DBT Module 4: Distress tolerance
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| Fri, 04-21-2006 - 11:56pm |
Goals of the module:
The goals of this module of the group Freedom From Chaos will not be to focus on teaching you skills to change situations. Rather the skills you will learn are intended to help you bear pain skillfully.
The skills that you will learn in this module include
- acceptance
- finding meaning, and
- tolerating discress
The ability to tolerated and accept distress is an essential goal in mental health for at least 2 reasons
- Pain and distress are a part of life; the cannot be entirely avoided or removed
*The inability to accept this immutable fact is in itself what can lead to further pain and suffering - Distess tolerance is an attempt to change oneself
*In the short term, distress tolerance helps you to ease your own pain
*In the long run, it teaches you a new strategy to cope with hassles and crises which will add to your cofidence that you can help yourself
*Changing yourself is necessary when impoulsive actions (jumping to conclusions, cutting, drink, anxious-irritable outbirsts, overdoses, drugs, fits of fage, temper tantrums, ecessive shopping) interfere with your efforts to establish desired changes
Distress Tolerance Skills and Mindfulness
- Distress tolerance skils constitute a natural progression from mindfulness skilss
- Distress toelerance skills have to do with the ability to accept in a non-evaluative and non-judgmental fashin, both oneself and the situation
- Essentially, distress tolereance is the ability to perceive one's environment without putting demands on it to be different. to experience your current emotional state without attempting to change it, and to observe your own thoughts and action patterns without attempting to stop or control them.
- A NON-JUDMENTAL STANCE DOES NOT MEAN APPROVAL
- This distinction is important. Acceptance of reality is not approval of reality
Distress otolerance behaviours to be targeted in this module are concerned with tolerating and surviving crises and with accepting life as it is in the moment.
Four sets of crisis survival strategies are taught
- distraction
- self soothing
- improving the moment
- thinking in pros and cons
Acceptance skills inclued
- Radical acceptance (complete acceptance from deep within)
- Turining the mind towar acceptance (chosing to accept reality as it is)
- Willingness versus willfulness

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Edited 4/22/2006 12:03 am ET by cl-schitz


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Distress tolerance assumptions
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What does acceptance mean?
Acceptance skills involve what we will call "radical acceptance". Radical acceptance requires a complet acceptance from deep within. Radical acceptance also requires that you turn your mind toward acceptance which means that you must actively choose to accept reality as it is. Finally radical acceptance means taking a position of willingness, not willfulness
Acceptance is an extension of nonjudgment. It adds a measure of kindness or friendliness. When therapists are working with intense emotions, such as shame, anger, fear or grief, it is esentail that they maintain an open, compassionate and accepting attitutde. Empathy and positve reegard are important relational aspects of successful therapty that overlap with acceptance. If either the therapist or the pation tursn away from unpleasnat experience with anxiety or revulsion, the ability to understand the problem is likely to be compromised.
Willingness (In Linehan, 1992)
"Willingness implies a surrending of ones self-separateness, and entering into an immersion in the deepsest processes of life itself. It is a realization that one already is a part of some ultimate cosmic process and it is a commitment to participation in that procees".
In contrast willfulness is the setting of oneself apart from the fundamental essesnce of life an an attempt to master, direct, control or otherswise maipulate existance. More simply, willingness is saying yes to the mystery of being alive in each moment. Willfulness is saying no, or perhaps more commonly; "Yes, but..."
Some times people have a problem with the notion of acceptance. This may have to do with thinking that willingness and acceptance imply approval.
Ackowledge the emotion
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Mindfulness practice First stage
Thomas Marra
The mnemonic for mindfulness is ONE MIND
One thing
Now
Environment (what is happening out there?)
Moment (immediate)
Increase senses (touch, taste, vision, hearing)
Nonjudgmental
Describe (words. Descriptive, not prescriptive or proscriptive)
I break mindfulness practice down into three stages in order to increase your chances of success. In the first stage you practice paying attention to simple events outside of you. In the second stage you practice paying attention to more complex events outside of you and in the final stage you pay attention to your own responses and feelings, as well as what is going on in the environment. By breaking the practice down into these three stages, you are more likely to profit from the powerful effects of mindfulness.
Each day try one of the following exercise. Don't just try the exercises once. Practice them daily. Spend ten to fifteen minutes in each activity. Attempt to keep in mind the following
Mindfulness with music
Music is a wonderful tool to help you practice mindfulness. Many of us use music to simply provide background noise. You play the music and enjoy it but are doing something else as well as listening. You may be reading the newspaper, cleaning the house, talking on the telephone or writing checks while you have the CD player or the radio turned on. While this is fine for everyday enjoyment, it is not mindfulness. With mindfulness you want to play a particular selection, sit down in front to f your stereo speakers or with your headphones on and really listen. Perhaps close your eyes so that the auditory sensory input is better highlighted. Listen to the sounds. All it to move you. But always come back to the sounds. Stay with it.
While I happen to enjoy classical music, you don't have to chose classical. I would suggest, however, that you first choose instrumental music rather than music with vocalist. While mindfulness can certainly be practiced with songs with lyrics, in the beginning attempting to stay with both the lyrics and the instruments may be too complex. Better to start either with instrumental music without vocalists or with vocalists using a foreign language that you do not understand. Then you are focusing on the instruments and the sound and cadence of the vocalists and will not become distracted with the meaning of the words or the message of the song.
...
Mindfulness with aromas
Many health-food stores, drug stores and variety stores sell liquid aromas or fragrant essential oils. Some of these can be a bit expensive, so don't break your budget. You need just two or three scents. If you put one or two drops of the liquid on a piece of paper the aroma is highlighted. Smelling directly from the bottle is not as effective, as it is too concentrated. While aromatherapy holds that particular scents produce certain moods and health benefits, you are not concerned with those ideas for the purpose of mindfulness. Aroma is an excellent tool to develop mindful ness because there are fewer words involved and thus fewer associations from the past. Tis will keep you in the momenta d in the present. Put one or two drops of one scent on a small piece of absorbent paper. Find a quiet place where your not likely to be disturbed, and place yourself comfortably in a chair
Mindfulness practice second stage
After you engage in mindfulness practice ask yourself"
Mindfulness practice third stage
You will eventually reach a point where your observational skills and ONE MIND come more naturally. After much practice you will find that you're no longer struggling to allow sensual imput to be primary and meories and feelings from other events will more easily fall to the background. When you have reached this point you are ready to begin to practice being mindful of yourself.
My mindfulness practice
Distraction Skills
Caution:
Activities
Contributing
Comparisons
Emotions
Pushing away
Thoughts
Sensations
Activities
Contributing
Making Comparisons
Generating Opposite Emotions (ALWAYS USE WHEN AFRAID OR ASHAMED)
Pushing away (do not chronically use when afraid or ashamed)
Distracting with other Thoughts
Intense other sensations
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