Psycho-Babble Psychology Thread 911764

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Re: Distress tolerance Phillipa

Posted by Dinah on August 12, 2009, at 23:36:35

In reply to Re: Distress tolerance Dinah, posted by Phillipa on August 12, 2009, at 13:52:39

> Dinah I know I need all the help I can get. But I don't have any suggestions. Sorry Phillipa

Maybe we can come up with some suggestions, and also encourage each other to implement them?

How about a brainstorming session? That would mean that you not worry about whether your ideas are good or not. Just mention anything that pops in your mind. Since different people find different things helpful, maybe someone will find something that would be helpful to them. :)


Re: Distress tolerance Angela2

Posted by Dinah on August 12, 2009, at 23:39:31

In reply to Re: Distress tolerance, posted by Angela2 on August 12, 2009, at 14:32:03

> Dinah,
> Sounds neat. What does distress mean in this instance? an upsetting situation? anxiety? jealousy? etc? Or anything? I'm not that familiar with dbt.

I'm not an expert on DBT, and in fact it's been a while since I read up on it, but I'll try to look again.

I think there are other parts of DBT that emphasize acting effectively in different situations. I think distress tolerance is more about learning to live through those awful moments of feeling anxious or angry or despairing - any sort of arousal that is unpleasant to bear. And that we tend to think will last forever, or that we may use coping mechanisms that may cause more harm than good.

If that makes sense?


Re: Distress tolerance obsidian

Posted by Dinah on August 12, 2009, at 23:41:07

In reply to Re: Distress tolerance Dinah, posted by obsidian on August 12, 2009, at 16:14:20

Let's try to come up with some ourselves, and I'll also look for some of my old lists. If anyone has the books, maybe they could look through and see if they see anything that strikes them. I think there were a few ideas on that website too, and probably there are other websites.


Re: Distress tolerance TherapyGirl

Posted by Dinah on August 12, 2009, at 23:42:32

In reply to Re: Distress tolerance Dinah, posted by TherapyGirl on August 12, 2009, at 17:56:25


At one point I ordered the videos. I don't remember finding them overly compelling, but maybe I'll glance through them again.

I wonder if this counts as a distraction?



Re: Distress tolerance seldomseen

Posted by Dinah on August 12, 2009, at 23:47:06

In reply to Re: Distress tolerance Dinah, posted by seldomseen on August 12, 2009, at 18:21:53

> I have two things that definately help me to tolerate distress. One I guess would fall under the category of distract by comparison. I created for myself the absolute most stressful scenario that I could possibly imagine - I won't elaborate,but it has to do with both drug dealers and cops chasing me because I stole and sold their drugs, spent the money which turned out to be also stolen. I then compare my current situation to that. Any current distress usually doesn't measure up and puts it in some sort of perspective.
> The next definately falls under the imagery category. I have a wonderful image of me in the woods being surrounded by multi-colored butterflies. It works and engages all of my senses.
> Seldom.

That reminds me of a conversation I had with my son. I was telling him that no matter what happened with grades or school, he'd be ok. He came up with more and more fantastical scenarios from failing a test to failing a class and finally ending up with failing to stop an invasion from aliens intent on destroying the world. We ended up laughing, and I don't know how much benefit he got from it, but I remember feeling a small shock as I realized that what I was saying was true. :)


Re: Distress tolerance

Posted by Dinah on August 12, 2009, at 23:51:47

In reply to Re: Distress tolerance, posted by Nadezda on August 12, 2009, at 22:27:35

> Definitely. This is something I use a lot-- and need to use more.
> Especially since I'm taking a short plane flight at the end of the month-- which is closer and closer by the minute.
> The DBT people have a lot of ideas about this-- distraction is definitely one of their techniques, but they recommend that you have a number of different ways of self-soothing, in order not to become too dependent on one-- for example, distraction which, in my case at least, often becomes an independent problem, if used too much. I don't see anything wrong with shopping (if you can afford it) or bubbles-- if they work. It's really about what works in the moment. What matters is whether distress tolerance takes constructive or destructive forms. So the shopping could be a problem on its own-- which would be a genuine reason to try to develop other strategies.
> Rocking, whether with or without a chair, would be a form of physical soothing-- using the senses, the sensation of touch in that case-- which is also a type of distress tolerance-- It can also be part of mindfulness, if you focus on it, and keep aware of all the sensations that are produced by it. Things like that can be the most effective in reducing distress, because it concentrates your attention on something else-- and in this case, it's rhythmical, and pleasant, or comforting in itself.
> So your approaches are all pretty much included in what they recommend. I haven't heard of mind smoothing-- but if it works, I'd say that's great.
> It's a great topic, though.
> Nadezda

Mind smoothing is a term that I think only I use. :)

Shopping is a very effective, but very harmful, method of distraction. I'd really like to substitute less harmful ones. Bubbles is a fairly innocuous one unless I play it when I should be working.

