Transcription

Distress Tolerance Handouts

DISTRESS TOLERANCE HANDOUT 1Goals of Distress ToleranceSURVIVE CRISIS SITUATIONSWithout Making Them WorseACCEPT REALITYReplace Suffering and Being “Stuck”with Ordinary Pain and the Possibility of Moving ForwardBECOME FREEOf Having to Satisfythe Demands of Your OwnDesires, Urges, and Intense EmotionsOTHER:From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 3When to Use Crisis Survival SkillsYOU ARE IN A CRISIS when the situation is: Highly stressful. Short-term (that is, it won’t last a long time). Creates intense pressure to resolve the crisis now.USE CRISIS SURVIVAL SKILLS when:1.2.3.4.5.You have intense pain that cannot be helped quickly.You want to act on your emotions, but it will only make things worse.Emotion mind threatens to overwhelm you, and you need to stay skillful.You are overwhelmed, yet demands must be met.Arousal is extreme, but problems can’t be solved immediately.DON’T USE CRISIS SURVIVAL SKILLS for: Everyday problems. Solving all your life problems. Making your life worth living.From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 4(Distress Tolerance Worksheets 2, 2a)373–273. pp;STOP SkillSTOPtopDo not just react. Stop! Freeze! Do not move amuscle! Your emotions may try to make you actwithout thinking. Stay in control!ake a step backTake a step back from the situation. Take a break. Letgo. Take a deep breath. Do not let your feelings makeyou act impulsively.bserveNotice what is going on inside and outside you. Whatis the situation? What are your thoughts and feelings?What are others saying or doing?roceed mindfullyAct with awareness. In deciding what to do, consideryour thoughts and feelings, the situation, and otherpeople’s thoughts and feelings. Think about yourgoals. Ask Wise Mind: Which actions will make itbetter or worse?Note. Adapted from an unpublished worksheet by Francheska Perepletchikova and Seth Axelrod, with their permission.From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 5(Distress Tolerance Worksheets 3, 3a )573–473. pp;Pros and ConsUse pros and cons any time you have to decide between two courses of action.An urge is a crisis when it is very strong and when acting on the urge will make things worse inthe long term.Make a list of the pros and cons of acting on your crisis urges. These might be to engage indangerous, addictive, or harmful behaviors, or they might be to give in, give up, or avoid doingwhat is necessary to build a life you want to live.Make another list of the pros and cons of resisting crisis urges—that is, tolerating the distressand not giving in to the urges.Use the grid below to evaluate both sets of pros and cons (this type of grid is also used inDistress Tolerance Worksheet 3). Or you can use the type of grid seen in Distress ToleranceWorksheet 3a and in the pros-and-cons worksheets for other modules.PROSActingon crisisurgesResistingcrisisurgesCONSPros of acting on impulsive urges,giving in, giving up, or avoiding whatneeds to be done.Cons of acting on impulsive urges,giving in, giving up, or avoiding whatneeds to be done.Pros of resisting impulsive urges,doing what needs to be done, andnot giving up.Cons of resisting impulsive urges,doing what needs to be done, andnot giving up.Before an overwhelming crisis urge hits:Write out your pros and cons; carry them with you.Rehearse your pros and cons over and over.When an overwhelming crisis urge hits:Review your pros and cons. Get out your list and read it over again. Imagine the positive consequences of resisting the urge. Think of the negative consequences of giving in to crisis behaviors. Remember past consequences when you have acted on crisis urges.From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 6(Distress Tolerance Worksheet 4)673.p;TIP Skills: Changing Your Body ChemistryTo reduce extreme emotion mind fast.Remember these as TIP skills:TITIP THE TEMPERATURE of your face with COLD WATER*(to calm down fast) Holding your breath, put your face in a bowl of cold water,or hold a cold pack (or zip-lock bag of cold water) on your eyes and cheeks. Hold for 30 seconds. Keep water above 50 F.INTENSE EXERCISE*(to calm down your body when it is revved up by emotion) Engage in intense exercise, if only for a short while. Expend your body’s stored up physical energy by running, walking fast, jumping,playing basketball, lifting weights, etc.PACED BREATHING(pace your breathing by slowing it down)P Breathe deeply into your belly. Slow your pace of inhaling and exhaling way down (on average, five to six breathsper minute). Breathe out more slowly than you breathe in (for example, 5 seconds in and 7seconds out).PAIRED MUSCLE RELAXATION(to calm down by pairing muscle relaxation with breathing out) While breathing into your belly deeply tense your body muscles (not so much asto cause a cramp). Notice the tension in your body. While breathing out, say the word “Relax” in your mind. Let go of the tension. Notice the difference in your body.*Caution: Very cold water decreases your heart rate rapidly. Intense exercise will increase heart rate. Consult your health care provider beforeusing these skills if you have a heart or medical condition, a lowered base heart rate due to medications, take a beta-blocker, are allergic tocold, or have an eating disorder.From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 6A(Distress Tolerance Worksheet 4 )673.p;Using Cold Water, Step by StepCOLD WATER CAN WORK WONDERS*When you put your full face into cold water . . . or you put a zip-lock bagwith cold water on your eyes and upper cheeks, and hold your breath, ittells your brain you are diving underwater.This causes the “dive response” to occur. (It may take 15–30 seconds tostart.)Your heart slows down, blood flow to nonessential organs is reduced, andblood flow is redirected to the brain and heart.This response can actually help regulate your emotions.This will be useful as a distress tolerance strategy when you are havinga very strong, distressing emotion, or when you are having very strongurges to engage in dangerous behaviors.(This strategy works best when you are sitting quietly—activity anddistraction may make it less effective.)TRY IT OUT!*Caution: Very cold water decreases your heart rate. If you have any heart or medical condition, have a lowered base heart rate due to medications, or are on a beta-blocker, consult your health care provider before using these skills. Avoid ice water if you are allergic to the cold.From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 7(Distress Tolerance Worksheets 5–5b )183–973. pp;DistractingA way to remember these skills is the phrase “Wise Mind ACCEPTS.”With Activities:Focus attention on a task you need to getGo out for a meal or eat a favorite food.done.Call or go out with a friend.Rent movies; watch TV.Listen to your iPod; download music.Clean a room in your house.Build something.Find an event to go to.Spend time with your children.Play computer games.Play cards.Go walking. Exercise.Read magazines, books, comics.Surf the Internet. Write e-mails.Do crossword puzzles or Sudoku.Play sports.Other:With Contributing:Find volunteer work to do.Call or send an instant message encouragingHelp a friend or family member.someone or just saying hi.Surprise someone with something nice (aMake something nice for someone else.card, a favor, a hug).Do something thoughtful.Give away things you don’t need.Other:With Comparisons:Compare how you are feeling now to a timeCompare yourself to those less fortunate.when you felt different.Watch reality shows about others’ troubles;Think about people coping the same as you orread about disasters, others’ suffering.less well than you.Other:With different Emotions:Read emotional books or stories, old letters.Ideas: Scary movies, joke books, comedies,Watch emotional TV shows; go to emotionalfunny records, religious music, soothing musicmovies.or music that fires you up, going to a store andListen to emotional music.reading funny greeting cards.(Be sure the event creates different emotions.)Other:With Pushing away:Push the situation away by leaving it for aNotice ruminating: Yell “No!”while.Refuse to think about the painful situations.Leave the situation mentally.Put the pain on a shelf. Box it up and put itBuild an imaginary wall between yourself andaway for a while.the situation.Deny the problem for the moment.Block thoughts and images from your mind.Other:With other Thoughts:Count to 10; count colors in a painting orWork puzzles.poster or out the window; count anything.Watch TV or read.Repeat words to a song in your mind.Other:Squeeze a rubber ball very hard.Listen to very loud music.Hold ice in your hand or mouth.With other Sensations:Go out in the rain or snow.Take a hot or cold shower.Other:From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT SkillsTraining Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

