470 – Distress Tolerance
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
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~ Define goals of distress tolerance
~ Discuss why some clients do not choose distress tolerance
~ Explore a variety of Distress Tolerance and Reality Acceptance Skills including
~ Pros and Cons
~ Self Soothing
~ IMPROVE the Moment
~ Radical Acceptance
~ Turning the Mind
Goals of Distress Tolerance
~ The goal of distress tolerance is to accept, find meaning for and tolerate distress
~ Pain and distress are part of life. Refusing to accept this leads to suffering
~ Any attempts at change will produce distress, therefore distress tolerance skills are necessary
Change causes crisis and crisis causes change
~ Distress tolerance is a natural progression from mindfulness
~ Accepting, nonjudgmentally, oneself and the situation
~ Not trying to change the situation, your feelings, thoughts or urges
~ Distress tolerance means surviving crises, accepting life as it is in the moment.
Tolerance and acceptance of reality do not equate with approval
Proving How Bad It Is
~ Sometimes people so want others to understand how bad it is they focus on that instead of surviving the situation
~ Short Term Gains (Look what you made me do)
~ Controlling anotherâ€™s behavior
~ Going to the hospital and getting attention/break
~ Long Term Benefits
~ Have clients remember a time they acted out to try to get someone to see how bad it was. What were the results?
Distress Intolerance Thoughts
~ I canâ€™t stand this
~ Itâ€™s unbearable
~ I hate this feeling
~ I must stop this feeling
~ I must get rid of it
~ Take it away
~ I canâ€™t cope with this feeling
~ I will lose control
~ Iâ€™ll go crazy
~ This feeling will keep going on forever
~ It is wrong to feel this way
~ Itâ€™s stupid and unacceptable
~ Itâ€™s weak
~ Itâ€™s bad
~ Itâ€™s dangerous
~ Urges are generally intense for 20-30 minutes
~ Every time you have an urge think, â€œI have a choice!â€
~ Surf the urge by opening yourself up to the urge. This doesnâ€™t mean that you consume yourself in it (which feels horrible) or fight it and push it away. What you do is experience the feeling of the urge with acceptance, non-judgement, and be sensitively aware that it is there.
~ Take a step back
~ Proceed Mindfully
Pros and Cons
~ What are the benefits to acting on impulsive urges?
~ What are the drawbacks to acting on impulsive urges?
~ What are the benefits to __[insert the skill] __
~ What are the drawbacks to __[insert the skill] __
~ Intense Exercise
~ Paced Breathing
~ Paired Muscle Relaxation
~ The act of muscle relaxation is paired with a verbal cue
~ What reactions do you have that are paired with verbal cues?
Distract with Wise Mind ACCEPTS
~ Activities (pleasant)
~ Emotions (opposite)
~ Pushing Away
~ Think about something totally different
~ 4 3 2 1
~ What did you used to do on long car trips?
~ Body Scan Meditation
~ Self-Soothing Using the 5 Senses
IMPROVE the Moment
~ Safe place
~ Successfully dealing with this
~ A force field
~ A coach/fairy godmother/angel
~ Feelings and thoughts are clouds in the sky
~ An unstoppable train
~ Changing how you think about yourself and your situation
~ Make lemonade. Find the silver lining.
IMPROVE the Moment
~ One thing in the Moment
~ Focus on one thing you are doing right now
~ Sitting in a chair
~ Mental vacation
~ Take a short break
~ Leave stress at work
~ Be your best friend
~ Create a mental coach
~ Radical Acceptance
~ Complete and total acceptance of the facts of reality
~ Turning the mind
~ Mentally looking to the other side
~ Seeing Emotions Differently
~ Fear and anger kick in when there is a threat
~ Sadness kicks in when you lose something important to you in some way, If you didnâ€™t feel sadness when these things occurred, it would mean that nothing was important.
Negative emotions are important to survival, rather than something to be feared and avoided at all costs
~ Willingness vs. Willfulness
~ Willfulness forgets, ignores or actively tries to change, master, direct, control or manipulate what is
~ Willingness is a surrendering to a process in which one is already a part
~ Half Smiling and Willing Hands
~ Emotions are partially controlled by facial expressions.
~ Half smiling with lips slightly upturned
~ Hands are unclenched, palms up, fingers relaxed
~ Mindfulness of current thoughts
~ Recognize that thoughts are just neural firing in the brain, not facts about the world
~ Allow the thoughts to come and fade
~ Clear Mind
~ Addicted Mind is governed by addictive behaviors
~ How is addicted mind similar to the emotional mind?
~ Clean Mind (Pink Cloud) forgets that relapse is possible
~ How is the clean mind similar to the rational mind?
~ Clear mind is not engaging in addictive behaviors but remains aware that relapse is possible.
~ How is the clear mind similar to the wise mind?
~ Burning Bridges and Building New
~ Actively eliminating triggers/vulnerabilities
~ Finding physical and emotional sensations and creating mental images that compete with the addiction
~ Alternate Rebellion
~ Finding alternative ways to act out which are safer
~ Harm reduction
~ Loud music
~ How does [this technique] make you feel?
~ How does it impact your feelings in the moment?
~ How does it affect how you handle the problem?
~ Sometimes emotions, thoughts, urges reappear
~ Notice them without negative judgement.
~ Tolerate the distress
~ Problem solve
~ Once clients are mindfully aware of their thoughts, sensations and urges and willing to accept the moment, they need skills to tolerate that distress
~ Help clients develop a menu of options which they can select from when they are in crisis.
~ They feel how they feel
~ Help them tolerate the distress until the intense emotions subside and they can get into their wise mind.
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