What do you find helpful? Is there anything you find helpful on planes?

I have to admit that on planes, I take medication, put noise canceling earphones on my ipod, and stare out the window at the clouds. When I went to England, I fell asleep instantly and slept all the way to and from London. That was a very comfortable plane though, by plane standards. And I seem to escape to sleep pretty easily.


Whoops. Above for (nm) Nadezda

Posted by Dinah on August 12, 2009, at 23:52:12

In reply to Re: Distress tolerance, posted by Nadezda on August 12, 2009, at 22:27:35


Re: Distress tolerance Nadezda

Posted by Dinah on August 13, 2009, at 0:05:44

In reply to Re: Distress tolerance, posted by Nadezda on August 12, 2009, at 22:27:35

"Distract by Pushing Away a distressing situation by leaving it mentally for awhile."

I guess mind smoothing would fall into this category, as would forgetting sleeps. However involuntary both are. :)


Re: Distress tolerance

Posted by Daisym on August 13, 2009, at 0:32:54

In reply to Re: Distress tolerance Nadezda, posted by Dinah on August 13, 2009, at 0:05:44

Loud music is one of my favorite stress tolerance activities. The type of music might change but I want it loud enough to drown out my thoughts. Usually I go for Jazz - Chris Botti - or for Sinatra but I love Country too.

Breathing also works very, very well for me. I focus on slow deep breaths, counting in and counting out. I think years of being a childbirth educator has given me great training here. But breathing calms the body and gives the mind something to focus on. You just have to practice.

Tapping works too. You tap in sequence on your outer hand or tap heel/toe. It works, don't know why exactly.

The other, kind of silly, thing I do is that I project forward. I tell myself that in 1 hour, or 1 day or 1 week, this will all be over with. It gets me through some of the immediate hard stuff.


Re: Distress tolerance

Posted by emmanuel98 on August 13, 2009, at 8:21:56

In reply to Re: Distress tolerance, posted by Daisym on August 13, 2009, at 0:32:54

In DBT, a big part of learning distress tolerance is through the practice of mindfulness. This can be as simple as sitting still and focussing all your attention on the sounds you hear, without judging or reacting, or washing the dishes and focusing solely on the feel and sound of the soap, water, dishes.

I find I need to practice doing this all the time, so that when I am distressed, I can easily call up the skills.

Mindfulness can also include meditation and deep-breathing, self-soothing techniques, which, again, should be practiced regularly.


Re: Distress tolerance Dinah

Posted by seldomseen on August 13, 2009, at 9:36:05

In reply to Re: Distress tolerance seldomseen, posted by Dinah on August 12, 2009, at 23:47:06

I've mentored a lot of graduate students through their qualifying exams.
In my field there is a horrible oral exam in which 7 experts in the field can basically ask you anything they want for two+ hours. It's horrible, but a hoop you have to jump through to become a candidate for a Ph.D.
I always ask them, what is the worst scenario they can imagine. Invariably, they say "failing the test".
I remind them that - "No, that is far from worst case scenario". In actuality, they could get so nervous that they pass out, hit their head on the table, evacuate their bladder, have to be rushed to the hospital, have a hole drilled in their head to relieve intracranial pressure and potentially never be the same again".

That, or they could ask to be excused for a drink of water and pull the fire alarm. Sure it's a felony, but it would give them time to compose themselves.

They always laugh and it helps to relieve the stress.

I guess the moral of this long tale is that keeping some kind of external reference frame is important especially when one's current frame might be skewed and there is always always an out.



Re: Distress tolerance

Posted by sunnydays on August 13, 2009, at 10:18:43

In reply to Distress tolerance, posted by Dinah on August 12, 2009, at 12:35:02

My T likes to talk about these things and how I have trouble 'managing my feelings'. I personally get so upset that I have a hard time fathoming how I am supposed to do any of these things when all I know is that I am falling to pieces and so terribly upset I think I'm breaking in pieces. It's always bothered me that I can't, but I haven't figured out how to make these work for me. Sometimes I can try a little mindfulness, or I watch tv or do something online. I think that my primary coping method is dissociation though - I think I might get that idea of brain smoothing you are talking about Dinah - I have to close my eyes, but then all of a sudden everything is gone and forgotten and I'm calm. The problem is then that I've forgotten whatever it was and it upsets me again when it comes back...



