Dialectical Behaviour Therapy (DBT) Skills - Distress Tolerance

One of the things I love about DBT (Dialectical Behaviour Therapy) are the practical skills it offers. These skills can help people to cope better with events that are painful or emotions that are overwhelming, and provide practical ways to take back control of their actions in response to these situations. DBT skills can be grouped into four key skills : Distress tolerance, Mindfulness, Emotion regulation, and Interpersonal effectiveness. The focus for this post is going to be on Distress Tolerance skills. The following is one of the first basic distress tolerance strategies that can be really helpful during times of emotional overwhelm.

REST - Relax, Evaluate, Set an intention, Take action

Change is hard, especially when we are trying to change a habit that is behavioural - those seemingly automatic actions we take in response to something, such as saying no to social invitations due to fear of judgment from others, or using alcohol or drugs when we feel stressed, reaching for junk food every time we feel sad, or taking things out on others. When we want to change a behaviour, like reaching for the wine glass after a big day at work, we need to firstly know what it is that we want to change, the timeline of when we want the change to occur, and what else we could instead of the automatic action. But most importantly, we need to remember that we want to change, and this is where it can get tricky with those actions we currently do that seem to be automatic. This is where REST can be very helpful. Practicing this distress tolerance skill can help with the impulsive urge to react as we always have. So what are the steps? (McKay et al., 2019).

Relax - stop what you are doing, freeze in the moment (as long as it is safe to do so - i.e. not while crossing a road!) and take a breath. Take a 5 second pause to allow your mind to take a break and consider a different response rather than an automatic, impulsive reaction you have typically resorted to. Some people find it helpful to say 'relax' to themselves, or 'stop'. Some like 'breathe' - play around with it - see what resonates for you. This step is a reminder to yourself that you want to do something differently this time.

Evaluate - take a moment to think about what is actually happening in this moment. What are the facts about this situation? You don't need to do a deep dive analysis here, just observe what is actually happening. Try to identify how you are feeling right now, are you experiencing any physical sensations in your body, what's happening around you? Remember - facts.

Set an intention - this could be setting a goal, or target, or a plan about what your next action is going to be. Do you need to use one of your coping skills to help regulate? Or is this a situation which needs some problem solving skills or communication skills? Whatever is needed, this step helps to decide what action is next. It doesn't have to be the best action, just one that is going to help you get through and cope with the current situation.

Take action - do what you intended, action your plan. Remember to do the action as mindfully as you can, remain calm and with awareness of what you are doing.

Let's look at an example of this in action......

Dotty gets home after a hectic day at work to find the kids have left the kitchen in a mess, towels from showers on the floor, and shoes kicked off and left as they have made their way from the front door to their bedrooms. Dotty sees red! On a typical day, she would walk through the door, see the mess and start screaming at the kids before even putting her bag down and start pouring a glass of wine to relax, which has recently turned into regularly finishing the bottle. However, Dotty has noticed this habit, and doesn't want to repeat what she saw her mother doing when she was growing up, so decided a few days ago to try to change this habit. Dotty recalls the REST strategy, so stops herself from yelling, and takes a big deep breath in through her nose and out her mouth (letting out a big sigh as she does this). Next, she looks at the facts. Yes the house is a mess, yes this annoys her, she feels this in her body as heat rising and bubbling up, and yes, the kids are in their bedrooms on their devices. These are the facts of the situation.

Next, Dotty sets an intention. She wants to communicate to the kids that she wants to come home from work to a relatively mess free house (let's be realistic about the situation), and yelling and screaming hasn't worked in the past (so why would it suddenly be the one time that it was effective). She also doesn't want to automatically reach for the wine glass - drinking a whole bottle of wine to try to drown out the frustration and feelings of disrespect just makes her feel worse in the morning, so using a coping strategy such as a few rounds of deep breathing may be helpful right now. The final step is for Dotty to now take action on these intentions. She starts with the deep breathing - very slowly in through the nose until she can't take in any more air, and then slowly out through the nose, closing her eyes to really focus on the feeling of breathing. Next she puts away her stuff and once she feels calm enough, asks the kids to come and have a chat with her about the house and responsibilities. This gives her the opportunity to effectively communicate with her family and to not wake up with a hangover the next day.

This skill can be used in all sorts of situations and can be very effective in helping to change behaviours that are destructive or tend to make matters worse.

Seeking Support

If you are finding emotions or behaviours difficult to manage, speaking with a registered health professional can be a helpful first step. They can provide an assessment and discuss evidence-based treatment options tailored to your needs. If you are in immediate distress or feel unsafe, contact Lifeline Crisis Support on 13 11 14, 000 for an emergency, or present to your local hospital emergency department.

Disclaimer: This information is intended for general educational purposes and does not replace professional advice, diagnosis, or treatment. Individual experiences vary, and support should be tailored accordingly.

Reference

McKay, M., Wood, J. C., & Brantley, J. (2019). The dialectical behaviour therapy skills workbook (2nd edn.). New Harbinger Publications Inc. Oakland, CA.