Benefits of DBT Distress Tolerance Skills

There are many benefits to distress tolerance skills for people who suffer from anxiety problems, people who are dealing with other psychological or emotional difficulties, and people without any psychological disorders. Indeed, most everyone could stand to benefit from a little practice with distress tolerance skills. Here are some of the main benefits you might notice if you practice these skills. We hope that as you go through this book, you notice these and other benefits, particularly those that help you with anxiety problems.

· You accept pain in life and experience less suffering.

· You feel more at peace with your problems, even as you work to change them.

· You learn to tolerate previously intolerable emotions or thoughts.

· You become disentangled from distressful thinking patterns, such as worry and rumination.

· You avoid making things worse.

· You feel free of the need to always have to fix or change things right now.

Exercise 3.2 Get Started with Distress Tolerance Skills

This exercise uses the skill of accepting things as they are. Find a quiet place where you will not be bothered; get into a comfortable sitting position; and if your mind wanders during the exercise, just do your best to gently guide it back to what you’re focusing on. We suggest that you do this exercise with your eyes closed.

1. Start by thinking of something (whether it’s a thought, emotion, or current or past situation in your life) that you have a moderate amount of difficulty accepting. You can think of acceptance as being on a scale from 0 (I couldn’t stand or accept this for even a minute) to 100 (I could stand or accept this for a hundred years). Choose something that’s approximately in the middle, around 50 or so. Think of that thing. Write down the number that represents how much you accept this particular thing.

2. Next, tense up your muscles, and fold your arms over your chest. Really try to get some muscle tension going in your shoulders, arms, and neck. Scrunch up your face and furrow your brow, making an irritated or angry expression. Tense your facial muscles. Now, think of that thing you’re having a hard time accepting, really getting it into your mind. Keep it in your mind, noticing any thoughts or images about it that float through your mind. Stay that way for about one to two minutes, and then note your level of acceptance from 0 to 100.

3. Next, relax your body and facial muscles. Open your arms and rest your hands palms up on your knees or the armrests of your chair or sofa (the “willing hands” strategy from Linehan 1993b). Sit with your legs slightly apart in an open posture. Try to let go of any muscle tension in your shoulders, arms, or neck, or anywhere else in your body. Then, put a very slight smile on your face, just turning up the corners of your mouth very slightly (this is the “half-­smile technique” from Linehan 1993b), much like the type of smile seen on the Mona Lisa, the Buddha, or anyone else you’ve seen who looks serene and at peace. Then, bring that thing that is difficult to accept back into your mind again. Notice any thoughts or images that pop up, and just let them roll in and out of your mind. Stick with the thing you’re having difficulty accepting, and keep it in your mind while maintaining your posture and half smile. Note your level of acceptance on a scale from 0 to 100.

4. Notice any difference in your acceptance level, from when you began, to when you had an angry or tense posture, to when you had the more open, relaxed posture with the half smile. Many people notice that with the more open posture, they find themselves feeling considerably more accepting. Simply changing your bodily posture or muscle tension can change your neurochemistry and brain activity and modulate your emotional reactions, making you feel just a bit more serene and calm. Other people, however, find that this strategy does not change their level of acceptance. The trick with all of these skills is to try them and then use the ones that work best for you.

Moving Forward

So far in this workbook, you’ve hopefully gotten a clearer understanding of your problems with anxiety, a general idea of what is involved in DBT, and an introduction to two of the major DBT skills (mindfulness and distress tolerance). We put mindfulness and distress tolerance skills together in this chapter, because both of these skills involve your learning to focus on the present moment and accept things the way they are, at least for now. These are fundamental skills, whether you’re dealing with anxiety or other problems. Here are some recommendations for you as you move forward with these skills:

· Spend a week or so practicing mindfulness and distress tolerance regularly.

· Look at your calendar, and set a schedule for practicing the skills.

· Try to spend at least five to ten minutes a day practicing mindfulness, acceptance, or another distress tolerance skill (such as self-­soothing or distraction). The more you regularly practice these skills, the more they will become habit and easier to put into action when you are experiencing anxiety and stress.

· When you begin, practice these skills to deal with problems that are mild to moderate. Don’t try them for the first time with an extremely distressing problem that you’ve been struggling with for ages. You will get there, but just give yourself a break the first few times you try new skills.

· Note which skills seem to work best for you.

Now that you have a little practice in mindfulness and distress tolerance, in chapter 4 we will go on to discuss two other important sets of DBT skills that we believe you will find extremely helpful: emotion regulation and interpersonal effectiveness.

Chapter 4

DBT Emotion Regulation and Interpersonal Effectiveness Skills

Remember in chapter 2, when we talked about how it can be helpful to strike a balance between trying to change yourself and your situation and accepting yourself and your situation as is? Well, in chapter 3, we went through DBT skills that can help you accept things as they are in the moment and combat avoidance. In this chapter, we balance things out a bit by guiding you through some skills to help you change things, specifically strategies to help you change and manage your emotions (emotion regulation skills), as well as your relationships and interactions (interpersonal effectiveness skills).

DBT Emotion Regulation Skills and Emotions

One important set of skills taught in DBT is emotion regulation skills. These skills can help you improve the way you manage or regulate your emotions. Researchers have defined emotion regulation as the ways in which people influence their emotional states, and how they experience and express their emotions (Gross 1998). Many professionals perceive that problems with emotion regulation are a common thread across many emotional problems and disorders. People with depression, anxiety disorders, substance-­use problems, personality disorders, and “psychotic disorders” (schizophrenia, for example) all have at least some difficulties with the management of their emotions. Emotion regulation skills also can be tremendously useful even if you don’t have any specific emotional disorder. Who among us couldn’t use some helpful hints on how to deal with our emotions more effectively?

To effectively manage your emotions, you need to know exactly what you’re dealing with in the first place: what are emotions anyway? Well, scientists who study emotions believe that they are a set of reactions in the body and brain to events, memories, and thoughts (ibid.). Emotional reactions have many different parts, so to speak, much as the mythical beast the hydra has many heads. In DBT, we emphasize the fact that emotions do have many parts to them and that they all work together as one big system, involving your brain, your body, your thoughts, and your actions (Linehan 1993b).