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Distress Tolerance~ Distress tolerance is a natural progression from mindfulness~ Accepting, nonjudgmentally, oneself and the situation~ Not trying to change the situation, your feelings, thoughts or urges~ Distress tolerance means surviving crises, accepting life as it is in the moment.Tolerance and acceptance of reality do not equate with approvalProving How Bad It Is~ Sometimes people so want others to understand how bad it is they focus on that instead of surviving the situation~ Short Term Gains (Look what you made me do)~ Controlling anotherâ€™s behavior~ Going to the hospital and getting attention/break~ Long Term Benefits~ ??~ Have clients remember a time they acted out to try to get someone to see how bad it was. What were the results?Distress Intolerance Thoughts~ I canâ€™t stand this~ Itâ€™s unbearable~ I hate this feeling~ I must stop this feeling~ I must get rid of it~ Take it away~ I canâ€™t cope with this feeling~ I will lose control~ Iâ€™ll go crazy~ This feeling will keep going on forever~ It is wrong to feel this way~ Itâ€™s stupid and unacceptable~ Itâ€™s weak~ Itâ€™s bad~ Itâ€™s dangerousAvoidance BehaviorsUrge Surfing~ Urges are generally intense for 20-30 minutes~ Every time you have an urge think, â€œI have a choice!â€~ Surf the urge by opening yourself up to the urge. This doesnâ€™t mean that you consume yourself in it (which feels horrible) or fight it and push it away. What you do is experience the feeling of the urge with acceptance, non-judgement, and be sensitively aware that it is there.STOP Skills~ Stop~ Take a step back~ Observe~ Proceed MindfullyPros and Cons~ What are the benefits to acting on impulsive urges?~ What are the drawbacks to acting on impulsive urges?~ What are the benefits to __[insert the skill] __~ What are the drawbacks to __[insert the skill] __TIP Skills~ Temperature~ Intense Exercise~ Paced Breathing~ Paired Muscle Relaxation~ The act of muscle relaxation is paired with a verbal cue~ What reactions do you have that are paired with verbal cues?Distract with Wise Mind ACCEPTS~ Activities (pleasant)~ Contributing~ Comparisons~ Emotions (opposite)~ Pushing Away~ Think about something totally different~ 4 3 2 1~ What did you used to do on long car trips?Self-Soothing~ Body Scan Meditation~ Self-Soothing Using the 5 Senses~ Sight~ Smell~ Hearing~ Touch~ TasteIMPROVE the Moment~ Imagery~ Safe place~ Successfully dealing with this~ A force field~ A coach/fairy godmother/angel~ Feelings and thoughts are clouds in the sky~ An unstoppable train~ Meaning~ Changing how you think about yourself and your situation~ Make lemonade. Find the silver lining.~ Prayer~ RelaxationIMPROVE the Moment~ One thing in the Moment~ Focus on one thing you are doing right now~ Sitting in a chair~ Driving~ Weeding~ Vacation~ Mental vacation~ Take a short break~ Leave stress at work~ Encouragement~ Be your best friend~ Create a mental coachReality Acceptance~ Radical Acceptance~ Complete and total acceptance of the facts of reality~ Turning the mind~ Mentally looking to the other sideReality Acceptance~ Seeing Emotions Differently~ Fear and anger kick in when there is a threat~ Sadness kicks in when you lose something important to you in some way, If you didnâ€™t feel sadness when these things occurred, it would mean that nothing was important.Negative emotions are important to survival, rather than something to be feared and avoided at all costsReality Acceptance~ Willingness vs. Willfulness~ Willfulness forgets, ignores or actively tries to change, master, direct, control or manipulate what is~ Willingness is a surrendering to a process in which one is already a partReality Acceptance~ Half Smiling and Willing Hands~ Emotions are partially controlled by facial expressions.~ Half smiling with lips slightly upturned~ Hands are unclenched, palms up, fingers relaxed~ Mindfulness of current thoughts~ Recognize that thoughts are just neural firing in the brain, not facts about the world~ Allow the thoughts to come and fade
~ Once clients are mindfully aware of their thoughts, sensations and urges and willing to accept the moment, they need skills to tolerate that distress
~ Help clients develop a menu of options which they can select from when they are in crisis.
~ They feel how they feel
~ Help them tolerate the distress until the intense emotions subside and they can get into their wise mind.