May 15

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​Distress Tolerance Skills


Pain and distress are part of life and cannot be entirely avoided or removed … learning to tolerate stress, surviving crises and accepting life as it is in the moment … that does not mean that you have to like it, but accepting it is the key. Listed here are some suggestions to help you through that painful event and emotions when you cannot make things better right away …

DISTRACTING

  • Activities
  • Contributing
  • Comparisons
  • Emotions
  • Pushing-Away
  • Thoughts
  • Sensations

SELF-SOOTHE THE FIVE SENSES

  • Vision
  • Hearing
  • Smell
  • Taste
  • Touch

IMPROVE THE MOMENT

  • Imagery
  • Meaning
  • Prayer/Meditation
  • Relaxation
  • One Thing at a Time
  • Vacation
  • Encouragement and Cheerleading

PROS AND CONS

Distracting

With Activities: 
Engage in exercise or hobbies; do cleaning; go to events; call or visit a friend; play computer games; go walking; work; play sports; go out for a meal, have decaf coffee or tea; go fishing; chop wood, do gardening; play pinball.

With Contributing: Contribute to someone; do volunteer work; give something to someone else; make something nice for someone else; do a surprising, thankful thing; random acts of kindness.
With Comparisons: Compare yourself to individuals copping the same as you or less well than you; compare yourself to those less fortunate than you; watch soap operas; read about disasters that offer you insight into other’s suffering.

With Opposite Emotions: Read emotional books or stories, old letters; go to emotional movies; listen to emotional music. Be sure the event will create a different emotion that what you are currently experiencing. Ideas would be scary movies, joke books, comedies, funny records, religious music, marching songs, “I am Woman” (Helen Reddy); going to a store and reading funny greeting cards.

With Pushing Away: Push the situation away by leaving it for a while. Leave the situation mentally. Build an imaginary wall between yourself and the painful situation. Or push the situation away by blocking it out of your mind. Censor ruminating. Refuse to think about the painful aspects of the situation. Put the pain on a shelf or lock box … and put it away for a while until you are at a better place to pull it out and look at it.

With Other Thoughts: Count to 10; notice colors in a painting or tree, windows, anything; work puzzles; do needlecraft projects; watch TV; read.
With Intense Other Sensations: Hold ice in your hand; squeeze a rubber ball very hard; stand under a very hard and hot shower; listen to very loud music; sex; put rubber band on wrist, pull out, and let go

Self-Sooth the Five Senses

With Vision: 
Buy one beautiful flower; make one space in a room pretty; light a candle and watch the flame. Set a pretty place at a table, using your best things, for a meal. Go to a museum with beautiful art. Go sit in the lobby of a beautiful old hotel. Look at nature around you. Go out in the middle of the night and watch the stars. Walk in a pretty part of town. Fix your nails so they look pretty. Look at beautiful pictures in a book. Go to a ballet or other dance performance, or watch one on TV. Be mindful of each sight that passes in front of you, not lingering on any.

With Hearing: Listen to beautiful or soothing music, or to invigorating and exciting music. Pay attention to sounds of nature (waves, birds, rainfall, leaves rustling). Sing to your favorite songs. Hum a soothing tune. Learn to play an instrument. Call 800 or other information numbers to hear a human voice. Be mindful of any sounds that come your way, letting them go in one ear and out the other.

With Smell: Use your favorite perfume or lotions, or try them on in the store; spray fragrance in the air; light a scented candle. Put lemon oil on your furniture. Put potpourri in a bowl in your room. Boil cinnamon; bake cookies, cake, or bread. Smell the roses. Walk in a wooded area and mindfully breathe in the fresh smells of nature.

With Taste: Have a good meal; have a favorite soothing drink such as herbal tea or hot chocolate (no alcohol); treat yourself to a dessert. Put whipped cream on your coffee. Sample flavors in an ice cream store. Suck on a piece of peppermint candy. Chew your favorite gum. Get a little bit of a special food you don’t usually spend the money on, such as fresh-squeezed orange juice. Really taste the food you eat; eat one thing mindfully.

With Touch: Take a bubble bath; put clean sheets on the bed. Pet your dog or cat. Have a massage; soak your feet. Put creamy lotion on your whole body. Put a cold compress on your forehead. Sink into a really comfortable chair in your home, or find one in a luxurious hotel lobby. Put on a silly blouse, dress, or scarf. Try on fur-lined gloves or fur coats in a department store. Brush your hair for a long time. Hug someone. Experience whatever you are touching; notice touch that is soothing.

Improve the Moment

With Imagery: 
Imagine very relaxing scenes (others may need to imagine very challenging and dramatic scenes). Imagine a secret room-within yourself, seeing how it is decorated. Go into the room whenever you feel very threatened. Close the door on anything that can hurt you. Imagine everything going well. Imagine coping well. Make up a fantasy world that is calming and beautiful and let your mind go with it. Imagine hurtful emotions draining out of you like water out of a pipe.

With Meaning: Find or create some purpose, meaning, or value in the pain. Remember, listen to, or read about spiritual values. Focus on whatever positive aspects of a painful situation you can find. Repeat them over and over in your mind. Make lemonade out of lemons.
With Prayer or Meditation: Open your heart to a supreme being, greater wisdom, God, your own wise mind. Ask for strength to bear the pain in this moment. Turn things over to God or a Higher Power.
With Relaxation: Try muscle relaxing by tensing and relaxing each large muscle group, starting with your ands and arms, going to the top of your head, and then working down; listen to a relaxation tape; exercise hard; take a hot bath or sit in a hot tub; drink hot milk or hot chocolate; massage your neck and scalp, your calves and feet. Get in a tub filled with very cold or hot water and stay in it until the water is tepid. Breathe deeply; half-smile; change facial expressions.

With One Thing in the Moment: Focus your entire attention on just what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present. Focus your entire attention on physical sensations that accompany nonmental tasks (e.g., walking, washing, doing dishes, cleaning, fixing). Be aware of how your body moves during each task. Do awareness exercises.

With a Brief Vacation: Give yourself a brief vacation. Get in bed and pull the covers up over your head for 20 minutes. Rent a motel room at the beach or in the woods for a day or two; drop your towels on the floor after you use them. Ask your partner or roommate to bring you coffee in bed or make you dinner (offer to reciprocate). Get a schlocky magazine or newspaper at the grocery store, get in bed with chocolates, and read it. Make yourself milk toast or hot chocolate and cinnamon toast, bundle up in a chair, and eat it slowly. Take a blanket to the park and sit on it for a whole afternoon. Unplug your phone for a day, or let your answering machine screen your calls. Take a one-hour breather from hard work that must be done.

With Encouragement: Cheerlead yourself. Repeat over and over: “I can stand it,” “It won’t last forever,” “I will make it out of this,” “I am doing the best I can do.”

Thinking of Pros and Cons

Make a list of the pros and cons of tolerating the distress. Make another list of the pros and cons of not tolerating the distress – that is, of coping by hurting yourself, abusing alcohol or drugs, or doing something else impulsive.

Focus on the long-term goals, the light at the end of the tunnel. Remember when there was no pain.

Think of the positive consequences of tolerating the distress. Imagine in your mind how good you will feel if you achieve your goals, if you do not act impulsively. If you just stay in the moment … without judgment.

Think of all the negative consequences of not tolerating your current distress. Remember what has happened in the past when you have acted impulsively to escape the moment … how might you do it differently this time?

References

Skills Training Manual for Treating Borderline

Personality Disorder by Marsha Linehan, 1993, Guilford Press)

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