A Brief Intro To Dialectical Behavior Therapy (DBT) Distress Tolerance Skills

Hey gang. With the holidays upon us, it’s easy to get overwhelmed so I wanted to share a quick and dirty guide to some basic Dialectical Behavior Therapy (DBT) skills aimed at helping you withstand grating family members, travel anxiety and endless societal expectations making all of us feel stressed to the max. Of course, these tips will help you regardless of the time of year so feel free to bookmark and refer to this quick reference when times get tough. Without further ado:

What the h*ck is DBT anyway?

In a nutshell, DBT is a specific variation of Cognitive Behavioral Therapy (CBT) that was originally designed with Borderline Personality Disorder (BPD) in mind. Folks with BPD tend to have very extreme emotional swings and some pretty black and white thinking patterns so there’s an emphasis on trying to address that. At it’s very core, DBT harnessed this sort of paradoxical spirit with its dual approach of acceptance and change. Of course, personality disorder or no, we all will experience situations that push us to the extremes of our emotional range so DBT skills are useful for any human who has ever felt feelings. That include you? I thought so.

There’s a lot more to DBT than what I’ll be talking about today so if you’re curious and would like to learn more about it, I highly recommend checking out Behavioral Tech’s page on it here: https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

Step One: Radical Acceptance

While modern clinical psychology has pretty much blurred the lines between CBT and DBT at this point, there’s one distinction between the two that led me to prefer DBT: radical acceptance. CBT is very focused on “this is the thing, change the thing, the original thing is bad” whereas DBT is a bit more like “this is the thing, I accept this thing, it may not be ideal but it’s the truth, I’ll change it but maybe not right away” which is a bit more realistic sometimes. Confused? I’ll give you a real life example.

Sometime in this past year, I made a series of poor choices that led to me quitting my job. While I had been thinking about it for some time beforehand in the abstract, I very abruptly and impulsively exclaimed, “Consider this my two weeks notice.” After I left my boss’ office, I curled into a ball on the bed in a state of shock, repeating, “I can’t believe I just quit my job.”

This situation was HELLA DISTRESSING. And considering I wasn’t super versed in DBT yet – only CBT – I handled it okay. But had I known more about DBT at this point, I think I would have been able to get over the emotional shock faster. Why? Because I would have ripped the bandaid off that was denial and tore right into radical acceptance.

“I quit my job,” I would have exclaimed. “This chapter of my life is over and now I’m going to move on to the next one, even though I have no idea what it is.” And that’s it. You don’t start spiraling into thinking about what’s next or conversely about what you should have done differently. You just face whatever’s happening head on and say, “This is what happened and I’m accepting that.”

It’s super important to define what you’re accepting as honestly and realistically as possible, by the way. Let’s say your boyfriend cheated on you so you freaked out and slashed the tires on his car, took a Louisville slugger to both headlights and carved your name into his leather seats Carrie Underwood style. You really shouldn’t say, “My boyfriend cheated on me so I gave him what he deserved!” This value judgement – that he deserved what you did – may or may not be true but it’s abstract and doesn’t really help you accept your actions. Instead, it’s important to try and be as matter-of-fact as you can about what happened: “My boyfriend cheated on me so I destroyed his car.” You’re not saying it’s good or bad. It just is what it is.

Also, it may be helpful to come up with a general acceptance statement that applies to many situations. You can even write it on a piece of paper and keep it in your wallet, (I did for a while until I memorized mine). A couple good ones I’d recommend are “I can’t change what’s already happened,” “the present is the only moment I have control over,” or “this moment is the result of over a million other decisions.” Or you can use my personal favorite: “I’ll focus on what I can do right now.” That’s a quote from Dragon Ball Super c; thanks, Goku!

This is probably the step that takes the most practice. If you believe anything Freud has ever said, the man was probably onto something when he came up with the concept of defense mechanisms. We humans do love our denial, after all. While this may be a tough knee-jerk reaction to reprogram, it really is worth it to fight for that acceptance.

After acceptance comes peace, right? Well, not usually. In the case of DBT, we’ve got a one-two punch follow up for radical acceptance that’ll help the sting of ripping off the denial bandage.

