Dialectical Behaviour Therapy (DBT) developed by Marsha Linehan in 1993 is used to treat many mental health disorders. It is widely used in regulating one’s emotions. Research shows that DBT strengthens a person’s ability to handle distress without losing control and makes the person better at managing overwhelming emotions.

DBT teaches four important skills which are used to keep a balance of your emotions.

1. Distress Tolerance Skills. They help you cope with traumatic events by building your resilience and softening the effects of the circumstances.

2. Mindfulness is the second skill used in DBT,  it helps in experiencing more fully the present moment while focusing less on the past or painful experiences. It also gives you the tools to overcome negative judgments about yourself and others.

3. Emotion Regulation Skills help you recognize more clearly what you feel through introspection. It aims to modulate your feelings without behaving in reactive ways. 

4. Interpersonal Effectiveness is the fourth skill that gives you new tools to express your beliefs and needs and negotiate your problems to give you solutions.

In this article, we will be expanding our knowledge on Distress Tolerance Skills.

We frequently manage pain and misery in life. A broken limb or an ant bite are examples of physical symptoms, whereas despair or rage are examples of emotional symptoms. You cannot always predict when an ant will bite you or when something would make you upset, thus the agony in both situations is unavoidable. Distraction from the situation that is causing you emotional pain is one way to use distress tolerance skills. This prevents you from thinking about your pain at the moment and allows you to respond appropriately.

People frequently use self-destructive coping mechanisms like abusing alcohol and drugs to feel better or isolating themselves to avoid pain, which makes them worry about the future,  and face issues in their jobs, law, and their relationships. These negative coping mechanisms have obvious costs. All of them cause your discomfort to become severe suffering over an extended period of time. Keep in mind that while suffering frequently can be avoided, sometimes it cannot be.

We tend to get anxious sometimes and use unhealthy coping mechanisms that have repercussions. For instance, earlier, my unhealthy coping mechanism used to be eating unhealthy food during stressful situations like scoring low in exams or, not being able to have a clear vision of the future. This later resulted in unhealthy weight gain, tiredness, emotional dysregulation, irritability, and inability to concentrate during tasks. Unhealthy coping mechanisms can be very hazardous for your mental and physical health in the long run.

Now that we have identified some of our own self-destructive coping methods and their repercussions let us look at some Basic Distress Tolerance Skills that will help us process problematic situations in a much healthier way.

BASIC DISTRESS TOLERANCE SKILLS

Let us look at 5 different techniques of distress tolerance. These techniques can be used individually or combined. You can create a distress tolerance emergency plan on a piece of paper and keep it in your wallet for easy access. 

Technique 1: REST STRATEGY

The first distress tolerance strategy we need to learn is REST. REST is an acronym that reminds you to:

Relax

Evaluate

Set an intention

Take action

In overwhelming situations, we often are not able to identify, how to deal with such emotions.  It can be getting frustrated at work because of the overburden of work or, getting angry because you are not shedding pounds. This is exactly where REST Strategy comes into the game. Through this strategy, you will be able to conduct the process of changing your habits efficiently.

1. Relax. The first step of the strategy is to relax, and just sit for a while.

Take deep breaths and stop all your thoughts from rushing in. Move away from the situation for a few seconds to get a whole new perspective. Just don’t do what you tend to do to ease out. Just remind yourself that you have an opportunity to behave differently.  Some space between your desire to act impulsively and your actual reaction is important.

2. Evaluate. Ask yourself what is happening in this situation. Just take a moment to evaluate and reflect on yourself. You don’t have to understand everything, and you don’t have to examine your feelings in great detail. If the issue is too difficult, you are not even required to address it. Simply try to acquire a rough understanding of what’s going on by asking yourself, “How do I feel?” “What’s going on?” Who might be in danger?

3. Set an Intention. The third step is to fix an intention. In this case, an intention could be a target, goal, or plan about what you are going to do. Choose one  coping skill that you want to go ahead with, “What do I would like right now?”’ Should one do something for themselves?’. Then maybe choose one among the coping or self-soothing skills that you decide. Whatever you select to try and do, it doesn’t should be the ultimate or best solution, but hopefully, it’ll be something healthy that will facilitate you.

4. Take Action. Finally, take action. Put your plan into motion. Proceed mindfully,

which means moving ahead slowly with awareness of what you’re doing. Whatever your intention was within the last step, roll in the hay now as calmly and effectively as you can.

