Last Saturday my DBT Skills Group started up again, so I am back posting regular updates about what we are covering on the program! It was the first week of the Distress Tolerance module – the 3rd module out of the 4 we have covered so far.
There were 8 people in the group, a big difference to the mere 2-3 of us who regularly attended the Emotional Regulation module back in August. My anxiety was high due to the new(ish) situation and people, however it was surprisingly more manageable than I had expected it to be – considering that on my first ever week I had a near panic-attack in the bathroom before we had even started. I guess that’s progress right there, and proof that exposure and Opposite Action really can lead to lasting change. (Damn, maybe the therapists really were right all along about that one 😜.)
Because there were many new members to the group, we started with a brief introduction to the Core Mindfulness skill of Wise Mind, as well as a briefing of the WHAT and HOW skills; because it is the Mindfulness aspect of DBT which underpins so much of what we learn over the whole.
We were then introduced to Distress Tolerance which I will outline here:
What are the goals of Distress Tolerance?
- Crisis Survival – ensuring not to make an already challenging situation worse.
- Reality Acceptance – how pain does not have to lead to suffering, and how to move forward from a place of “stuckness”.
- Becoming Free – escaping from the confines and control of urges, desires and intense emotions.
We started off by looking at the Crisis Survival aspect. A crisis is a situation that is highly stressful, short-term and where there is pressure to resolve the crisis now – to avoid otherwise worsening the situation.
When do you need to use Crisis Survival skills?
- If you have intense pain that cannot be helped quickly.
- If you want to act on your emotions, but it will only make the situation worse.
- If you are experiencing high urges for harmful or destructive behaviours – either to yourself or others.
- If you are struggling within a highly stressful or emotionally overwhelming situation, but where demands must be met.
- If Emotion Mind threatens to take over, and being able to access skills is essential.
- If you are highly aroused or dysregulated, but the problem cannot be solved effectively, straight away.
What are the Crisis Survival skills?
- STOP skill
- Pros and Cons
- TIPP (tip body chemistry)
- Distract with ACCEPTS
- Self-soothe with the senses
- IMPROVE the moment
We then read through the STOP skill handout and discussed situations in which it would be helpful to implement it:
Examples could be anything from receiving an email from a colleague evoking anger and the desire to respond aggressively and disrespectfully, to experiencing feelings of intense shame of fear after a triggering interaction to the point of emotional overload.
It is important to remember that the STOP skill, alongside the other Distress Tolerance skills, always need to be followed up with other skills too. This is because they are only short-term and targeted at not worsening the problem, however they will not solve things long-term; this is where the other skills will come in.