Step Two: Distraction

So if you’re in a heightened emotional state, the truth is that your head really isn’t in the right place to solve problems. And you might think it’s bad to put things off but life is about managing a dichotomy – it’s all about balancing opposing forces. Problem solving is good and great but keeping your emotional state as chill as possible is also important. In comes distraction!

The things you can do to distract yourself is only limited by your imagination. Not all of these things work if you’re trapped in a family gathering, for example. But some of them do! And with the magic of smart phones, we can find distractions easier than ever! You may want to write a list on a small piece of paper and keep it in your wallet – that’s actually where the following list came from (my wallet, that is, not yours). Here’s my top 50 ideas for distracting yourself:

  1. Yoga, stretch, exercise

  2. Get out of the room/house, even if I just sit in the laundry room

  3. Take a nap

  4. Eat chocolate or something sweet

  5. Brush kitty

  6. Vine compilations (this one is a personal favorite – they’re so quick that they manage to keep my attention even when I’m having a panic attack)

  7. Go to the movies

  8. Play a video game

  9. Blog/journal

  10. Buy something on the internet (or just window shop)

  11. Email jo@samaritans.org (these folks are super nice and if you really need to let it all out, I would recommend them)

  12. Go shopping

  13. Watch TV

  14. Organize desk

  15. Plan meals

  16. Make the bed

  17. Clean out clothes

  18. Do laundry

  19. Wash dishes

  20. Pay bills

  21. Make something for someone

  22. Read

  23. Go to the library, a book store, or a coffee shop

  24. Visit a museum or a gallery

  25. MEDITATE (there’s apps you can download if you don’t have a current practice – some people use Calm or Headspace, I prefer the simplicity of Meditation Helper)

  26. Call Mom (this can be whoever for you, obvs but my mom is always available lol)

  27. Sing, play ukulele

  28. Write a song or poem

  29. Listen to upbeat music (sad music just keeps you feeling sad, my dudes)

  30. Take photos

  31. Paint your nails

  32. Take a bath or shower

  33. Study

  34. Go people watch

  35. Think of your favorite person & imagine a conversation with them

  36. Write a letter to a loved one

  37. Do a puzzle

  38. Write a loving letter to yourself when you’re feeling good & keep it with you to read when you’re feeling upset

  39. Observe the world around you outside

  40. Draw

  41. Masturbate

  42. Imagine yourself as the hero correcting a past/future event in your life

  43. Make a list of people you admire and want to be like (real or fictional). Describe what you admire about these people

  44. Make a list of 10 things you want to do before you die

  45. Write a letter to someone who has made your life better & tell them why (you don’t have to send it)

  46. Have sex with someone you care about

  47. Text a friend

  48. Cook something you’ve never made before

  49. Browse Reddit

  50. Turn on some loud music and dance it out

There’s so much more you could do but this is just my personal list. Some of these don’t always work. Some of these depend on if you’re home or not. But there’s always at least one thing on this list you can do – even if you have to lock yourself in the bathroom to do it.

So you’re sitting at dinner and Trump comes up and you know you shouldn’t bite but you do anyway. The conversation degrades into shouting and you feel absolutely shitty. What do you do? Guess what? You don’t owe anyone ANYTHING. You don’t HAVE to sit there. Really. If you’re really upset and you can’t bear to be there anymore, excuse yourself. I don’t care if your dad is screaming at you to sit back down, we’re going to eat like a family, damn it. With all the coolness you can muster my beautiful cucumber, you need to say, “I need a moment.” If you can go outside, great! Honestly, the cold can be a wonderful distraction. Just focus on the feeling on your skin, look for tracks in the snow, watch headlights in the distance. But you can always open your phone and do lots of the things on this list, even if you’re stuck somewhere.

So you’ve broken the repetitive thoughts and you’re no longer stuck on whatever it was that upset you thanks to your distraction plan. Great! Now it’s time for the final step.

