doesn’t necessarily need to be to god, you can address it to your own ‘wise mind’. Doesn’t make sense? Let me explain.
There are several types of prayer. The first is the ‘Why me?’ prayer, which is you asking yourself why the awful situation is happening to you. Personally I cannot see any benefit from this other than serving to make yourself feel worse by allowing self pity to creep in. The next is the ‘distress’ prayer, which is asking for relief from the pain and suffering. The third, the acceptance prayer, asking to just be in the presence of the pain and suffering but being able to accept it for what it is.
Marsha Linehans’ book says to open yourself up to a higher power, to god, but I won’t go into that as I am not religious.
Trying to be relaxed is making a concious effort to relax your body and mind, avoiding being tense about a bad situation. Being tense can make a situation worse, it can cause physiological effects such an headaches, an increased heart rate, sweating and anxiety amongst other things. By accepting reality and the situation, and allowing yourself to relax, you are enabling yourself to control your bodies responses to a situation, and therefore become in control of that situation. Are you still with me?!
Some techniques which can be used are listening to calming music, having a nice hot bubble bath, exercising, yoga, reading, meditating, hot chocolate (!). We all have our own things that relax us, you just have to find what works best for you.
To practice (courtesy of dbtselfhelp):
Note: All of these exercises involve breathing, most of them deep breathing. Some people find that this causes panic. A couple of people have suggested to me that reversing the sequence, that is, breathing out first and then in, instead of in and then out, does not cause the same panic. So give that a try. If it does not help, then just go ahead with the rest of the exercise.
Try to learn and practice these exercises when you are feeling good. This way you will be better able to use them when you are in distress.
Lie down on the floor with your legs flat or bent at the knees, your arms at your sides, palms up, and your eyes closed. Breathe through your nose if you can. Focus on your breathing. Place your hand on the place that seems to rise and fall the most as you breathe. If this place is on your chest, you need to practice breathing more deeply so that your abdomen rises and falls most noticeably. When you are nervous or anxious you tend to breathe short, shallow breaths in the upper chest. Now place both hands on your abdomen and notice how your abdomen rises and falls with each breath. Notice if your chest is moving in harmony with your abdomen. Continue to do this for several minutes. Get up slowly. This is something you can do during a break at work. If you can’t lie down you can do it sitting in a chair.
This exercise can be practiced in a variety of positions. However it is most effective if you can do it lying down with your knees bent and your spine straight. After lying down, scan your body for tension. Place one hand on your abdomen and one hand on your chest. Inhale slowly and deeply through your nose into your abdomen to push up your hand as much as feels comfortable. Your chest should only move a little in response to the movement in your abdomen. When you feel at ease with your breathing, inhale through your nose and exhale through your mouth, making a relaxing whooshing sound as you gently blow out. This will relax your mouth, tongue and jaw. Continue taking long, slow deep breaths which raise and lower your abdomen. As you become more and more relaxed, focus on the sound and feeling of your breathing. Continue this deep breathing for five or ten minutes at a time, once or twice a day. At the end of each session, scan your body for tension. As you become used to this exercise, you can practice it wherever you happen to be, in a standing, sitting or lying position. Use it whenever you feel tense.
One Thing In the Moment
This is the same still as the Core Mindfulness skill One-Mindfully. Here are some exercises from dbtselfhelp – I have gone over them already but I thought it would be worth copying and pasting them here too:
You might try this exercise, suggested by Marsha Linehan in the manual. Close your eyes and get in touch with some current discomfort or anxiety – one that you are experiencing right now. Notice your level of discomfort. Now start thinking about times in the past that you have had to endure such feelings, and think about how many more times you are going to have to endure such feelings. Notice your level of discomfort.
Now let your mind refocus on this moment, letting all the past and future thoughts and feelings go. Take some time to focus again just on this present moment. Notice your level of discomfort. What do you notice? Share with the list if you are comfortable doing so.
To get a sense of what “in the moment” or mindfulness feels like, try the following exercises. Just breathe slowly and gently through each exercise, and concentrate fully on what you are doing right then.
Close your eyes, put your right hand on your abdomen, right at the waistline, and put your left hand on the center of your chest.
Without trying to change your breathing, notice how you are breathing. Which hand rises most as you inhale, the hand on your chest or the hand on your belly?
If your abdomen expands, then you are breathing from your abdomen or diaphragm. If your belly doesn’t move, or moves less than your chest, then you are breathing from your chest.
The trick to shifting from chest to abdominal breathing is to make one or two full exhalations that push out the air from the bottom of your lungs. This will create a vacuum that will pull in a deep diaphragmatic or abdominal breath the next time you breathe in.
Focus on your breathing in this way for a few minutes.
Close your eyes, and starting with toes and moving slowly up your body, ask yourself “Where am I tense?” When you discover a tense area, exaggerate it slightly, so you can become aware of it. Be aware of the muscles in your body that are tense. Then, for example, say to yourself, “I am tensing my neck muscles…I am creating tension in my body.” At this point, be aware of anything that is creating tension in your body and what you might do to change it.
Use your breath in helping you to become more aware in your everyday life. Cue into the process of mindful breathing in all different situations – waiting for the bus, watching the sunset, sitting in church, eating an ice cream cone, playing with your dog, listening to your favorite music.
This awareness is the verbalized appreciation of the way things are – the experience of “just being with” the flower, the other person, the movement of your body as you dance. You are in the moment, enjoying and appreciating what is.
Awareness of Sound
Sit at a table with a tangerine or an orange in front of you. (You may also use a grape.) Look at the tangerine. Look at the color and the shape. Notice any markings. See the dimple at the center. Is it exactly round? Hold the tangerine in your hands. Feel the skin. Smell the skin. Imagine the grove where the tangerine grew, and see it hanging on the tree. See the other trees in the grove. Now begin to peel the tangerine. Feel the oiliness of the skin. Notice the inside of the peel. Notice the color and shape of the section. See the white strings on the section of tangerine. Hold it to your nose and smell its fragrance. Bite into the tangerine. Feel its texture. Notice its taste. Are there seeds? Is it juicy? Does the juice run down your chin or get on your fingers? Continue to eat the pieces of tangerine – how many slices are there? Notice how you feel after eating the tangerine. How was the experience of really taking notice of how it looked, smelled, tasted? This is mindful eating.
Try eating some other foods in this way, really paying attention to the food and the experience of eating it.
This skill is about taking a ‘planned vacation’ from the responsibilities of being an adult. As Borderlines, I think we are all experts at taking unplanned vacations from responsibilities – trips into hospital, dissociating, avoidance – but the art of this skill is planning to do it, to give yourself a break for anything from a couple of seconds to a number of hours.
In basic terms, this is cheerleading yourself – talking to yourself as if you would to a friend in a similar crisis.