What To Do When
(Distress Tolerance)
(Distress Tolerance)
It's 3am, Baby is crying. You've slept 2 hours total. Your brain says, "I can't survive this." What skill comes first?
Cognitive Restructuring or nervous system regulation? Why?
Regulate first. Sleep deprivation= low capacity and survival brain online
Name it release it:
Take 30 seconds to silently notice a guilt-filled thought you’ve had this week. Now, share one word that labels it.
Notice that labeling it (“overwhelmed,” “inadequate”) gives you some space from the thought. No judgment, just noticing.
You realized you havent eaten all day and you feel completely drained. You think, "I'll just finish everything first, then eat."
what is most likely to happen?
- Your energy stays low and irritability increases
- You get a chance to recharge through cleaning
Your energy stays low and irritability increases
DBT encourages us to take care of our physical needs to support baseline energy.
After that, I noticed...
You feel rage while talking with partner.
Drop:
Do:
If still escalated:
Drop: proving your point
Do: state one need clearly
If still escalated: pause conversation and use skill
You have an intrusive thought/image. Anxiety spikes to 9 out of 10. Do you analyze the thought, suppress it, or label and allow?
Label and allow. Intrusive thoughts lose power when not engaged.
Bonus: Follow up with physical grounding skill
Think of one thing you could say no to this week without guilt. Role-play saying it out loud to someone in the group.
Observe your body’s reaction. Notice if guilt arises and practice letting it float by.
You used to enjoy painting, reading, or playing music, but lately nothing feels fun. Your child is nearby, and your brain keeps saying, “I don’t have the energy or focus for that.”
Which approach might help you reconnect with something you enjoy?
Start small — 5 minutes of the activity, even if it feels “off”
Wait until you feel fully motivated and energized
Start small. Motivation often follows action, not the other way around.
Even brief engagement can boost mood, reduce stress, and remind you that you’re capable of enjoying life again, which also models self-care for your child.
Shoulder drop
Lift shoulders - hold - drop
"My body feels...."
You notice yourself thinking about how things were before your baby was born and you feel a wave of sadness or regret.
Drop:
Do:
If still escalated:
Drop: Shaming yourself (“Good moms don’t think this”)
Do: Take 3 slow breaths before spiraling
If still escalated: Bring it to therapy instead of suppressing it
Your partner says, “You’re overreacting.” You feel rage and shame. What regulation + communication combo skill applies?
1) Confront him
2) pause, breath, and communicate one need
3) say "forget it and walk away"
pause, breath, and communicate one need. Your feelings are valid and sometimes just making one need clear can be helpful
Name something you feel you “should” do this weekend. Decide one thing you could delegate or ask help with.
Taking action by asking for support moves guilt into problem-solving and models healthy boundaries.
Think of two activities that drained you most this week. For one, brainstorm a small way of giving yourself credit for showing up. Share with the group
Round of applause for your efforts and showing up!!!!! (seriously, clap for your self)
Wall push for 20 seconds
Now, my energy feels...
A friend or someone in group says, "nothing will ever get better, I feel stuck, hopeless, and numb". What would you say to that friend?
Remind yourself of this statement when these types of thoughts and feelings come up.
You’re dissociating. The room feels foggy. Your kids are loud. You feel unreal and detached.
What comes first? Correcting behavior or strong sensory grounding (movement, temperature, texture? Why
Sensory grounding. Cognitive processing is harder during dissociation. Stabilize orientation first.
Pick a self-critical thought (e.g., “I’m a bad mom because…”). Identify one or more concrete examples from your day or week that show this thought isn’t true.
It can be regulating to shift attention from self-criticism to factual evidence, helping you to recognize patterns of care and competence you might overlook.
Think about your weekend plans and choose one small action just for yourself. Something that brings you joy or rest. Spend 2–5 minutes imagining doing it fully. Share with the group (or write down) how it might feel.
Examples could be sipping tea quietly, reading a chapter of a book, stretching, or listening to music. Notice anticipation and the sense that your needs matter.
Big overhead stretch, slow exhale and release.
I feel more/less ____.
You are noticing yourself getting into a thought spiral about all the things... What does support in this moment look like from a loved one?
having them redirect you to skills/grounding, asking you "what would you say to a friend", or let them know what works best for you and have them remind you of it
You have used a skill an noticed it calmed you down a bit but not as much as you would have liked. Your body is still tense, your thoughts are racing, and your child may be nearby. What comes first ?
Double down on the same skill? or Switch to a different nervous system strategy?
Switch to a different nervous system strategy. Sometimes one tool isn’t enough and require layering. Flexibility keeps regulation moving instead of plateauing.
Imagine your guilt as a funny, exaggerated character or creature (like a tiny bossy troll, a clumsy monster, or a dramatic cartoon villain). Give it a name and one silly habit.
Cognitive Defusion can transforms guilt into a playful, manageable object.
Take 60 seconds right now. Close your eyes, place a hand on your chest or belly, and notice one positive thing about yourself today. Breathe into that feeling. What came up for you?
Could feel like warmth, softness, or pride. No judgment, just noticing.
It also may have felt hard, that is okay. remind yourself of what you would tell a friend in a moment like this.
Choose one sense, sight, sound, touch, smell, or taste. Engage it fully for 20 seconds. Observe how your nervous system responds
Engaging senses signals safety to the nervous system. You may feel calmer, more present, or slightly more alert, any observation is valid.
Nothing has helped, you still feel anxious and overwhelmed. What do you do?
What is, call on-call.