Re: Distress tolerance Dinah

Posted by Angela2 on August 13, 2009, at 10:35:47

In reply to Re: Distress tolerance Angela2, posted by Dinah on August 12, 2009, at 23:39:31

Dinah, yeah that makes a lot of sense. I am a LITTLE familiar with it because when I was in the hospital 3 years ago, our groups were all based on dbt and I remember bits and parts. I also have a book buried in my closet on dbt that I read a little of about 3 years ago too.

Distress tolerance sounds really interesting and I like the idea.


Re: Distress tolerance Angela2

Posted by Dinah on August 13, 2009, at 11:17:06

In reply to Re: Distress tolerance Dinah, posted by Angela2 on August 13, 2009, at 10:35:47

If you could find it, maybe you could share some ideas from it? I'm going to try to hunt down the videos, although I have no idea where I put them. Sometimes my filing system is *too* complex.


Re: Distress tolerance sunnydays

Posted by Dinah on August 13, 2009, at 11:24:31

In reply to Re: Distress tolerance, posted by sunnydays on August 13, 2009, at 10:18:43

I am going to tell my therapist that there is at least one other person who understands the brain smoothing experience! From the inside I mean. He's watched me do it so many times that he can recognize when it's happening. I'm not totally without senses when it happens, and I can feel his intent regard.

I also have problems trying to apply these things when I'm in acute distress, when as you say, I've fallen apart. I liken it to a computer screen saver dissolving into pixels. Once I'm at that point, nothing but meds, sleep or dissociation has any chance whatsoever of helping. At least I've quit self injuring.

But maybe the distress tolerance could help in the time leading up to the meltdown. Keep the meltdown from happening. Of course, that might take more awareness of my mental state than I often have. I've only recently (well, in years) been able to have any consistent ability to notice when I'm getting angry or scared or upset. And my ostrich tendencies and dissociative tendencies tend to get in my way. I often go from zero to sixty in ten seconds flat, because I haven't paid attention to the pressure building. I've gotten better at that - often from looking at my behaviors rather than my feelings. Maybe that's the point to apply the distress tolerance practices.

It's an interesting question. I wish my therapist did DBT so I could ask him and reasonably expect more than a general opinion.


Re: Distress tolerance seldomseen

Posted by Dinah on August 13, 2009, at 11:31:15

In reply to Re: Distress tolerance Dinah, posted by seldomseen on August 13, 2009, at 9:36:05

Ok, that one is definitely going into my personal kit. :) I do have a tendency to lose the larger picture - not only emotionally but in many ways. Daddy used to fuss at me about it.

One thing I find helpful to tolerate distress is probably more in the area of effectiveness than distress tolerance. But it also works in that area.

I find that I am such an avoider that I stew over things I needn't stew over. For example, I often get two assignments with deadlines that overlap. My tendency is to struggle to do both, do neither very well because my brain gets disorganized from stress, then present my bosses with the best I have.

The last few months, maybe almost a year, I've been trying to remember, when I'm feeling stressed enough that I can't concentrate, to call one of my bosses and tell them what's going on and ask them what to do. They may prefer that I figure it all out on my own, but they prefer that I ask rather than waffle, so they tell me something and poof! my distress is gone. The same is true for other types of indecision or issues that cause me to try to avoid instead of act.

It may not be distress tolerance per se, but it sure is a way to stop distress. :)


Re: Distress tolerance emmanuel98

Posted by Dinah on August 13, 2009, at 11:36:32

In reply to Re: Distress tolerance, posted by emmanuel98 on August 13, 2009, at 8:21:56

I have a very hard problem with mindfulness. One place I can do it very well is in the bath. I feel the water run over my hand, and focus all my attention on that.

When I'm distressed, I have a special problem with it because to be mindful and aware of the sensations in my body is a very uncomfortable sensation. Still, there is a difference between feeling them and observing them. A little gap in the experience.

I don't think I'm good at meditation. It usually slips into self hynosis and the opposite of mindfulness. My therapist hasn't had much luck teaching me the difference.