Technique 2: RADICAL ACCEPTANCE 

Although radical acceptance might often take a lot of effort, it can be very effective when used. People frequently experience a sense of being in control, which heightens their anxiety and distress. 

Radical acceptance simply means accepting things as they are without trying to make them different. The temptation to correct things frequently lessens when we give up trying to control things and accept that there is nothing we can do to change them. 

Radical acceptance is the acknowledgment that we are not all-powerful beings and that some things are simply beyond our control while objectively evaluating a scenario. If we attempt to control something, we could experience more distress if we fail. We can go on without being emotionally stuck if we give up attempting to control and just accept things as they are. It is no longer our duty to bring about a change.

Some Radical Acceptance Coping statements include:

• “It is pointless to overthink a topic that has already occurred.”
• “The present moment is perfect, fighting the past simply makes my present worse.”

Technique 3: DISTRACTION SKILLS

Using distraction skills is the simplest method is to divert your attention. Although we like to believe that we are multitaskers, our working memory has a limit on how much data it can hold at once. When feeling really overwhelmed, it may be helpful for the person to temporarily put aside their stressful issue and focus on something else until they are in a position to return and handle it calmly. Distraction can involve moving away physically from a place or engaging in an activity like talking on the phone, watching television, reading a book, playing with pets, etc.

– Distracting yourself from self-destructive behavior – It’s crucial to divert your attention away from a detrimental activity if you want to control your emotions. 

Here are a few safer things you can do to take your mind off of self-destructive feelings and thoughts:

• Squeeze an ice cube with one hand instead of harming yourself. The cold ice’s numbing feeling is quite disorienting. 

OR 

• On balloons, draw the faces of people you despise, and then pop them.

-Do something for someone else. Ask your friends if they require assistance with many tasks, such as housecleaning, grocery shopping, or chores. Find out if you can assist your parents, grandparents, or siblings. Inform them that you’re bored and want to find something to do.

-Take your attention off yourself. Visit a neighborhood shop, retail mall, library, or park. Simply observe others while sitting or mingling with them. Observe what they do. Take note of their attire. Listen to their conversations. Check how many buttons are on each of their clothes. Take in as much information as you can about these other folks.

-Consider a person you value. Keep a photo of this individual with you at all times in your wallet or purse. This might be your spouse, your parents, your boyfriend or girlfriend, your kids, your friends, or another person you look up to, like Mother Teresa, Gandhi, Jesus, the Dalai Lama, and so on.

Technique 4: SELF-SOOTHING YOUR SENSES

Some self-soothing techniques include feeling all your senses which results in mental and emotional stability. This includes:

1. See: Take a note of all the hues textures in the environment;
2. Hear: Make them pay attention to their own breathing and the sounds around them;
3. Touch: Ask them how the wind feels gushing into their hair. How their clothing feels against their skin;
4. Taste: Encourage them to consume a tiny amount of food and pay close attention to how it tastes in their mouths. 
5. Smell: Ask them to name the aromas they can smell, light a candle, or employ aromatherapy.

Practitioners usually give the clients raisins. It is a great method to introduce sensory grounding (self-soothing) techniques. They can smell the raisin, touch its rough exterior, see its ridges and color, taste it, and hear the sound the raisin makes when it is swallowed.

 Technique 5: IMPROVING THE MOMENT

The IMPROVE skills stand for:

• Imagery,
• Meaning,
• Prayer,
• Relaxation,
• One thing in the moment,
• Vacation, and
• Encouragement (Linehan, 2014).

These are more specific distress tolerance techniques that the client can use as per their requirement. The client may be able to imagine (imagery) a different scenario or derive meaning from the painful incident. 

Deep breathing and progressive muscle relaxation, which will be covered further below, are two examples of relaxation. 

“One thing in the moment” refers to slowing down and breaking down a problem into smaller, more manageable parts, rather than trying to deal with the entire thing at once. 

Vacationing is like the ability to divert attention, taking a break from the stress (a vacation from your thoughts). Encouragement, on the other hand, is a method of self-soothing that includes affirmations and a reminder that this upsetting mental state is only passing.

