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Distress Tolerance Skill- ACCEPTS

The Distress Tolerance Skill ACCEPTS is typically the FIRST intervention that I teach to my clients who just can not bounce back from high/extreme/big emotions.

We start with Activities and the trick is to FULLY throw yourself into the activity for a set amount of time. Set a timer for 15/30/45 minutes. Check in with yourself at each timer and see how you are feeling. Remember this will NOT SOLVE THE PROBLEM, but it will hopefully being to bring you down from the intense emotion and possibly move you into Problem Solving.

Contributing is one that is harder to do and takes a good “shift” in your mind. This is exactly what we want. We want you to think of others at this time. Remember to use the timer with this to so you can check in and make sure you are not making “irrational” decisions. This is a good time to go through your closet and make a pile of things you can donate. The same for you pantry and any excess you might have.

Comparisons is not what you might be thinking of. In fact, comparisons of what people are doing and you are not is NOT what we are asking from you. We are asking that you find a moment from your past you had something really tough to get through, and how did you get through that. How long did it take for the intensity of the movement to pass? What is something from that past experience you can pull from and help you during this tough situation?

Moving on to Emotions, this is where we want to figure a way to validate our emotions and change them if needed. For instance, if I am feeling sad, then maybe I have a playlist of sad music that matches my mood and doesn’t make me feel alone. I can also do something to make me feel opposite of my emotion. Again, if I am sad, then maybe I want to watch some funny videos on You Tube or something silly on Netflix.

The Push Away skill is an abstract concept that involves you visualizing yourself putting the distressing event, thought or problem in a box and then putting that box on a shelf and walking way. You can also physically do this skill. The caveat is that YOU HAVE TO COME BACK TO THE PROBLEM! Remember to use the timer for this, we do not want to run from our problems or avoid them forever. In fact, when we come back and problem solve them we tend to grow in independence, self assuraduness and self esteem.

With the Thoughts skill we are trying to re-balance to middle path by trying to do actives that do not involve emotions. Such as naming fruits and vegetables in alphabetic order. You can even find some easy math worksheet or word puzzles. It is really important that if you find yourself feeling overwhelmed to try hard to come back to the task at hand and block out the intense emotions ( temporarily ).

The last is a great go to with anyone who’s intense emotions cause a physical reaction or cause a numbness. Sensations is about regaining the attention to your body and learning what you have control over. These ideas are NOT suppose to cause additional destress or pain. This is really about using your senses to “snap” you out of the intense emotion. Like eating sour or spicy foods/candy. Drinking extremely cold water or holding ice.

Remember these are QUICK interventions and not ment to solve the problem.

We can not live our life in distraction Mood

Rachael Julstrom

Grief around the Holidays

Dealing with grief this year is going to be tough for many families. I want to make sure you have the skills you need to stay on the path and keep using your DBT skills to help you though this time.

How do you deal with grief? How have you been taught to deal with it? Is it just to avoid or to drink or spend money? Or have you been taught to honor the memory of those who are not with us any more and to lean into your uncomfortable emotions?

  1. Know your grieving process. Yes, there is a grieving process for everyone. What is yours?
  2. Start a new tradition this year. What can you do that you have wanted to do, that you saw on pintreset or that you think might be a unique.
  3. Continue an old tradition. How can you weave in a past dish, decoration or activity that would help to keep a “living legacy” of those who are not with us.
  4. Be skillful. When the Big Emotions come ( and they will ) what are you going to do? Did you create a plan? What are your distress tolerance skills you can use to help?
  5. Don’t make it worse. Remember, when you want to engage in old behaviors and do something “chaotic” I want you to stop and ask yourself “what is it that you are trying to avoid?” Can you do some alternate rebellion instead?

You will get through this, you have in the past and while this year is much harder, I want you to STOP right now and think of the hardest thing you have had to do in the past. What was it? How did you get through it? How can you use 1 or more of those skills to cope now.

If you need some ideas on how to get through the holidays check out this list of 64 ideas.

Values Assessment

Have you ever filled out a values assessment or taken the time to put words on what your values are? This is a quick exercise that will help you to narrow down the language to help you understand the things that are most important to you and check in with yourself that you are respecting and honoring those values.

