Distress Tolerance Helping Students and Staff Cope with Overwhelming Emotions Helena Mackenzie PhD LP Region 5 Mental Health Specialist Pain is Unavoidable Life is SufferingBuddha ID: 698673
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Slide1
Surviving Intense Emotions
Distress Tolerance:
Helping Students and Staff Cope with Overwhelming Emotions
Helena Mackenzie, PhD, LP
Region 5 Mental Health SpecialistSlide2
Pain is Unavoidable
“
Life is Suffering”--BuddhaSlide3
Stressors Are Everywhere…
JC Student Stressors
Away from home/friends
Fitting in with peers
Relationship challengesNew rules/structureDealing with drama/gossipAcademic/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/regulationsSlide4
Recall a Time When You Felt Emotionally Overwhelmed…Slide5
Evolution of the Human Brain (basic)Slide6
Making A Crisis Worse
Ways that Distress Can Lead Us to Make Things Worse…
Using alcohol/
drugs
Screaming at someone
Cutting
Getting in fight
Eating too much
Breaking SomethingSlide7
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, ABPPSlide8
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 MeaningSlide9
Distress Tolerance Skills
The Four Basic Skills
Distraction
Self-Soothing
IMPROVE the momentPros/consSlide10
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 EmotionsSlide11
Distracting with
Pleasurable Activities
Doing something that feels good can help distract from painful emotions…
Go for a walk
Listen to musicPlay a gameCall a friend (don’t talk about the crisis)
Take a napPlay a sportTake a shower
Read a magazineSlide12
Distract Yourself With Tasks and Chores
Clean your room
Organize your CDs
Do your homework
Organize your closet
Return phone callsFill out forms/paperworkSlide13
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 gratitudeListen to someone else’s problems and comfort themSlide14
Replace Y
our Thoughts
(
Distract Your Thoughts)
Remember happy, fun, exciting memory in detail (all senses)Sing song lyricsLook 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. Slide15
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 backwardsSlide16
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 OutPut yourself in a new environment until calmSlide17
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 showerSnap a rubber band on your wristThrow rolled up socks against the wall
Run up and down stairsSlide18
My Distraction Plan
Next time I’m feeling overwhelmed and distressed, I will…
1
.
2.3.4.5.6.Slide19
Self-Soothing:
Distress Tolerance Skill #2
What 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 Slide20
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 foodSlide21
Self-Soothing/
Relaxation
Plan
1.2.
3.4.5.6.7.Slide22
IMPROVE the Moment:
Distress Tolerance Skill #3
Imagery:
Meaning:
Prayer/higher power:Relaxation:One thing in the moment:
Vacation/time-out: Encouragement:Slide23
I for Imagery
Imagine a place where you feel…
Calm
Safe
HappyRelaxed
What do you see, hear, smell, feel/touch, taste?Slide24
M is for Meaning
Reflect on what you value and what is important to you:
Family
Romantic relationshipParenting
Friends/social lifeWorkEducation/trainingRecreation/Fun
Spirituality/religionCitizenship/communitySelf CareSlide25
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 sayingSlide26
R is for Relaxation
Progressive 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 musclesSlide27
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 environmentSlide28
V is for Vacation/Time Out
We all need time
away
Small, simple “vacations
” to relax and rechargeTreat yourself—do something nice for yourselfDon’t talk to anyone for an hour/afternoon
Take a napCurl 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 centeredSlide29
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.”
From McKay, Davis, & Fanning, 1997Slide30
My IMPROVE
Plan:
List One Way to Practice Each
I
MAGERY:
M
EANING:
P
RAYER/HIGHER POWER:
R
ELAXATION:
O
NE THING IN THE MOMENT:
V
ACATION/TIME OUT
:
E
NCOURAGEMENT:Slide31
Pros and Cons
Distress Tolerance Skill #4
Pros
Cons
Make 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 workSlide32
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 moneySlide33
Thank you!
Resources:
Skills Training Manual for Treating Borderline Personality Disorder (
Linehan, 1993)The Dialectical Behavior Therapy Skills Workbook (McKay, et al, 2007)