DBT Skills: This Feels Awful

Holy moly guys, we have finished emotion regulation made it to the last DBT module, distress tolerance! Props for keeping up. Distress tolerance is a wonderful set of skills to have when your brainparts are still forming and your hormones are a little wonky, because it’s what keeps you from doing unintelligent things when you’re feeling too much. There are times when it’s really important to just be able to ride out your feelings. Many times actually. More often than not, acting immediately when you’re feeling something strong doesn’t lead to great choices. When you wait a little bit, you can incorporate both the rational part of your mind and those emotional elements to reach a better decision.

Unfortunately sometimes it’s really, really hard to just ride out the feelings. Especially if you have any sort of mental illness, feelings aren’t just pesky things that can inconvenience you. They can be entirely crippling. It can be incredibly helpful to have some things in your back pocket to get through rough situations. So today we will start our distress tolerance skills with ACCEPTS (yet another acronym. Sorry guys. If I was naming this they would have way more badass names). This skill focuses on distracting from negative feelings. Later in this module we’ll look at some other types of skills that are helpful for other parts of distress tolerance, but sometimes distraction is important.

So here’s the breakdown:

(opposite) Emotions
Pushing Away

Aw yeah, you’re totally set to deal with any hard feelings now right? So some of these things aren’t the most obvious phrases. Activities is fairly straightforward. Do things that engage your mind and body, focus on hobbies or things you enjoy, or just get yourself involved in something. Sometimes it can help to have a list handy of activities that you enjoy or that are easy to access so that if you’re having a rough day you don’t have to brainstorm it all by yourself. Contributing essentially means doing an activity that focuses outside of yourself, like volunteering, doing a nice thing for a friend, or offering to help someone out with a project or task. It takes activities to the next level by getting you outside of your own head and thinking about someone else.

The next piece is comparisons, and this skill is hit or miss. Some people find it very helpful while others find it frustrating and invalidating, so proceed with caution here. The basic idea is to think about people who have it worse than you do, or who aren’t coping as well as you are. This could be your past self, or imagining problems that haven’t been an issue for you and feeling some gratitude for what you have. One technique that can be helpful to pair with this if you find it invalidating is to focus on what you’re doing well in comparison to others or your past self rather than simply circumstances. Overall I haven’t gotten much mileage out of this skill, so don’t get too frustrated if it doesn’t work for you.

Opposite emotions is another one that can be a little more difficult. It doesn’t simply mean making yourself feel a different way, but rather to do something or focus on something that elicits emotions opposite from the ones you’re having. If you’re feeling incredibly sad, listen to upbeat music or watch a funny movie. If you’re angry, try lighting candles, taking a soothing bath, or even a scary movie.

Pushing away can sound a little woo woo to some people, so if imagery isn’t your jam then maybe skip this one, but if you find it helpful to imagine your emotions as objects then try to put them in a box, closet, or drawer that you seal away for a while. You might imagine a wall holding them back for a little bit. This isn’t meant to be a long term strategy, just a way to give yourself some breathing room.

Thoughts is usually something you’ll want to use in unexpected circumstances or places where you don’t have the time or availability to do a lot of the other skills. Of course we are always thinking, but in this case the point is to focus on something other than the emotion that’s causing you distress. That might mean doing a puzzle or riddle, counting something very carefully, or even learning something new. These all sound like they could be trite, but if you’re in a really distressing situation in public it’s much better to count ceiling tiles than have a meltdown right then and there.

Last but not least, sensations! This skill is one of my favorites for distraction. There are lots of ways to use sensations to distract yourself, but anything that gives you a strong, physical sensation should do: extremely hot or cold showers, holding ice, snapping a rubber band against your wrist. Even an extremely soothing sensation can help, like putting on lotion. The key is to focus on how something actually feels: don’t just take a shower. Mindfully take a shower so that you notice what the water feels like, the temperature, whether your body is relaxed or tense. One of the biggest benefits of this is that emotions often come with physical side effects. Adding new sensations that will elicit new reactions to the mix can change whether you’re tense or how you’re holding your body, which can help alleviate some of the emotion associated with that physical sign.

So go forth friends and distract yourselves from nasty feelings! Next week we’ll continue on in the land of distress tolerance so that during the wonderfully stressful holiday season you don’t utterly lose it.


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Olivia is a giant pile of nerd who tends to freak out about linguistic prescriptivism, gender roles, and discrimination against the mentally ill. By day she writes things for the Autism Society of Minnesota, and by night she writes things everywhere else. Check out her ongoing screeds against jerkbrains at www.taikonenfea.wordpress.com

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