Surviving Intense

Emotions

Distress Tolerance: Helping Students and Staff Cope

with Overwhelming Emotions

Helena Mackenzie, PhD, LPRegion 5 Mental Health Specialist

Pain is Unavoidable“Life is Suffering”--Buddha

Stressors Are Everywhere…

JC Student Stressors

• Away from home/friends

• Fitting in with peers

• Relationship challenges

• New rules/structure

• Dealing with drama/gossip

• Academic/trade pressure

JC Staff Stressors• Too much work/too little

time

• Staff cutbacks

• Frustrating interactions with students

• Hearing traumatic stories

• Lack of resources

• Changing rules/regulations

Recall a Time When You Felt Emotionally Overwhelmed…

Evolution of the Human Brain (basic)

Making A Crisis Worse

Ways that Distress Can

Lead Us to Make Things Worse…

Using alcohol/drugs

Screaming at

someoneCutting

Getting in fight

Eating too

muchBreaking Somethin

g

Distress Tolerance Skills:Surviving A Crisis Without Making It

Worse

• Distress Tolerance Skills are used to help us cope and get through periods of overwhelming emotions and pain in healthier ways to avoid additional suffering

• Use when we can’t change a distressing situation (because we are unable, unwilling, or it’s inappropriate)

• Other skills (problem solving, emotion regulation, interpersonal effectiveness) may help us later prevent or “fix” the situation, but not when our brain is “off line” due to intense emotion

Distress Tolerance Skills are one of four sets of skills taught as part of Dialectical Behavior Therapy (DBT), an evidence-based therapy developed by Marsha Linehan, PhD, ABPP

Dialectical Behavior Therapy

Wise Mind

“Between Stimulus and response there is a space, and in that space lies our power

and our freedom”

--Victor Frankl, Man’s Search for Meaning

Distress Tolerance Skills

The Four Basic Skills

• Distraction

• Self-Soothing

• IMPROVE the moment

• Pros/cons

• Pleasurable activities

• Do basic tasks and chores

• Pay attention to others

• Replace your thoughts

• Count something. Anything!

• Leave the situation

Distraction:Distress

Tolerance Skill #1

Turn Away From Painful

Emotions

Distracting with Pleasurable

Activities• Doing something that

feels good can help distract from painful emotions…• Go for a walk• Listen to music• Play a game• Call a friend (don’t talk

about the crisis)• Take a nap• Play a sport• Take a shower• Read a magazine

Distract Yourself With Tasks and Chores

• Clean your room

• Organize your CDs

• Do your homework

• Organize your closet

• Return phone calls

• Fill out forms/paperwork

Distracting by Paying Attention

to Others• Do something for someone

• Take attention off yourself by people watching (describe details of what you see)

• Think of someone you care about. Look at picture and imagine telling them you care

• Thank someone/express gratitude

• Listen to someone else’s problems and comfort them

Replace Your Thoughts(Distract Your

Thoughts)• Remember happy, fun,

exciting memory in detail (all senses)

• Sing song lyrics

• Look outside and describe what you see in nature or recall an image of nature

• Imagine your wildest fantasy coming true. What would it be.

• Read a favorite saying, supportive message, prayer to yourself. Repeat.

Distract Yourself by Counting

• Count your breaths

• Count the tiles on the ceiling, cracks in the wall, students in the class, whatever

• Do basic math. Count or subtract by sevens.

• Count the letters in your friends’ names and spell them backwards

Distract Yourself by Leaving

• Sometimes emotions are so strong that you need to walk away and put distance between you and the situation

• Walk Away

• Take a Time Out

• Put yourself in a new environment until calm

Match Your Method to Your Level of Distress• If you are completely

emotionally overwhelmed, distracting yourself by doing homework is not realistic

• Distract from self-destructive behaviors by..• Hold an ice your hand• Splash cold water on your

face; take cold shower• Snap a rubber band on

your wrist• Throw rolled up socks

against the wall• Run up and down stairs

My Distraction Plan

• Next time I’m feeling overwhelmed and distressed, I will…

• 1.

• 2.

• 3.

• 4.

• 5.

• 6.

Self-Soothing:Distress Tolerance Skill

#2What would you do if your partner/best friend was in distress/going through a

crisis?