SOME ADVANCED SKILLS INCLUDE:

Technique 6: SAFE-PLACE VISUALIZATION

One of the most effective methods for reducing stress is safe-place visualization. By using it, you can calm yourself by visualizing a tranquil, secure location where you can unwind. The truth is that your body and brain frequently can’t distinguish between what is actually happening to you and what you are simply imagining. Therefore, if you can effectively conjure up a serene, unwinding scenario in your mind, your body will frequently respond to those calming thoughts. 

Make sure you carry out this exercise in a calm area where you won’t be interrupted. Switch off your radio, computer, TV, and phone. Tell our family and friends, that you are not to be interrupted for the next 20 minutes. Give yourself the space and time to unwind; you deserve it. After that, close your eyes and pay attention to the guided imagery you made. Consider images that give you a sense of security and relaxation before you start the activity. It might be a real location that you’ve been to before, like the beach, a park, a field, a church, a temple, a synagogue, your room, etc. Or it may be a place you’ve made up entirely, like a white cloud hovering in the sky, a castle from the Middle Ages, or the surface of the moon. You will observe yourself in a better state after the exercise.

 Technique 7: CUE-CONTROLLED RELAXATION

You may quickly and easily relax using the cue-controlled relation technique, which will help you feel less stressed and less tense in your muscles. A cue is a signal or directive that encourages relaxation. Your cue in this situation will be a word, such as “relax” or “peace.” By using this method, you can teach your body to relax its muscles when you think of your cue word. To begin with, you’ll need the guided instructions to assist you with relaxing the muscles in various parts of your body. However, after using this method for a few weeks, you’ll be able to instantly relax your entire body by taking a few quiet breaths and focusing on your cue word. With regular practice, this can become a very quick and easy way to help you relax.

Technique 8: REHEARSING VALUES-BASED BEHAVIOR 

We often face irrational thoughts gushing into our minds which might also change our way of behavior negatively. It’s difficult because of the fear of failing or being rejected. It can also be challenging when one feels ashamed or defeated. To get beyond these difficulties, it helps to mentally walk through each phase of a values-based activity, including identifying potential roadblocks and how to deal with them. 

In such situations, we use cognitive rehearsal. With the use of this technique, you’ll even picture yourself advancing towards your objective while projecting a confident demeanor and posture.

 Here’s a simplified version of how to do cognitive rehearsal: 

• Determine the precise circumstance in which you want to live out your values. Who is present? Where are you? What are people saying and doing? 
• What goals do you wish to pursue in this circumstance? What actions or words would you use to put this value into practice? 
• Organize your conduct based on your values into clear steps. Imagine yourself in the circumstance acting in accordance with your values and intentions as vividly as you can.

Technique 9: TAKE A TIME-OUT

Not only are time-outs for children. We all require some downtime to rejuvenate our bodies, minds, and souls. However, a lot of people avoid taking time for themselves out of fear of disappointing someone else, such as their boss, spouse, family, or friends. The continual pressure to satisfy others causes many people to suffer and, as a result, they often overlook their own needs. But those who neglect their own needs live very unbalanced lives. Many people don’t take care of their own needs because they feel guilty or self-centered about doing so. However, how long can you care for someone else without caring for yourself? Self- Love and taking care of yourself should be a priority for every individual to be emotionally, physically, spiritually, and mentally regulated.

Ways to teach these skills:

1. Worksheets and Handouts: Worksheets and handouts can be incorporated into therapy sessions as tools. 

2. Audio recordings: Clients can use instructional audio recordings to practice skills on their own at home. Customers can choose from a wide variety of audio recordings, many of which come with workbooks or are offered as guided audio meditations. 

3. Books: The client can be given recommendations for therapy books like The Dialectical Behavior Therapy Skills Workbook by McKay, Wood, and Brantley (2007), and homework can be given between sessions. 

4. Group therapy: Patients are more responsive to the therapeutic process when they arrive at treatment sessions with a more centered mental state. The therapist reinforces a serene and collected mindset throughout sessions, which furthers the benefits of the skills in strengthening the therapeutic connection.

Therefore, how to deal with stress varies from person to person. Some learn to deal with stressful situations as a child, while others did not acquire proper coping skills. Distress tolerance skills as a module of dialectical behavior therapy can be taught to all clients who need to improve their crisis management skills. There are many resources that practitioners can use to teach these skills. They may behave irrationally when clients are experiencing serious distress,  but as they practice stress tolerance skills,  they can make healthier choices. With the tools and proper guidance, therapy seekers should be able to learn hands-on coping skills resulting in their well-being and emotional regulation.

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