DBT Distress Tolerance | Center for Growth Therapy

DBT Distress Tolerance

Amanda , MSS, RYT200, CPRP, LSW — Associate therapist

DBT Distress Tolerance

Distress tolerance is one of the pillars of Dialectical Behavioral Therapy, or DBT. As humans, we will inevitably experience stress, overwhelm and situations that are unfavorable and outside of our control. Dialectical behavioral therapy emphasizes the need to bear pain in a skillful way, so that it doesn’t overwhelm us and take us into crisis mode. Distress tolerance skills are helpful when our emotions are heightened and we are having trouble sorting them out. Rather than being carried away on an emotional wave, the IMPROVE skill can serve as an anchor.

The IMPROVE Skill (DBT in Philadelphia, Mechanicsville, Santa Fe, Ocean CIty)

Sometimes when we are heading towards crisis mode, or being completely overwhelmed, our thoughts and behaviors end up adding fuel to the crisis fire, or keeping us in the crisis for longer. The IMPROVE skills teaches how to improve the present moment, no matter what it is, so that the distressing situation does not get any worse. And a bonus is that sometimes the IMPROVE skill can actually help us to feel better, too.

Skills like IMPROVE can go into your toolbox as a beneficial, tangible way of acknowledging the present moment, and ways in which you can take action in a way that can help improve it.

The risk of staying in a negative state for long periods of time, or staying stuck in crisis mode, is that we become much more vulnerable to things like fighting with romantic partners, arguing with family members, or socially isolating oneself. We’ve all been there, we have a bad day at work, we come home without having had the time to do any self-soothing work, we’re emotionally all over the place, and we continue to feel this way throughout the evening. And by the end of the night we start yelling at the kids, or becoming frustrated with our spouse, and our negative emotions escalate.

The IMPROVE skill, like many DBT skills, can serve as a way of reminding us that there are ways out of negative mood states and that we have the power to improve our situation. We might not be able to fix it, but maybe we can make it 10% better.



The IMPROVE Skill with Examples

When you find yourself overwhelmed, upset, angry or heading towards crisis mode, the IMPROVE skill offers actionable steps to make the moment better. The IMPROVE skill can serve as a ritual; something that you know is there for you when your negative emotions feel overwhelming. It can be helpful to have a notebook handy, although it’s not a requirement to write anything down, sometimes writing can help you stay on track.



(I)MPROVE- Imagery: Set a timer for 3-5 minutes and take some time to imagine a safe place. It could be a temporary escape from the current situation, it could be a place that you’ve been that you’ve found peaceful or comforting. If you need more time, reset the timer for 3-5 minutes. The reason to do this in small increments is to put a boundary around the time, so you have the option to come up for air. There is no right way to do this, just try your best.

Examples: Envision being in the mountains. Imagine being on a beach. Envision being at a friend’s house whom you love and care for deeply. Does the place you’re imagining have a smell? What does it feel like to be there? Are there any sounds you can imagine? It’s okay if none of the visualization is clear, and if nothing happens. The intention to sit with yourself and use your imagination during a crisis is a brave act, and the practice of this is often enough to serve as a small step towards self-regulation.

Another option is to write about a safe place, describing it in detail. You can even write a short story about the qualities of the place you’re imagining. Again, this can be somewhere you’ve been before, or a place you’re imagining in your mind’s eye.



I(M)PROVE- Meaning: Ask yourself if there’s any way in which you can grow from the challenges you’re facing. Ask yourself if you can find any positives in the situation currently, or even in your life as a whole. And ask yourself what your strengths are? Again, the intention to try out this very skill shows your strength and willingness to care for yourself and try to lessen your pain and suffering. The intention to learn about yourself and the situation at hand is a strength and a triumph.

Example: [imagine having this conversation with yourself] I’ve been really overwhelmed at work lately, and when I came home today I really lost control of my emotions. I am seeing how I need some extra support and would probably benefit from calling a therapist or joining a support group. It’s okay to become overwhelmed, but this is showing me that work is too stressful and I need extra support. I am strong because I can ask for help, and I can sit here and do this exercise with a willingness to find relief.



