Distress tolerance skills, taught primarily in DBT (Dialectical Behavioral Therapy), are used for when the patient’s SUDs (Subjective Units of Distress) are between a 7 and a 10. SUDs can be thought of as a thermometer, used to rate the patient’s distress or discomfort on a scale of 0-10. If you’re not familiar with DBT or distress tolerance skills, don’t worry; you can use any of the 5 coping mechanisms I explain below when you’re having a panic attack or feel like you just can’t calm down.
I remember this skill with the acronym ACCEPTS: Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, and Sensations. Activities could be anything from watching your favorite show on Netflix to hanging out with your best friend. Contributing aims to shift your focus from yourself to helping someone else by helping a friend or family member. Comparisons compares how you’re currently feeling to a time when you felt different, or to people less fortunate than you. Emotions aims to redirect your current emotion to something else, maybe by watching or reading something that’s funny or scary; anything that’s a different mood than what you’re currently feeling. Pushing away allows you to put whatever issue you’re currently dealing with on a shelf to come back to when you’re feeling better. Thoughts could be something as simple as counting to ten in your head or repeating words to a song in your mind. Lastly, Sensations let’s you focus on how you feel in your body rather than your mind, perhaps by taking a hot or cold shower or holding ice in your hand.
If you’re feeling incredibly overwhelmed and want to act impulsively, it might be a good idea to use the STOP skill. STOP stands for Stop, Take a step back, Observe, and Proceed mindfully. The first step — Stop — aims to catch you before you do anything you might regret. You might be so upset you want to lash out at someone you love, or make a decision that isn’t in your best interests. Stop, and then, Take a step back. Take a deep breath and a break from whatever’s upsetting you in the moment. Then, Observe what’s going on in your head and around you. Notice the situation for what it is, your thoughts and feelings, and what others are saying and doing. When you’ve become noticeably calmer, Proceed mindfully. Ask yourself which actions will help or hinder your current situation, and consider all your options before deciding what to do.
Self-soothe allows you to take care of yourself using the five senses; Vision, Hearing, Smell, Taste, and Touch. Some ideas for each of these: Take a walk and notice everything around you, or go people watching or window shopping. Listen to your favorite songs, or nature sounds (I do this a lot; if there aren’t any around you, download some thunderstorms or fireplace sounds on Spotify). Burn incense or light your favorite candle, or cook something that smells delicious. EAT YOUR FAVORITE FOOD; because who doesn’t love that? Don’t feel guilty about indulging, because sometimes, comfort foods are necessary. And lastly, perhaps take a nice bubble bath or change your sheets and get into bed. Any of these and more could be great examples of distress tolerance skills.
If you need to reduce your emotional intensity fast, use TIP; Tip the Temperature of your face with COLD WATER, Intense Exercise, Paced Breathing and Paired Muscle Relaxation. The first step entails putting your face in cold water — you can splash your face in the sink, go under a cold shower, or hold ice if you can’t do the first two — for thirty seconds. The cold water will immediately calm you down. Next, engage in intense exercise; you don’t have to go do a full work out, this could be as simple as doing 20 jumping jacks in your room. The goal is to get your heart rate up and blood pumping. Lastly, pace your breathing and relax your muscles while doing so. Slow your inhaling and exhaling down (about five to six breaths per minute) and breathe out more slowly than you breathe in. While breathing in, tense your muscles; upon breathing out, relax them. You should feel noticeably calmer and in less distress after doing this exercise.
5. IMPROVE the moment
IMPROVE stands for Imagery, Meaning, Prayer, Relaxing actions, One thing in the moment, a brief Vacation, and self-Encouragement and rethinking the situation. Creating a relaxing image in your mind, such as a scenario where everything is going well, or remembering good times of the past, will immediately lift your mood and distract you from your current state of distress. Finding meaning in a difficult situation will give you a sense of purpose, and remind you that although you may be going through a hard time, there’s always a silver lining. Prayer, while sounding religious, doesn’t have to be; you ask for strength from the universe, or turn things over to God as you understand him. Relaxing actions can be anything from breathing deeply to stretching to changing your facial expression. Focusing on one thing in the moment allows you to stay in the present and not get wrapped up in the past or future. Taking a brief vacation doesn’t have to be physically going anywhere; you can get in bed and pull the covers over your head, turn your phone off for a day, or even go to the beach or park and spend an afternoon in the sun. Self-encouragement merely involves being your own cheerleader. Think to yourself, “I will make it out of this,” “I’m doing the best I can,” or my personal favorite, “Everything will be okay in the end; and if it isn’t, it isn’t the end.”