Is there anything that helps you practice mindfulness when you are already upset?


Re: Distress tolerance Daisym

Posted by Dinah on August 13, 2009, at 11:44:30

In reply to Re: Distress tolerance, posted by Daisym on August 13, 2009, at 0:32:54

Projecting forward might be sort of like what seldomseen was saying? Giving perspective?

Kath has been talking about tapping. Is there any special sequence?

I try all the time to remind my son about breathing, but I rarely do it myself. Well, that's likely not true. I do it but I don't *just* do it. It's part of a whole stilling of my body.

Jazz and Country. That's an intriguing combination. :) I probably ought to start listening to music again. I have playlists of sad and happy music. I could probably put together some other emotions too. I really like listening to melancholy music when I'm sad. Not to wallow in it or intensify the mood, but to coalesce the feelings so that I can express them and ease them. I have a very vivid memory of holding one of my dogs, and stroking her very silky hair, with the warm weight of her body against my chest, and listening to "No More Tears in Heaven" and sobbing about really nothing in particular during my postpartum period.


Re: Distress tolerance

Posted by Tabitha on August 13, 2009, at 12:14:53

In reply to Re: Distress tolerance Daisym, posted by Dinah on August 13, 2009, at 11:44:30

Great topic. I can only think of a few things I do

- for general anxiety, I usually distract myself by watching movies, reading, or web-surfing. This isn't really the best thing, since I end up procrastinating things I need to do. But otherwise it's relatively harmless

- for anger, I'll take a walk to work it off physically.

- for everything else, I guess what I do comes under mindfulness. I just go inward and notice the components of it-- the physical sensations, the thoughts. I find this really comforting since it immediately breaks it down into harmless components. Sometimes this will stop it, or sometimes it just keeps coming back together, and I repeat. I do this a lot during the work day when things are winding me up.


Re: Distress tolerance

Posted by emmanuel98 on August 13, 2009, at 17:28:54

In reply to Re: Distress tolerance emmanuel98, posted by Dinah on August 13, 2009, at 11:36:32

It helps to remember the concept of wise mind - not being ruled by your emotions, but keeping some rational part of your brain free to reflect on what's happening. Meditation and deep breathing help me the most when I'm distressed.


Re: Distress tolerance

Posted by TherapyGirl on August 13, 2009, at 19:21:39

In reply to Re: Distress tolerance, posted by Daisym on August 13, 2009, at 0:32:54

One thing I found helpful when it got so bad last winter was to sing. I think it forces me to breathe better than I do when I'm that upset without having to think about it, which just makes it worse.

The other regular thing I have done in the past, which is not working so well right this moment, is imagine that my T is holding me. This is particularly effective in the middle of the night when the anxiety is through the roof.

I also do the projecting forward thing that Daisy mentioned. That's also what I do with physical pain. I never have anesthesia with dental work, for instance.

Now if I could just figure out how to use ALL of this when my T leaves. I did tell her tonight that I wanted to be able to use her as a distraction again without it being so painful as to make things worse. I didn't tell her exactly what I do because it sounds pathetic, but she probably has a guess.

And Dinah -- she LOVED the handout that I printed from your link. She wishes she had thought of that. I looked at her and said, "I wish you had, too." Off topic -- all in all, the best session we've had in months. Let's see if our Ts can pull off a double header this week!


Re: Distress tolerance

Posted by Phillipa on August 13, 2009, at 19:50:02

In reply to Re: Distress tolerance, posted by TherapyGirl on August 13, 2009, at 19:21:39

Ride my bike anything physical, and be creative and post a listing for sale on ebay. Phillipa


Re: Distress tolerance

Posted by sunnydays on August 13, 2009, at 21:37:50

In reply to Re: Distress tolerance, posted by Phillipa on August 13, 2009, at 19:50:02

I dug out the notebook of stuff I have from the dbt distress tolerance group I was in a long time ago. Not too much of it really 'stuck' at the time, but maybe it will help someone here.

I will make a series of posts b/c it's different topics. These say at the bottom that they are from "Skills Training Manual for Treating Borderline Personality Disorder" by Marsha Linehan.

I don't have BPD, but I think these skills can be helpful for anyone.




Posted by sunnydays on August 13, 2009, at 21:52:14

In reply to Re: Distress tolerance, posted by Phillipa on August 13, 2009, at 19:50:02

Mindfulness Skills:

-Just notice the experience. Notice without getting caught in the experience. Experience without reacting to your experience.

