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Distress Tolerance Part 1-Crisis Survival It is how people respond to stress that determines whether they will profit

from misfortune or be miserable. Mihaly Csikszentmihalyi -Eustress vs Distress "...the capacity to experience and withstand negative psychological states...[which] ...consists of one's evaluations and expectations of experiencing negative emotional states in respect to (1) tolerability and aversiveness, (2) appraisal and acceptability, (3) tendency to absorb attention and disrupt functioning, and (4) regulation of emotions, specifically, the consequent strength of action tendencies to either avoid or immediately attenuate the experience." -Simons and Gaher, 2005 "...an individual's behavioral persistence in the face of emotional distress". -Daughters et al., 2008 In DBT, distress tolerance skills are used to teach patients " how to tolerate and survive a crisis situation when the crisis cannot be changed right away." -Linehan, 1993 Tolerating and accepting distress are important mental health goals because: 1. Pain and distress are unavoidable parts of life. Trying to avoid them leads to suffering. 2. Low distress tolerance leads to impulsive actions that interfere with desired changes in tx Four sets of crisis survival strategies 1. Distracting 2. Self soothing 3. Improving the moment 4. Thinking of pros and cons Distraction skills can be remembered with "wise mind ACCEPTS" Activities- distract attention and fill short-term memory (also affect physiological responses and emotional expressive behavior) Contributing- focuses attention on others and what one can do for them- has the ability to increase a sense of meaning in life and support ones self-respect Comparisons- direct attention away from self towards others who are struggling in order to make ones own life problems seem less bleak Emotions- determine which emotion you are feeling and perform an activity that will produce the opposite emotion Pushing Away- Physically leave a situation or temporarily block it out of your mind.... Those w/ BPD often know how to do this without any sort of training, but should be coached to use it a a last resort, since it is not effective for very long Thoughts- consciously thinking about topics unrelated to your distressing thoughts can offer a temporary distraction and allow the emotions to cool down. Generating lists of things in your mind can keep it occupied.

Sensations- intense sensations can help distract from the feelings in the body that are associated with negative emotions. Holding ice cubes or eating something spicy are examples

Self-soothing- comforting, nurturing, and being gentle/kind to oneself -involves engaging the five senses in ways that are pleasurable and relieving of stress. Examples are a hot bath, aromatherapy, self-massage -important to try some of these out when you are not in crisis to find out what works... it is unlikely you will be willing to try something new in the midst of a crisis Improving the Moment- includes techniques for changing your thoughts about self (encouragement) or a situation (positive thinking, meaning, imagining), or changing physiological responses through relaxation Imagery- visualizing a future event going well to counteract negative (worry) thoughts, imagining oneself in a safe place to help cope with flashbacks... must be practiced OUTSIDE of crisis situations so that it is accessible during them Meaning- similar to "making lemonade out of lemons"- thinking about how one's struggles may actually promote growth/learning, considering the ways in which our suffering might be carrying an important message Prayer- appealing to a higher power for help in accepting a situation Relaxation-relaxing the physical body through various techniques in order to relax the mind/reduce distress One thing in the moment- second mindfulness "how" skill... involves focusing on the present moment as tolerable in order to stop ruminating about the past or worrying about the future Vacation- a break "from adulthood". Should not be harmful, and should last no more than one day. This is something our pts do already, but often not in a skillful way. So, the idea here is to practice planning vacations in a responsible way that minimizes negative outcomes. Encouragement- positive self-talk Thinking of Pros and Cons- evaluating the advantages/disadvantages of tolerating distress vs. doing something harmful that will temporarily eliminate the distress -important to focus on both long and short-term pros and cons -most effective when done while in wise mind... BEFORE a crisis arises -should be kept somewhere that is accessible in the event of a crisis (wallet/purse)

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