Beauty and the Borderline

A Journey towards Integration

Distress Tolerance: Introduction

Welcome to DBT Module 2:  Distress Tolerance Skills!

(Note:  I am not following the layout in the Skills Training Manual for Treating Borderline Personality Disorder.  I am following the lessons as they were taught to me: 2 weeks of Mindfulness –> 6 weeks Distress Tolerance –> 2 weeks Mindfulness –> 6 weeks Emotion Regulation –> 2 weeks Mindfulness –> 6 weeks Interpersonal Effectiveness, and repeat it all.  That totals about one year.)

Distress Tolerance is “the ability to perceive one’s environment without putting demands on it to be different, to experience your current emotional state without attempting to change it, and to observe your own thoughts and behaviours without attempting to stop or control them (or judge them).”

Angry, Frustrated Woman

What a mouthful!  Basically, it means experiencing your situation, feelings, thoughts, and actions — even though you’re in distress — and just letting it be what it is in that one moment. You’re in severe emotional pain, or enraged, or some trigger has just metaphorically punched you in the gut, leaving you breathless — and Distress Tolerance skills help you to cope with it until you can calm down and think (somewhat) rationally.

Distress Tolerance skills and attitudes WILL help you get through a crisis WITHOUT MAKING THINGS WORSE

and

These skills WILL NOT help you solve your problems or change things about yourself or your life

You need Distress Tolerance when: 1) you have a crisis, 2) it can’t be resolved right now, and 3) you can’t afford to make things worse.  A crisis is a stressful event or traumatic situation that is short-term, and you feel the urge to resolve it immediately.

There are two main rules to crisis survival:

  1. If you can solve the crisis immediately, DO IT!
  2. If you cannot solve the crisis immediately, then SURVIVE it until you can solve it.

MP900438968For fellow BPDers, please remember, do NOT invalidate yourself!!  Just because somebody else may think it’s not a crisis, or they might think you’re overreacting, does not mean it’s not a crisis for you.  YOU are the expert on your own feelings, and BPD feelings are often much more intense than a non-BPD person would have (which might possibly account for why we’re so often in crisis).  Do whatever you need to do to get through it, and don’t judge yourself!  If you could do better, you would.

Distress Tolerance skills fall into two categories, Crisis Survival skills and Reality Acceptance skills.

Crisis Survival skills

  • distraction (A.C.C.E.P.T.S.)
  • self-soothing (nurturing yourself)
  • alternate rebellion
  • I.M.P.R.O.V.E. the moment
  • pros & cons
  • using humour
  • urge surfing

Reality Acceptance skills (or, attitudes that help Crisis Survival skills)

  • radical (or reality) acceptance
  • half-smile
  • turning the mind
  • willingness vs. willfulness

The key to Distress Tolerance is this:  In order to change something, first you must accept it. 

??????????????????????????????????????For example, my Prince is an utter slob (sorry, honey!) and it drives me up the wall.  I hate picking up after him, but I like to live in a relatively tidy environment.  Before I started learning and using DBT Distress Tolerance skills, I would complain at him, get angry when he didn’t pick up after himself, and eventually blow up (and you all know that means a KABOOM not seen since Hiroshima).  I took his messiness personally — I felt he didn’t respect me, which meant that he didn’t love me, which meant he had been lying to me all this time!!!  (You can see the black-and-white thinking, the “splitting” happening in my thinking.  Leaving dirty socks lying around = pure badness.)

By using Distress Tolerance skills, I can handle this situation very differently.  My partner is messy.  (Yes, I know it’s a judgment, but that doesn’t make it any less true.)  Instead of judging him, making him “bad” in my mind, I practice Non-Judgmental Stance and look around at the mess.  I don’t like it, but ignoring it or getting upset about it won’t make it disappear.  Maybe I feel irritated or even angry about it, and that’s okay — it’s perfectly normal to feel irritated about having to clean up someone else’s mess (Validation and Acceptance).  Maybe I feel self-righteous — “I shouldn’t have to pick up after him!  He’s doing me wrong!”  Well, I  don’t want to pick up after him, but is he really doing me wrong?  He was a slob before I ever met him, so it probably has nothing to do with me (The Dialectic).

But I’m still irritated, so I distract myself by writing a blog post or reading (ACCEPTS), soothe my jangled nerves with a warm shower (Self-Soothe), and leave the mess as it is (Alternate Rebellion).  I can play with our son (ACCEPTS and IMPROVE) and incorporate a fun game and song about cleaning up (a more sly Alternate Rebellion).

After I’m calmer I can think, without judging, about how to get my Prince to behave like he’s working-class.  I’ve yelled at him so many times that he’s probably resistant to cleaning up anything, regardless of whether he made the mess or not.  I have to start showing him some respect (by asking for what I want and NOT yelling) if I want him to respect my wants and needs (Interpersonal Effectiveness).  After using DBT skills repeatedly, I can report that I am much more relaxed about mess, that he has apologized for his inattention to his own mess (and for his teenage-like rebellion), and that he cleans up after himself!  (Most of the time.)  Success!

The point is that in order to get what I wanted, I had to change my thinking and my approach.  I had to accept that my behaviour wasn’t effective, and change it.  And my whole family is happier for it!

Other resources:

Distress Tolerance: Overview@dbtselfhelp.com

Ways to Manage Distress RIGHT NOW by Seth Axelrod

Dialectical Behaviour Therapy and Distress Tolerance@GET.gg

Distress Tolerance Skills for BPD@About.com

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One comment on “Distress Tolerance: Introduction

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