When values are violated thats when we have added stress, anxiety and depression.

Remember to do this from a JUDGEMENT FREE place.

Click here for Google Doc Values Assessment

DBT Resources – DBT Workbook for Kids and Caregivers by Carol Lozier, MSW LCSW

As a therapist I have used a few of the mainstream DBT books that help clients individually and in a group setting and while they are good, I would like for you consider the following workbook as a great addition for your DBT toolbox.

Carol Lozier is a wonderful DBT writer and social worker who has been doing this for 30+ years and has written other books on DBT and helping those to understand the skills.

I was gifted this book during the COVID-19 Pandemic and while writing my own workbook. This workbook is so wonderful for children who are in an age group that I am not trained in ( under 14 ) and she does such a great job with her examples on mindfulness and how she describes these abstract ideas/concepts to a younger population. She has some wonderful activities for the parent/caregiver or therapist to use with the client. I have not seen a workbook for this age range that truly tackles all of the DBT skills.

If you would like to know more about Carol Lozier and her other books you can find her at www.carollozierlcsw.com. You can also purchase her book on her website or from amazon.

Distress Tolerance Review and the Beginning of Emotion Regulation – Finding Middle Path Podcast

  1. Distress Tolerance Review and the Beginning of Emotion Regulation
  2. The STOP skill and DBT Pros and Cons
  3. Are you being Willing or Willful?
  4. The DBT Improve Skill“
  5. Self Soothe through the 5 Senses

Distress Tolerance Skill – TIPP Skill

The TIPP Skill is a quick intervention that is used to change your body chemistry, so that you can begin to regain some control and then look for validation or problem solving. This is especially helpful in a panic attack situation or where you have just been triggered and feel numb. 

Distress Tolerance Review and the Beginning of Emotion Regulation – Finding Middle Path Podcast

  1. Distress Tolerance Review and the Beginning of Emotion Regulation
  2. The STOP skill and DBT Pros and Cons
  3. Are you being Willing or Willful?
  4. The DBT Improve Skill“
  5. Self Soothe through the 5 Senses

Practicing Mindfulness with Mindful Eating ( Hersey Kisses )

This is a BONUS episode to help practice mindfulness. You will need a Piece of Chocolate or Candy to do this activity. I used Hershey Chocolate Kisses. 

Take about 5 minutes to practice practice mindfulness.

Distress Tolerance Review and the Beginning of Emotion Regulation – Finding Middle Path Podcast

  1. Distress Tolerance Review and the Beginning of Emotion Regulation
  2. The STOP skill and DBT Pros and Cons
  3. Are you being Willing or Willful?
  4. The DBT Improve Skill“
  5. Self Soothe through the 5 Senses

Starting Mindfulness – What & How Skills

MINDFULNESS: EXERCISE

What do you think of when you hear the word Mindfulness?

____________________________________________________________________________________________________________________________________________________________

“Mindfulness means paying attention in a particular way; On purpose, in the present moment, and non-judgmentally.” Jon Kabat-Zinn    

Benefits of Mindfulness:

1. It helps you to slow down.

2. Helps you to know yourself better.

3. It helps to strengthen your concentration.

4. Learn to control ruminating thoughts.

5. Builds resiliently.

6. Helps restore from traumatic experiences.

7. Repairs the prefrontal cortex and increases impulse control.

WHAT SKILLS

OBSERVE

  • Just Notice the experience.
  • Watch your thoughts and feelings come and go like clouds in the sky.
  • Do not push away your thoughts and feelings, just let them happen.
  • Notice your body sessions – with all Senses (Seeing, smells, touch, taste, hearing) 
  • Practice wordless watching

Exercise: Take a quick 5-10 second glance at your surroundings, what did you notice that you didn’t before?

DESCRIBE

  • Put words on the experience
  • Label what you observe. Put a name on your feelings. Label a thought as a thought, a feeling as a feeling, and an action as an action.
  • For example: “I feel sad right now,” or “My stomach muscles are tightening.”
  • Remember: “If you can’t observe it from your senses, you can’t describe it.”
  • Practice the “Who”, “What”, “Where”, “When” and “Why”
  • Lean on “Just the Facts”

Exercise: Name 5-10 objects around you.

