In
DBT, we use Emotion Regulation skills in order to change our emotions or
situations. But sometimes it's not appropriate or we're not able to change
the situation or our emotions, then we should use
Distress Tolerance skills.
Emotions are
normal and everyone experiences them. Sometimes, particularly when we have
had persistent distressing experiences during our lives, we can emotionally
react more often to situations (that others may not find distressing) where we
feel threatened. The distress can be very intense and it's difficult to
manage ourselves and situations when things are feeling so over-whelming.
Learning
Emotion Regulation skills will help us learn to effectively manage and change
the way we feel and cope with situations.
Emotions,
thoughts and what we do or feel an urge to do (behaviours) are all linked and
become vicious cycles. Changing one part of the cycle will help improve
the situation and help you feel better.
When we
experience really strong negative emotions, it’s easy to get caught up into the
old pattern of using unhelpful and damaging coping strategies such as using
substances, self-harming or unhealthy eating habits.
Emotions are
closely linked to our bodies, and each emotion has a particular behaviour linked
to it. The word "emotion" can be described as E - MOTION (Elicit Motion).
Emotion causes us to react and move in certain ways. Examples of emotions and
their action urges:
EMOTION
ACTION URGE
OPPOSITE
ACTION
Fear
Run away,
avoid
Approach:
go anyway and participate fully
Anger
Attack
Gently avoid,
be kind, see their perspective
Sadness
Withdraw
Be with
others, increase activity
If emotions
cause our bodies to react in certain ways, then doing something different -
doing the opposite ('Opposite Action') - can affect and help change our
emotions.
Opposite
Emotion – do something that will help you to feel the opposite of what you
feel now. For example, if you feel depressed, watch a funny movie or tv
programme, or listen to some uplifting music.
The acronym “PLEASE Master” can remind
us what we can do regularly
in order to keep ourselves healthy and stable.
PL
treat Physical iLness
E
Eat healthily
A
Avoid mood-altering substances
(alcohol or drugs)
S
Sleep well
E
Exercise
Master
plan and do something every day that gives you a sense of achievement or ability
Increase positive emotions
Do more enjoyable activities – every day
(see the list of distractions for ideas). Do more enjoyable activities than you
would normally do, schedule them in each day.
DO ONE THING each day.
Be mindful of positive experiences
Focus your attention on positive events as
they happen
Notice when your mind wanders to unhelpful
thoughts, and bring your focus back to the current situation
Changing
the way we think
As thoughts play such an important role in
our distressing emotions, it can be very effective to notice these thoughts, and
learn to think differently, or to think about thoughts in a different way. When
you start to feel upset
Questions
to ask
yourself when you feel distressed
STOPP!
Pause, take a breath, don't react automatically
Ask yourself:
What am I
reacting to?
What is it that's really pushing my buttons here?
What is it that I
think is going to happen here?
What's the worst
(and best) that could happen? What's most likely to happen?
Am I getting
things out of proportion?
How important is
this really? How important will it be in 6 months time?
What harm has actually been done?
Am I expecting something from this person or
situation that is unrealistic?
Am I
overestimating the danger?
Am I
underestimating my ability to cope?
Am I using that negative filter? Those
gloomy specs? Is there another way of looking at it?
What advice would
I give to someone else in this situation?
Am I spending
time ruminating about the past or worrying about the future? What could I do
right now that would help me feel better?
Am I putting more
pressure on myself, setting up expectations of myself that are almost
impossible? What would be more realistic?
Am I mind-reading
what others might be thinking?
Am I believing I
can predict the future?
Is there another
way of looking at this?
What advice would
I give someone else in this situation?
Am I putting more
pressure on myself?
Just because I
feel bad, doesn't mean things really are bad.
Am I
jumping to conclusions about what this person meant? Am I mis-reading between
the lines? Is it possible that they didn't mean that?
Am I exaggerating
the good aspects of others, and putting myself down? Or am I exaggerating the
negative and minimising the positives? How would someone else see it? What’s
the bigger picture?
Things aren’t
either totally white or totally black – there are shades of grey. Where is
this on the spectrum?
This is just a
reminder of the past. That was then, and this is now. Even though this
memory makes me feel upset, it’s not actually happening again
right now.
What do I want or
need from this person or situation? What do they want or need from me? Is
there a compromise?
What would be the
consequences of responding the way I usually do?
Is there another
way of dealing with this? What would be the most helpful and effective action
to take? (for me, for the situation, for the other person)
If your distressing emotions are caused by an
upsetting image or picture which keeps coming into your head, you can practice
manipulating the image to reduce the distress:
Image
Manipulation
Sometimes we
can get horribly distressing intrusive images that just pop into our heads, and
we have trouble getting rid of them again. The image may be based on a real
memory, or just some random terrible image. These images can trigger strong
physical sensations, and intense emotions of fear, dread, anger or sadness.
We can learn
to manipulate the image so that we reduce the distressing feelings:
Imagine putting the image on a TV
screen. Now with an imaginary remote control, make the image smaller, making it
more distant, perhaps turn it into black and white, remove the sound or give it
a different soundtrack.
Imagine a plate or sheet of strong
clear plastic and put it between your face and the image. Push that image away
from your face, until it gets smaller and is further away.