Step Three: Self-Soothe

Now that you’ve gained a little distance from the problem, it’s time to heal the hurt that it caused you. When it comes to dealing with stress, there’s two approaches: problem-based solutions and emotion-based solutions. In my opinion, applying both categories of solutions will result in maximum happiness. Self-soothing is very much in the category of emotion-based solutions for stress. I think DBT’s got the right idea by suggesting self-soothing before you try and dive into any problem-based solutions. If your emotional tank is empty, how are you supposed to have the energy to really fix anything?

Distraction and soothing can have a bit of overlap – some of the things that you might use to distract yourself can also be relaxing. The main difference between the two is that your items for distraction should be able to demand your attention, forcing you not to obsess over whatever it is that made you upset. Your soothing techniques, on the other hand, focus on creating pleasant sensations so you can return to feeling good or at the very least neutral. It’s only once you’ve return to an emotional equilibrium that you should attempt to address the thing that distressed you in the first place.

It may be helpful to consider your five senses while coming up with soothing strategies – what smells relax you? What sounds calm you down? Are there certain textures that soothe you (like a lovely fuzzy pink scarf)? Do you have any favorite flavors you can keep on hand? How about pictures or mementos you could carry with you?

This step is broken into three categories: things that you can only really do at home, things that you can do away from home and things that you can do anywhere – home or on the go.

Self Soothe At Home

  • Burn scented candles or incense

  • Look at your decorations (or in my case, altar), and rearrange if you see fit

  • Open your window and listen to the sounds outside

  • Eat a soothing food like ice cream, chocolate or something else that makes you feel good

  • Take a hot or cold shower, or a warm bubble bath with scented oils

  • Play with your pet and give them lots of snuggles

Self Soothe On The Go

  • Buy fresh cut flowers or seek out flowers in your neighborhood

  • Carry candy or snacks to eat when you’re feeling upset (this has genuinely been one of the most helpful items on my list – cinnamon candy always makes me feel better)

  • Carry a worry stone

Self Soothe Anywhere

  • Hug someone whose smell makes you calm

  • Draw a picture or color in a coloring book (I carry a tiny notepad with me)

  • Listen to a recording of nature sounds

  • Make a calming playlist on Spotify/YouTube or look up relaxing acoustic music

  • Listen to rushing or trickling water – fountains, waterfalls, even the sink in the bathroom

  • Wash your hands thoughtfully

  • Drink something soothing, such as tea, coffee or hot cocoa

Self soothing is pretty well rooted in mindfulness, which is a huge cornerstone of DBT. This is my personal list so you obviously can think of other things that work better for you or ignore whatever doesn’t seem relevant but the emphasis should be on things that you experience deeply and fully, with great pleasure. Engaging as many of your senses as possible is generally a good idea. Whatever you choose to do, try your very best to be totally present for it. Do as many things on the list as necessary to feel better. Appreciate this moment of repair and restoration. Refuel and re-energize so that when you’re done, you’re ready to take on the world!

Back At ‘Em, Tiger!

The more you practice these sets of skills, the easier they’ll be. I do genuinely recommend writing some of these down and putting them in your wallet for when your brain is on fire and you can’t remember a damn thing I wrote here. If you’re anything like me, the act of simply writing them down will help you remember even if you end up never looking at them. Take five minutes to grab a little piece of paper, or even open a note app like Evernote, and write your favorites or come up with your own. I’d absolutely love to hear your ideas so please comment below with your own acceptance statements, distraction plans and self soothing techniques!

Once you’ve completed the full cycle and you’re feeling better, then it might be time to tackle the thing that made you upset in the first place. Sometimes, though, the best answer is just to let it go. Every situation is different and only you can decide that, however. With something like my previous example of quitting my job, after I got over the initial shock and solved my emotion-based problem, I focused on the problem-oriented solutions. Of course, my job hunt was cut short and now I have the immense pleasure of being a full-time bum – I mean writer. Kind of goes to show that worrying about the future is a bit pointless because whatever’s going to happen, will happen. Not to say that you shouldn’t try and be proactive – it’s not like I just threw my hands up and went “welp, time to be unemployed” – but learning to find that balance between being action oriented and accepting the inevitable will serve you greatly.

I hope this guide is helpful! If you have any questions, please feel free to comment. And for those of you reading at the time of publication, take care of yourselves this holiday season. Happy Holidays, my kittens.

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