- Have a "teflon mind", letting experiences, feelings, and thoughts come into your mind and slip right out.

- Control your attention, but not what you see. Push away nothing. Cling to nothing.

- Be like a guard at the palace gate, alert to every thought, feeling, and action that comes through the gate of your mind.

- Step inside yourself and observe. Watch your thoughts coming and going, like clouds in the sky. Notice each feeling, rising and falling, like waves in the ocean. Notice exactly what you are doing.

- Notice what comes through your senses - your eyes, ears, nose, skin, and tongue. See others' actions and expressions. "Smell the roses".

- Put words on the experience. When a feeling or thought arises, or you do something, acknowledge it. For example, say in your mind, "Sadness has just enveloped me.".... or... "Stomach muscles tightening"...or..."A thought 'I can't do this' has come into my mind"...or..."walking, step, step, step."

- Put experiences into words. Describe to yourself what is happening. Put a name on your feelings. Call a thought just a thought, a feeling just a feeling. Don't get caught in content.

- Enter into your experiences. Let yourself get involved in the moment, letting go of ruminating. Become one with your experience, completely forgetting yourself.

-Act intuitively from wise mind. Do just what is needed in each situation - a skillful dancer on the dance floor, one with the music and your partner, neither willful nor sitting on your hands.

- Actively practice your skills as you learn them until they become part of you, where you use them without self-consciousness. Practice:
1) Changing harmful situations.
2) Changing your harmful reactions to situations.
3) Accepting yourself and the situation as they are.

- See but don't evaluate. Take a nonjudgmental stance. Just the facts. Focus on the 'what', not the 'good' or 'bad', the 'terrible' or 'wonderful', the 'should' or 'should not'.

- Unglue your opinions from the facts, from the 'who, what, when, and where."

- Accept each moment, each event as a blanket spread out on the lawn accepts both the rain and the sun, each leaf that falls upon it.

- Acknowledge the helpful, the wholesome, but don't judge it. Acknowledge the harmful, the unwholesome, but don't judge it.

- When you find yourself judging, don't judge your judging.

- Do one thing at a time. When you are eating, eat. When you are walking, walk. When you are bathing, bathe. When you are working, work. When you are in a group, or a conversation, focus your attention on the very moment you are in with the other person. When you are thinking, think. When you are worrying, worry. When you are planning, plan. When you are remembering, remember. Do each thing with all of your attention.

- If other actions, or other thoughts, or strong feelings distract you, let go of distractions and go back to what you are doing - again and again, and again.

- Concentrate on your mind. If you find you are doing two things at once, stop and go back to one thing at a time.

-Focus on what works. Do what needs to be done in each situation. Stay away from 'fair' and 'unfair', 'right' and 'wrong', 'should' and 'should not'.

- Play by the rules. Don't 'cut off your nose to spite your face.'

- Act as skillfully as you can, meeting the needs of the situation you are in. Not the situation you wish you were in; not the one that is just; not the one that is more comfortable; not the one that...

- Keep an eye on your objectives in the situation and do what is necessary to achieve them.

- Let go of vengeance, useless anger, and righteousness that hurts you and doesn't work.


Distress Tolerance - Distraction Crisis Survival

Posted by sunnydays on August 13, 2009, at 21:59:13

In reply to Mindfulness, posted by sunnydays on August 13, 2009, at 21:52:14


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 to a meal, have decaf coffee or tea, go fishing, chop wood, do gardening, play pinball.

Contribute to someone, do volunteer work, give something to someone else, make something nice for someone else, do a surprising, thoughtful thing.

Compare yourself to people coping the same as you or less well than you. Compare yourself to those less fortunate than you. Watch soap operas, read about disasters, others' suffering.

Opposite Emotions
Read emotional books or stories, old letters, go to emotional movies, listen to emotional music. Be sure the event creates different emotions. Ideas: 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.

Pushing Away
Push the situation away by leaving it for a while. Leave the situation mentally. Build an imaginary wall between yourself and the situation.

Or push the situation away by blocking it in your mind. Censor ruminating. Refuse to think about painful aspects of the situation. Put the pain on a shelf. Box it up and put it away for a while.

Other Thoughts
Count to 10, count colors in a painting or tree, windows, anything, work puzzles, watch tv, read.

Intense other sensations
Hold ice in hand (not for too long or it could hurt you), 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.

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