March 29, 2012
DBT Skills Series: Coping with Intense Emotions, Suicidal Feelings, or Destructive Impulses (Distress Tolerance)

(by Devyn)

“DBT” (which stands for “Dialectical Behavior Therapy”) is a type of therapy commonly used by people with borderline personality. The purpose of the DBT Skills Series is to share information, techniques, and strategies among borderline people.

"Distress tolerance" is a subset of DBT that specifically talks about how to handle intense emotions, including extreme emotional turmoil, suicidality, urges to do self-destructive things, and impulsiveness. Not all of these strategies will be accessible, affordable, or useful for everyone, of course. If you reblog, feel free to add on to what I have listed here.

Distraction

Step away from your current emotions

-Go for a walk, bike ride or drive, especially if you’ll see some calming scenery on the way

-Watch a TV show or a movie

-Read something light and/or funny.

-Go to the gym. Make sure that your workout isn’t boring, though, because monotonous workouts can be a breeding ground for escalating ideation. Try a class or else pump upbeat music and tire yourself out.

-Listen to music. I have a playlist specifically for laying listlessly on my bed and one for favorite songs that perk me up.

-Intellectual pursuits: Immerse yourself in a favorite project. Read about something that you find fascinating. Jump from wikipedia entry to wikipedia entry (or trope to trope). Make “logophilia lists” of cool words that you want to commit to memory. Learn some fucking German!

-Organize or decorate your room. Throw out old papers. Go through your clothes to see what fits and what you want to get rid of.

-Play an instrument, discover new music online, or sing along to a power ballad. Soundcloud has a bunch of tracks by independent artists for you to listen to (and in some cases, download for free). And tumtaster is great for saving mp3s found on tumblr. I often go hunting through the tags for new musicians that I’m starting to get into.

-Plan for (or fantasize about) the future. Think about goals, visions, anything you want to incorporate into your life at some point in the future. Research dream colleges, jobs or grad schools.

Self-Soothing

Introduce new, pleasant emotions to replace the bad ones

-Take deep, intentional breaths

-Self-groom: shower, shave, floss, style your hair, etc. Doing kind things to your body sends yourself the message that you are lovable and worthy.

-Take a bath. Incorporate as many senses as possible: warm water, nice-smelling oils, music (or just the quiet whooosh of the bath itself), even some strawberries

-Cry. Fucking sob. It’s awesome and endorphins-releasing (probably). People generally feel much better after a totally self-indulgent cry.

-Write in a journal. It can be on paper, on a word document, or even on a website like tumblr or dreamwidth. You can publish it or make sure it never sees the light of day. “Free write” about anything that comes to mind. Pay as little attention to the mechanisms of style or coherence as possible.

-Practice self-care by the senses (written by Tuesday, one of the mods here)

-Do something that will make your life easier these next few days or weeks. Reply to emails that have been pilling up in your inbox or do your laundry.

-Try these excellent grounding exercises from Pandora’s Project, if applicable.

-Find poetry that speaks to you. Repeat it in your head again and again. I particularly recommend “We are Hard on Each Other" and "You Fit into Me" by Margaret Atwood. Gwendolyn Brooks has some amazing stuff too, as do Richard Siken and Lucille Clifton.

-Do kind things for others. Send nice notes/texts/messages, run an errand for a friend, volunteer to help out in your community.

-Think about what you would say to a friend who was in your position. Would you call them worthless or broken? Would you tell them that they should go ahead with destructive behavior or that things will never get better for them? Probably not. It can be easier to show kindness and love to a hypothetical person than to yourself. Think about what you would want for someone else in your situation. Then do that.

Buy Yourself More Time:

While major problems rarely work themselves out on their own, acute feelings of crisis often do. Taking “time off” from dealing with a stressful situation or making a potentially self-destructive decision will often help you calm down.

-Give yourself a time-frame. For example, if you’re too angry/paranoid to think clearly you can say “I won’t make any decisions about this relationship today.” This also works well with suicidal ideation: “all I’m going to ask of myself right now is that I make it through tonight.”

-Go to sleep (really!). It’s very, very common for a borderline person to go to sleep angry, despondent, or even suicidal and wake up feeling fine.

-If a situation is really triggering some bad things for you, step away from it if at all possible. Ask for an extension on the paper, step out of the room, turn off the computer, etc. At one point in a really [really] bad relationship, I actually wound up asking someone if we could postpone a fight for a few days so that I could finish my college applications. Some situations require immediate action, but whenever it’s possible, taking a few days to get some perspective and regain stability can be great.

Interpersonal “Grounding:”

For many people, dysphoric episodes are triggered or made worse by being alone. Making contact with other people can be a huge help.

-Reach out to a friend, partner or family member

-Post to your tumblr asking people to send you messages. You can specify if you don’t have the energy to respond or if you don’t want people to ask what’s wrong/offer advice.

-If you want to vent or get validation about something specific, you can post a request on your tumblr saying “can someone who has experienced [thing] email me?” It can be good to talk to one or two people who know what you’re going through.

-Call a suicide hotline (1-800-273-8255 in the US) or use crisischat online.

-Participate in some kind of forum or IRC chat that’s relevant to one of your interests (FYBP has a channel of our own, just saying).

-Simulate interpersonal interactions. Write letters, re-read old IM conversations—even watching a TV show with characters you’re familiar with or reading an advice column can make you feel better.

Long-Term Strategies:

-Do away with sources of significant stress or upsetment. Be they a toxic relationship, an overly-demanding job, a triggering volunteer project, something you haven’t come to accept about yourself, or even your location, external factors can often make your experiences of “intense, episodic dysphoria” much worse and much more frequent. If you’re finding that some things about your life now are triggering these feelings often, it can be very helpful for you to cut back on them or get rid of them entirely, if you’re able.

-Take care of your health as best you can. Physical discomfort often magnifies mental distress, so the more you can do to feel good in your body, the better. Some things to try include exercising regularly, keeping a steady sleep schedule, and finding/taking the right medication(/s).

-Set realistic, flexible, and constructive goals. Before you do this, take an inventory of the goals and self-promises you’ve made before. What worked? What was terrible? What do you want to accomplish, and how can you lovingly hold yourself accountable for accomplishing it? For example, I have a lot of lofty academic ambitions and a lot of equally lofty health-related ambitions (like “brush your fucking teeth today,” which I just did(!!!)). I find that my most motivating goals are process-focused and not results-focused. I would do better to say “my goal is to work on this paper for at least twenty minutes a day” instead of “my goal is to get an A.” Working on your goals can be a source of self-esteem and consistency. It’s a way of being your own ally and feeling the control you have over your own actions and life. These goals should make you feel better, not worse. Avoid the temptation to “punish” yourself for falling short at all costs. AT ALL COSTS.

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    Distress Tolerance - DBT skill explained
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