Distress Tolerance
These are the two main categories of distress tolerance skills.
Crisis Survival and Reality Acceptance
These are situations in which you need crisis survival skills.
1. When you're about to be overwhelmed with emotion
2. You're about to do something harmful or destructive.
You are waiting for an important phone call and are extremely stressed. You decide to volunteer that day. Name the skill you are using and describe the other parts of this skill.
ACCEPTS— Contributing- volunteer, help someone
You are practicing the skill of ______________ when you fully embrace a situation with your mind and heart.
radical acceptance
What does TIPP stand for?
Temperature, Intensive Exercise, Paced Breathing, Paired Muscle Relaxation
This is a serious problem causing intense emotional distress, generally short term, often not immediately solvable
A crisis.
You are in an argument with your partner and feel completely out of control. You decide to splash your face with cold water. Name the skill you are using.
TIPP ***Temperature-hold ice, splash face, cold AC
You are completely overwhelmed with a longer term project you are completing. You decide to take a mini-vacation and go out to the movies and ice cream with a friend before restarting your work. Which skill are you using? Describe other parts of this skill and when you might use it.
IMPROVE- Vacation- step away for a bit to do something fun
True or false: Radical acceptance means you approve or agree with a situation.
False!
Give an example of a coping statement
’it is what it is’
’i can get through this’
’it’s okay to feel this way’
’this is hard, but I’ll figure it out’
‘I’m doing the best i can in this moment’
True or false: If the distress tolerance skill is not making you feel better, it's not working.
False! While they may help you feel better, the true purpose is to be able to endure the situation without making it even worse
You are furious and about to yell at someone but then you take a pause. Which skill are you using? Describe it and name a specific situation in which you might use it.
S-top!
T-ake a step back
O-bserve
P-roceed mindfully
You find out about a problem while you are on a plane and are certain you cannot address it right away. You decide to "put it on a shelf" in your mind for the duration of the flight and return to it later. Name the skill you are using.
ACCEPTS- Push away***-put the problem on a shelf/in a box for now
You feel angry at a coworker and decide to think about this while sitting with your face relaxed with corners of your mouth slightly turned up as well as palms relaxed and facing upwards. Name the skill you are using and the rationale for using it.
Willing hands
Half smile
Sends signals to deep structures in brain to change emotions, decrease fear and anger.
Give an example of effective rethinking
Original reactive thought: “They’re ignoring me, and it’s awful.”
Reframed thought: “I don’t know why they haven’t replied. I can follow up politely if needed. Their response or lack of it doesn’t define my worth.”
New perspective: Focus on what you can control—your own actions and reactions—rather than what you can’t control (their behavior).
These are different distress tolerance skills.
STOP, TIPP, ACCEPTS, Self Soothe, IMPROVE the moment, radical acceptance, turning the mind, willingness, willing hands, etc.
You are about to act on an urge to do something destructive, but instead you decide to make a list of positive and negative consequences of tolerating the distress as opposed to acting. Which skill are you using?
Pros and Cons
You are taking a test and are extremely nervous. You say to yourself in your head, "You got this!!" Name the skill you are using.
IMPROVE
****Encouragement- "you got this!" "you can do it!"
You think about how you messed something up at work and embarrassed yourself. You are about to scold yourself for being "so oversensitive," but instead you tell yourself "this is just a thought." You mindfully observe and notice the thought without judgment. Name the skill you are using.
Mindfulness of Current Thoughts
What does IMPROVE stand for?
Imagery, Meaning, Prayer, Relaxing, One thing, Vacation, Encouragement
These are situations in which distress tolerance skills are NOT helpful.
When they lead to avoidance of all problems
When they impair your functioning at school or work
You feel panicked and decide to put on a nice smelling land lotion. Which skill are you using? Describe other types of activities you might do with this skill.
Self soothing
You are trapped on an extremely slow A train and running late for a meeting. As you feel the panic and rage rising, you decide to breathe in a specific pattern--inhale for 4 seconds, hold for 4s, exhale for 4 s, hold for 4s, repeat. Name the skill you are using.
TIPP **Paced breathing-"box breathing"
You make a conscious decision to accept something difficult but true over and over in your mind. Name the skill you are using.
Turning the mind
What does ACCEPTS stand for?
Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, Sensations