DBT: Distress Tolerance

May 13th, 2024
When in the moment upsetting, uncomfortable, and distressing emotions can feel too much. There is proof that with time the emotions will lessen and fade away. Imagine these emotions like a wave in the ocean – it comes in, gets bigger, harder to stay standing in, then will recede back out into the ocean. Emotions have a similar quality. 
The rest of the distress tolerance skills are aimed to help us tolerate that distress and discomfort until we feel capable of managing the emotions directly. This one is called ACCEPTS and shares 7 skills to help tolerance: 
Activities – do an activity that requires thought and concentration: cleaning a room, going for a walk, listening to music, talking to a friend. 
Contributions – do something that allows you to focus on another person: volunteer, help someone, collect items to donate, make a gift for someone. 
Comparisons – put the situation in perspective by comparing it to a time when things were worse or you felt less able to cope. Recognize your growth and ability to manage emotions has increased. 
Emotions – do something that creates a new emotion: watch a funny video, watch a happy movie, practice some deep breathing. 
Pushing Away – avoiding a painful situation or block it from your mind using a technique: set a timer, put thoughts in a box and tape it shut until you’re ready to come back to it. 
Thoughts: use a mental strategy or an activity to shift your thoughts to something neutral. Ex: start with A and name something for each letter of the alphabet, counting, looking at an item and naming creative uses for it. 
Sensations – find safe, physical sensations to distract from the distress emotions. This can be to “wake up” or “soothe” the sensations. Using sour candy, hold ice in your hand, drinking some water. 
Our next skill is IMPROVE the moment which include many activities that can help you get through emotionally difficult times. 
Imagery – using imagination to create a two minute vacation mentally from what’s going on. 
Meaning – focusing on things that are personally important: consider values, purpose or reasons for what is going on. 
Prayer – connecting to something greater can help. Does not need a religious connotation; use a mantra, quote, or song lyric to ground you. 
Relaxation – take a warm bath or shower, practice yoga, breathing, go for a walk somewhere safe, pet an animal, curl up with a warm blanket. 
One thing in the moment – bring mindfulness to what you’re doing. Tune in to the present, take things one thing at a time. Possibly using it as a mantra – “all I have to do right now is…” and complete the one task without the concern and worry of everything else. 
Vacation – take a break. It’s as simple as putting down for a few minutes to hours; going for a drive or helping yourself be somewhere else. Does not have to be an actual trip. Cannot take more than one day. 
Encouragement – sometimes be your own cheerleader; tell yourself “I can do it”, “I’m doing my best”, and many other statements that are reality based with a more positive tone. 
Radical acceptance: this is one of the most difficult and helpful to adapt to personal life. This is accepting things as they are without resistance. Instead of the mental power of wanting things to be different or how they “should” be; radical acceptance means all the way, completely and totally. 
It “rests on letting go of the illusion of control and a willingness to notice and accept things as they are right now, without judging.” 
What needs to be accepted: 
the facts of the situation or reality as it is – past and present
everyone has issues, focus on what you can control
everything has a cause even things that cause pain
life can be worth living even with painful moments
Why accept reality:
to change it, we must accept it first
pain can’t be avoided but we can avoid suffering by accepting the pain. Pain + Non-acceptance = Suffering
refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, sadness, shame, or other painful emotions
acceptance may lead to sadness; usually peace and contentment follow
Remember radical acceptance is *not*: 
approval, compassion, love, passivity, or resistance to change. 
A lot of this can come down to looking at what you can and can’t control. You can control yourself (actions, reactions, words, most thoughts, behaviors, attitudes). You can’t control just about anything else (other people, situations, things)
acceptance mindset image