Distress tolerance is the third module in DBT therapy. This section is exactly what it sounds like; how to handle those overwhelming moments.There are multiple techniques that can be used individually or jointly to help with getting through distressing moments. These fall into three acronyms, ACCEPTS, TIP, IMPROVE, and the skills for self-soothing. I’m going to use a personal example of how these skills work rather than restate each.
I recently had a very large bill arrive in the mail from when I had a stroke on Christmas Eve. To say I was distressed is almost an understatement. My heart rate remained very high, I couldn’t sleep, and my appetite dropped to almost nothing. I admit that I spent a few days simply trying to avoid the situation. During that time I used ice packs to try and relieve the physical symptoms (sensations). I knew, rationally, that I needed to call the hospital and possibly my insurance company to handle the matter. The idea of making that call left me feeling like laying in bed and crying.
The first thing I did to begin preparing myself was to work on a cleaning list (activities). As I worked, I listened to a playlist of music that inspires and reminds me of my strength and ability to handle problems effectively (emotions). With my environment in order and my body exhausted, I was able to sleep that night. Getting enough sleep is critical in handling distress, even as difficult as it can be.
The following morning, I prepared myself for the phone calls. Using self-soothing, I burned a favorite incense (smell) and did relaxation exercises (progressive relaxation). I also played my little playlist again (hearing), watched the trees and clouds (vision), and allowed myself a bit of chocolate with my morning coffee (taste). When it was time to call, I had my dog sit nearby so I could pet her while I talked (touch).
During the call, I remained focused on completing only this task. I did not allow myself to think about my writing, my work, my family, or anything else (one thing at a time). Instead of berating myself for putting it off, I reminded myself that I had needed time to get my head around the exorbitant numbers on the bill and had done what was needed for my own stability (encouragement). I pictured myself as being strong, an undefeated fighter, confident and sure in myself (imagery). I also set my mind to the fact that if I handled those calls, I would be freed of the risk of financial ruin and able to continue forward with my plans for my future (meaning).
In the end, it was the call to the insurance company that provided me with answers and a way to seek resolution with their aid. Neither the call to the hospital or the insurance company were a tenth as stressful as I had feared. When it was done, I had earned hopefulness and peace from the stress responses that had been dominating my life for days. I followed the call with a nap (vacation) to allow my mind a chance to recover and reset.
Admittedly, during the time I was doing these things, I didn’t think to myself “I’ll use activities and get some housework done.” I’ve also been practicing these skills for around twenty years. When I first started learning, I often referred to this exact list and chose things to help myself through distress. Over time, this has just become my way of approaching difficult situations. With consistent practice, it can become equally ingrained as a useful set of behavior patterns for anyone.