How would you soothe them?

Don’t make a hard situation harder by becoming your own best critic

Soothe yourself at times of distress

Self-Soothe with Five Senses

VISION: Carry picture of soothing place; make collage of calming pictures; look at nature; carry picture of loved person/animal

HEARING: Listen to soothing music; listen to nature/recording; listen to relaxation exercise; listen to voice that is calming (message on phone)

TASTE: Suck on mint/hard candy; savor cup coffee/tea; chew gum; eat fruit slowly, savoring taste

TOUCH: Rub a smooth stone in your hand; stroke your arms; massage yourself; play with a pet/animal; put on your favorite comfy clothes

SMELL: Wear favorite scented lotion/oil/cologne; smell a scented candle/diffuser; go outside and smell nature; smell favorite food

Self-Soothing/Relaxation Plan

• 1.

• 2.

• 3.

• 4.

• 5.

• 6.

• 7.

IMPROVE the Moment:Distress Tolerance Skill

#3• Imagery:

• Meaning:

• Prayer/higher power:

• Relaxation:

• One thing in the moment:

• Vacation/time-out:

• Encouragement:

I for Imagery

• Imagine a place where you feel…• Calm• Safe• Happy• Relaxed

• What do you see, hear, smell, feel/touch, taste?

M is for Meaning

• Reflect on what you value and what is important to you:• Family• Romantic relationship• Parenting• Friends/social life• Work• Education/training• Recreation/Fun• Spirituality/religion• Citizenship/community• Self Care

P is for Prayer/Spirituality

“Sometime I go about in pity for

myself, and all the while a great wind

is bearing me across the sky.”

--Ojibwa saying

R is for RelaxationProgressive

Muscle Relaxation• Tighten each part of

your body for 5 seconds, then completely relax it

• Start at your toes and work upward

Walk, yoga, stretching

• Any exercise that relaxes your muscles

O Is for One Thing in the Moment

Next time you are in distress, ask:

• Where am I right now?

• Am I time traveling to future, worrying or planning?

• Am I traveling to past, reviewing mistakes?

• Am I in the present?

• Redirect attention to present by focusing on breathing, describing internal sensations or external environment

V is for Vacation/Time Out

We all need time away

• Small, simple “vacations” to relax and recharge

• Treat yourself—do something nice for yourself

• Don’t talk to anyone for an hour/afternoon

• Take a nap

• Curl up with your favorite book, music

Time Out• Not only for kids

• Remove yourself (temporarily) from distressing situation

• Calm and self-soothe yourself

• Remember your needs are important

• Go back and face the problem once centered

From McKay, Davis, & Fanning, 1997

E is for Encouragement

Use Self-Encouraging Coping Thoughts “This situation won’t last forever.”

“I can ride this out and not let it get to me.”

“I’ve survived worse than this. I’ll be okay.”

“Feelings will pass. I’ll feel better again.”

“I’m strong and I can deal with this.”

“It’s okay to feel angry/afraid/sad. Feelings will pass.”

“My thoughts don’t control my life. I do.”

My IMPROVE Plan:

List One Way to Practice Each

IMAGERY:

MEANING:

PRAYER/HIGHER POWER:

RELAXATION:

ONE THING IN THE MOMENT:

VACATION/TIME OUT:

ENCOURAGEMENT:

Pros and ConsDistress Tolerance Skill #4

Pros ConsMake situation worse by…Smoking pot

--get to relax--won’t have to think

--get drug tested and kicked out--can’t get up in am--use all my money

Tolerate distress by…Self-soothing

--feel little relaxed--focus on my goals--money for phone--feel better in am

--may not sleep well--won’t be as chilled--harder work

Pros and Cons

Motivate yourself to tolerate distress and not engage in destructive behavior by…

Writing out and carrying with you the pros of tolerating distress and the cons of making it worse..

PROS of Following Distress

Tolerance Plan

--feel little relaxed--focus on my goals--money for phone--feel better in am

CONS of Making it

worse

--get drug tested and kicked out--can’t get up in am--use all my money

Thank you!Resources:

Skills Training Manual for Treating Borderline Personality Disorder (Linehan, 1993)

The Dialectical Behavior Therapy Skills Workbook (McKay, et al, 2007)