DBT Module 4: Distress tolerance

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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



  1. 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
  2. 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



  1. distraction

  2. self soothing

  3. improving the moment

  4. thinking in pros and cons

Acceptance skills inclued



  1. Radical acceptance (complete acceptance from deep within)

  2. Turining the mind towar acceptance (chosing to accept reality as it is)

  3. Willingness versus willfulness 

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

Amanda

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Registered: 08-02-2005
Sat, 04-22-2006 - 12:09am

Distress tolerance assumptions



  • distress tolerance skills training is concerned with tolerating and survivng crises and with accepting life as it is in the moment

  • distress tolerance strategies, such as taking a mindful approach to feelings are intended for getting through crisis situations and overwhelming emotions

  • distress tolerance skills are not presented as a cure for all one's problems or life

  • beneficial effects may be temporary, but achieving them is no small feat

  • distress tolerance strategies are not emotion regulation strateies (ways to reduce or end painful emotions)

  • distress tolerance stragies ay ultimately help with regulating emotions

  • distress tolerance strategies are instead to help with surviving painful emotions
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Amanda

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Sat, 04-22-2006 - 12:20am

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.

Amanda

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Sat, 04-22-2006 - 12:45am



Ackowledge the emotion

Amanda

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Sat, 04-22-2006 - 12:58am
I can't seem to fix the table so here is the chart in doc format
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Amanda

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Sat, 04-22-2006 - 1:44am

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



  • Before each activity, review ONE MIND and remind yourself of the meaning of each principle. For example "one thing" means that as you engage in the mindfulness practice exercise you are not doing something else as well. While killing two birds with one stone is efficient in our routine daily live,s it is not optimal in learning an new skill like manfulness.
  • If other things, not happening in the moment, come into your mind, notice them and let them go. For example, if you're listening to music and you become aware that your mind wanders to you you are going to gather enough money to make your mortgage payment this month, simply say to yourself, "I'm aware that I'm worried about money. I'm going to let it go for now. Focus on the music. Listen to the sounds. Attend with my ears. It's okay. What do I hear?"
  • If an external distraction occurs (the telephone rings, someone comes to the door, your child asks you for something), pause what you are doing and come back to it immediately thereafter. Remember you don't necessarily have to be a slave to your phone. It's okay to ignore and continue practicing your mindfulness you find that your mind is going a thousand miles an hour about all sorts of things don't give up. Mindfulness is designed to help us concentrate. It is precisely at times like these that practice is helpful. The goal is not to be able to be perfectly mindful each time. The goal is to be able to notice that your mind is wandering and bring yourself back more quickly and easily each time.
  • First attend to what is going on outside of you. What are your senses finding? The pay attention to what is going on inside of you - just for a few seconds - returning your focus to what is going on in the environment. This participative approach, being involved in what is going on, incorporates attending to both the environment and yourself
  • Afterward, having finished your mindfulness practice for the day, return to the ONE MIND mnemonic and ask yourself to what degree where you able to accomplish each of the principles

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



  1. Slowly move the scented paper close to your nose, just close enough that you barely perceive the scent. Leave it just barely perceptible for fifteen to twenty seconds. Slowly breath in. How does the scent change the feelings in your nostrils? What does it smell like? Can you feel the scent deeper than your nostrils (can you feel it in your throat)? Does it have a "taste"?
  2. Move the scented paper closer to your nose,

Amanda

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Registered: 08-02-2005
Sat, 04-22-2006 - 1:51am

Mindfulness practice second stage



  • more complex music (e.g. what is the emotion behind the words?)
  • pay attention as you eat a relaxing meal
  • try to look at th elements of a room with which you are very familiar
  • listen to he engine of your car
  • go to a local candle shop, plant nursery, cosmetic counter or art gallery. Notice the visual, kinesthetic, olfactory and e motional responses

After you engage in mindfulness practice ask yourself"



  • Was iI able to allow myself to really concentrate and control my attention?
  • Did I push away nothing and cling to nothing?
  • Was I able to have other thoughts simply

Amanda

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Registered: 08-02-2005
Sat, 04-22-2006 - 1:56am

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.