IM(P)ROVE- Prayer- Prayer means different things to different folk. If you are a part of a religious community, you might ask for guidance from God as you know them, or engage in a prayer ritual. Prayer can also be acknowledging that there are parts of life that are outside of your control, and you can honor and respect the mystery of life, even in a philosophical sense. You might ask the universe for guidance, or to aid you through the current situation. Or, you could ask your own wisdom to come forth and help you to regulate your emotions.

Example: [imagine having this conversation with yourself] Taking a few moments, I know I am suffering at this time. I recognize it. I am going to remind myself that I’m not alone. I am a part of a human family, where everyone is trying to “figure it out.” I am asking for love and calmness to enter into my heart, so that I can think clearly. Although there are problems beyond my control, I am not helpless, and the universe is benevolent.



IMP(R)OVE-Relaxation: Do something that could potentially help you to relax. This can be something like taking a shower or a bath. For some it could be 10 minutes of intense exercise, for others, a brisk walk outside. Remember that the IMPROVE skill is not saying that 10 minutes of exercise will solve all of your problems, but it might make things 10% better, and that counts for something. Doing something actionable is key here, the relaxation step is not something you want to think too much about.

Example: I am feeling really stressed. I do not have the energy to go to a workout class, so I will go on youtube and find a 10 minute high intensity work out to engage in. I will do the best I can, remembering that even the act of trying to help myself is a valuable act and shows I am caring for myself. I will note how I feel after this 10 minute work out. If I feel better, I will keep this in my coping tool box for next time I am feeling this way.



IMPR(O)VE-One thing in the Moment: Try your best to stay focused on one thing at a time. This is easier said than done, of course, but remember, it’s all about intention and not perfection. It may help to set a timer for 1-2 minutes and see if you’re able to concentrate on the present moment. Where are you right now? Where is your body? Remember your mind can go into the past and future, but your body is right here and now. You can also hold an object and take a thorough look at it. What does it look like? Describe it to yourself. What color is it? What shape is it? Does it have a cool texture?

Example: I set a timer for 1 minute and remind myself that although I am overwhelmed, I am surviving this moment. I grab a paperweight that I really love, it looks like a pink diamond. I notice the color, the weight and the shape of it. I look through it and see the light reflected. I am here and now, although my mind is busy, and that’s valid, I am here and now.

IMPRO(V)E-Vacation: Take a mini-vacation from your responsibilities if you’re able to. This does not mean planning a trip. This might mean watching a show on Netflix in order to give yourself a break. There is nothing wrong with distracting yourself from stress. Sometimes a short reprieve like watching a movie can de-escalate stress and allow you to better manage your emotions.

Example: I just got into a fight with my partner. I am totally overwhelmed. I want to figure it out and resolve, but it’s likely that some time and space is needed. It’s tempting to stew in my thoughts about the relationship, and replay the fight in my head, but that’s likely not going to help anyone. I am going to take a walk in the park, and give my friend a call. When I come back I bet my head will be a little more clear.



IMPROV(E)-Encouragement: Provide yourself with praise and encouragement. This is not always easy at first, but with practice, you can get into the habit of talking to yourself like you would a friend. We all deserve love, care and empathy. We all deserve encouragement. Sometimes we have to give it to ourselves. Reminding ourselves that we’ve gotten through tough situations in the past, and that we seriously care about the suffering we’re experiencing. Consider the Encouragement step of the IMPROVE skill an act of self-compassion. Remind yourself that you’re strong and capable. And that you’re here, taking care of yourself in a crisis.

Example: I can say to myself: although I am not perfect, I deserve love. My emotions are really strong today and I am feeling some pain. I care about the pain, and I’m wishing myself well. I am strong and I’ve gotten through similar pain in the past. It’s okay to call a friend or go online to a supportive community to connect. However, I am also simultaneously wishing myself well. I deserve love and compassion, no matter what. You can also write this down, or make a list of strengths and ways in which you’ve gotten through tough situations.



Conclusion

The Improve Skill is not a cure all, but it’s a tool with the potential to help you not go deeper into crisis mode. And it may improve your state of being. When we find ourselves in intense emotion, overwhelm or crisis, we need to have our go-to coping strategies, because we can’t construct them in the midst of a crisis mode. Practical tools like IMPROVE can be something you lean on during highly stressful times. Remember, this skill is not about perfection, but practice. And the very act of practicing this skill when you’re upset is an act of self-love and a success in and of itself.


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