PARTICIPATE

  • Throw yourself completely into what you are doing in the moment (talking, sitting, cleaning, dancing, driving, feeling emotions)
  • Become one with your experience, throw your attention to the moment.

Exercise: What are you doing? – Just the Facts (i.e. – talking, breathing, eating)

HOW SKILLS

NON-JUDGMENTALLY

  • Don’t evaluate. Just the Facts
  • Accept the moment
  • Let go of your opinions
  • Acknowledge the helpful – let go of the Could, Should and Would thoughts
  • Don’t judge your judging.

Exercise: Give descriptors to 5 objects around you without adding judgment (i.e. ugly, small, big, awful)

ONE-MINDFULLY

  • Do one thing at a time.
  • Let go of distractions.
  • Think of one thing at a time.

Exercise:  Pick a simple activity and spend the next 15-30 seconds just focusing on that activity.  

EFFECTIVELY

  • Focus on what works.
  • Play by the rules. Act as skillfully as you can, meeting the needs of the moment you are in, not the one you WISH you were in.
  • Let go of vengeance, useless anger, and righteousness that hurts you and doesn’t work.
  • Keep your eye on what you want in the long run.
  • Let go of perfectionism and leaning into imperfections,
    remember being effective doesn’t mean being perfect.

Exercise: Evaluate what you are not doing right now due to “extremes.” What can motivate you to focus on moving forward? (If you need help try starting with Observe, Describe and Participate.)

Distress Tolerance Review and the Beginning of Emotion Regulation – Finding Middle Path Podcast

  1. Distress Tolerance Review and the Beginning of Emotion Regulation
  2. The STOP skill and DBT Pros and Cons
  3. Are you being Willing or Willful?
  4. The DBT Improve Skill“
  5. Self Soothe through the 5 Senses

How to use DBT to set goals in Therapy and in Life.

The main goal in DBT is to decrease any-type of problem behavior.

Behaviors to Decrease:

  • Interpersonal Chaos, loneliness, being in unhealthy relationships 
  • Unstable moods and emotions, and willfulness
  • Impulsive behavior, difficulty accepting reality 
  • Mindlessness, emptiness, judgmental attitude

Behaviors to Increase:

  • Interpersonal effectiveness
  • Emotional Regulation
  • Distress Tolerance
  • Mindfulness

Before setting a goal with a client we do a quick Values Assessment:

The next step is the fun DBT activity of the DBT House:

As stated in the Podcast other people have used the SMART goals Model :

Please reference here for more info on SMART Goals.

Distress Tolerance Review and the Beginning of Emotion Regulation – Finding Middle Path Podcast

  1. Distress Tolerance Review and the Beginning of Emotion Regulation
  2. The STOP skill and DBT Pros and Cons
  3. Are you being Willing or Willful?
  4. The DBT Improve Skill“
  5. Self Soothe through the 5 Senses

Top 3 Therapy Books ( Non-DBT )

Boundaries – Dr Henry Cloud and John Townsend

Co-Dependent No More – Melody Beattie 

Trauma Stewardship -Laura van Dernoot Lipsky

As stated in my recent podcast I highlight reasons why these are my GO TO books that are non-DBT.

What you need to know when starting DBT.

What to know at the beginning of starting DBT ( Dialectical Behavioral Therapy). Some key elements all clients should be aware of are: 

  • Individual Therapy Sessions
  • Coaching Calls
  • Diary Cards
  • Group Therapy

Each is a vital part of DBT and add an extra element that some other therapies do not offer. 

What questions do you have about DBT? You can email me at middlepathmo@gmail.com or Find on IG @FindingMiddlePath. http://www.findingmiddlepath.com 

Distress Tolerance Review and the Beginning of Emotion Regulation – Finding Middle Path Podcast

  1. Distress Tolerance Review and the Beginning of Emotion Regulation
  2. The STOP skill and DBT Pros and Cons
  3. Are you being Willing or Willful?
  4. The DBT Improve Skill“
  5. Self Soothe through the 5 Senses