Amanda

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Registered: 08-02-2005
Sat, 04-22-2006 - 1:58am

Amanda

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Sat, 04-22-2006 - 2:02am

My mindfulness practice







Amanda

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Sat, 04-22-2006 - 2:28am

Distraction Skills


Caution:



  • DO NOT CHRONICALLY USE DISTRACTION WHEN AFRAID
  • DO NOT CHRONICALLY USE DISTRACTION WHEN ASHAMED
  • USE SPARINGLY, LIKE SALT AND PEPPER

  • Distraction methods have to do with reducing contact with emotional stimuli (events that set off emotions)
  • in some cases distraction methods can work to change parts of an emotional response
  • there are 7 distracting skills Mnemonic = wise mind ACCEPTS

Activities
Contributing
Comparisons
Emotions
Pushing away
Thoughts
Sensations


Activities



  • activities can work to modulate negative emotions in a number of ways
  • activities distract attention and fill short term memory with thoughts, images and sensations counteractive to the thoughts images and sensations that activate and reactivate the negative emotions
  • distraction activities can affect physiological responses and emotional expressive behaviour directly
  • engage in exercise or hobbies
  • do cleaning
  • go to events
  • call or visit a friend
  • go walking
  • go out for a meal
  • have tea or coffee
  • chop wood
  • do gardening
  • play pinball
  • read
  • knit
  • sing
  • email
  • ebay
  • blogs/boards
  • exercise

Contributing



  • Contributing refocuses attention from oneself to what one can do for others
  • for some, contributing also increases a sense of meaning in life, thereby improving the moment
  • contributing also enhances self respect for some people
  • do volunteer work
  • give something to someone else
  • backed cookies for someone else
  • make something nice for someone
  • do a surprising thoughtful thing
  • engage in a random act of kindness
  • make a mixed cd fro my friend
  • bring a coffee for a friend
  • tell someone you love them
  • greet the neighbour with a smile and "good morning"

Making Comparisons



  • Comparison making also refocuses attention from oneself to others, but in a different way
  • in this case, the situations of others who are in the same position or doing less well, or are less fortunate in general, are used to recast one's own situation in a more positive light
  • the important thing to note here is this only works if you make downward comparisons
  • watch soap operas
  • read about disasters
  • read bout another's suffering
  • (just for the record I don't agree with this one)

Generating Opposite Emotions (ALWAYS USE WHEN AFRAID OR ASHAMED)



  • Generating opposite emotions with other, less negative emotions that helps to interfere with the current mood state
  • this technique requires that you figure out the current mood states so that activities to generate an opposite one can be sought
  • read emotional books or stories, old letters
  • watch emotional movies'
  • listen to emotional music
  • BE SURE THAT THE EVENT CREATES DIFFERENT EMOTIONS
  • going to a store to read funny greeting cards
  • go on a roller coaster
  • smile
  • sing

Pushing away (do not chronically use when afraid or ashamed)



  • Pushing away from a situation can be done by leaving it physically or by blocking it in one's mind\
  • Leaving the situation decreases contact with the emotional cues associated with the situation
  • Blocking is a somewhat conscious effort
  • Do not always use as a first skill choice
  • Can be used in emergencies - the secret - don't over use this
  • push the situation away by leaving it for a while
  • leave the situation mentally
  • build an imaginary wall between yourself and the situation
  • censor ruminating
  • refuse to think about the painful aspects of a situation
  • put the pain in a box and box it away for a while
  • "Don't even go there"
  • gives you time to think

Distracting with other Thoughts



  • distracting with other thoughts fills short term memory with other thoughts so that thoughts activated by the negative emotion do not continue to reactivate the emotions
  • count to 10
  • count colours in a painting
  • count anything
  • do puzzles
  • watch TV
  • read
  • mantras (mine..."I'm happy, I'm healthy, I'm fine"

Intense other sensations



  • Intense sensations can help because they interfere with the physiological component of the current negative emotions
  • also the sensations may wok to focuses attention on something other than the stimuli arousing the emotion
  • holding ice cubes
  • squeezing an object for as long as you can
  • clothes-pinning your nose
  • listen to very loud music
  • stand in a very hot or very cold shower
  • roller coaster
  • eat a lemon
  • elastic band on wrist
  • pinch yourself
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Amanda

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