DISTRESS TOLERANCE HANDOUT 8(Distress Tolerance Worksheet 6–6b )483–283. pp;Self-SoothingA way to remember these skills is to think of soothing each of your FIVE SENSES.With Vision:Look at the stars at night.Sit in the lobby of a beautiful old hotel.Look at pictures you like in a book.Look at nature around you.Buy one beautiful flower.Walk in a pretty part of town.Make one space in a room pleasing to look at.Watch a sunrise or a sunset.Light a candle and watch the flame.Go to a dance performance, or watch it on TV.Set a pretty place at the table using your bestBe mindful of each sight that passes in front ofthings.you.Go people-watching or window-shopping.Take a walk in a park or a scenic hike.Go to a museum or poster shop with beautifulBrowse through stores looking at things.art.Other:With Hearing:Listen to soothing or invigorating music.Burn a CD or make an iPod mix with musicPay attention to sounds of nature (waves,that will get you through tough times. Turn itbirds, rainfall, leaves rustling).on.Pay attention to the sounds of the city (traffic,Be mindful of any sounds that come your way,horns, city music).letting them go in one ear and out the other.Sing to your favorite songs.Turn on the radio.Hum a soothing tune.Other:Learn to play an instrument.With Smell:Use your favorite soap, shampoo, aftershave,Sit in a new car and breathe the aroma.cologne, or lotions, or try them on in the store.Boil cinnamon. Make cookies, bread, orBurn incense or light a scented candle.popcorn.Open a package of coffee and inhale theSmell the roses.aroma.Walk in a wooded area and mindfully breathePut lemon oil on your furniture.in the fresh smells of nature.Put potpourri or eucalyptus oil in a bowl in yourOpen the window and smell the air.room.Other:With Taste:Eat some of your favorite foods.Suck on a piece of peppermint candy.Drink your favorite soothing drink, suchChew your favorite gum.as herbal tea, hot chocolate, a latté, or aGet a little bit of a special food you don’tsmoothie.usually spend the money on, such as freshTreat yourself to a dessert.squeezed orange juice or your favorite candy.Eat macaroni and cheese or another favoriteReally taste the food you eat. Eat one thingchildhood food.mindfully.Sample flavors in an ice cream store.Other:With Touch:Take a long hot bath or shower.Take a drive with the car windows rolled down.Pet your dog or cat.Run your hand along smooth wood or leather.Have a massage. Soak your feet.Hug someone.Put creamy lotion on your whole body.Put clean sheets on the bed.Put a cold compress on your forehead.Wrap up in a blanket.Sink into a comfortable