Distress Tolerance

STOP

When

The instant you feel the surge: an urge to lash out, to drink, to send the text. The skill for the first ten seconds.

How

1. Stop. Freeze. Don't move a muscle.
2. Take a step back. Out of the room if you can. Breathe.
3. Observe. What is going on inside and outside you?
4. Proceed mindfully. Ask what will make this better, not worse, and do that.

For example

The text that sets you off at 10 pm. Phone face down, into the kitchen, three breaths, then decide whether to reply tonight at all.

On your card

Note it whenever you caught an urge and put a gap between it and your action.

TIP

When

When the body is in overdrive: racing heart, shaking, can't think, and no thinking skill can get a grip. TIP changes body chemistry in minutes. The P stands for two things, which is why you will also see it written TIPP.

How

1. Temperature: tip the temperature of your face. Hold your breath and put your face in cold water, or hold a cold pack over your eyes and cheeks, for about 30 seconds. Not ice-cold.
2. Intense exercise: a short burst of anything that uses the stored-up energy, fast walking, running, jumping, then stop.
3. Paced breathing: slow right down, about five or six breaths a minute, breathing into the belly, out longer than in. Five seconds in, seven out.
4. Paired muscle relaxation: tense the muscles as you breathe in, notice the tension, say "relax" in your mind as you breathe out and let go.

Cold water slows the heart quickly and hard exercise speeds it up. If you have a heart or medical condition, a low resting heart rate from medication, take a beta-blocker, react to cold, or have an eating disorder, check with your doctor before using these two.

For example

Panic in the car park before a hard meeting: cold water from the bottle on your face, then slow breathing until your hands stop shaking.

On your card

Note which letter you used. Cold water and paced breathing are the two most people reach for.

Distract (ACCEPTS)

When

When you need a break from pain you can't act on yet. Not avoidance for good, a pause that lets the intensity drop. The full name is Distracting with wise mind ACCEPTS.

How

1. Activities: do something that takes attention.
2. Contributions: do something for someone else.
3. Comparisons: to a harder time you got through.
4. Emotions: something that produces a different one, a funny film, loud music.
5. Pushing away: shelve it, deliberately, for a set time.
6. Thoughts: count, read, do a puzzle.
7. Sensations: strong taste, cold, a hard workout.

For example

Poker after a long day of dealing with your daughter's return. A deliberate break that gives the day somewhere to go.

On your card

Note it when you chose a break on purpose. Add what you did in the note.

Self-soothe

When

When you are raw and need comfort that doesn't cost you tomorrow. One sense at a time.

How

1. Vision: a view, a photo, a candle flame.
2. Hearing: music, rain, a familiar voice.
3. Smell: coffee, soap, outside air.
4. Taste: something warm, slowly.
5. Touch: a hot shower, a blanket, the dog.

For example

A hot shower and a specific album at the end of a day that had nothing good in it.

On your card

Note it when you comforted yourself on purpose, not out of habit.

IMPROVE the moment

When

When the situation can't change but how you are inside it can.

How

1. Imagery: picture a place you are safe.
2. Meaning: find what the pain is for, or what it is teaching.
3. Prayer: hand it over, in whatever form that takes for you.
4. Relaxation: drop your shoulders, unclench your jaw.
5. One thing in the moment: this breath, this step.
6. Vacation: a short, deliberate one. Twenty minutes with the phone off.
7. Encouragement, and rethinking: talk to yourself the way you would to a friend ("this will pass", "I can stand it"), and re-say the situation in a way that is true and bearable.

For example

Choosing prayer and meditation over a drink when the sadness comes. That is this skill, used well.

On your card

Note the letter you used.

Pros and cons

When

Whenever you have to choose between two courses of action, and especially for a crisis urge: one that is very strong and that acting on would make things worse later. The trick is to write it out before the urge hits, then read it when it does.

How

1. Four boxes: acting on the urge, pros and cons; resisting it, pros and cons. Be honest about the pros of the urge. It wouldn't be an urge otherwise.
2. Mark each one short-term or long-term. The pros of acting are nearly all short-term.
3. Ask wise mind: would I rather have a good night or a good life?
4. Keep the list where you can reach it, and rehearse it. When the urge comes, get it out and read it, including what happened the last time you gave in.

For example

The drink: it would take the edge off tonight. It would also be the first since July, and you would have to say so on Thursday.

On your card

Note it when you did this on paper, in your notes app, or as a deliberate list in your head.

Radical acceptance

When

When something cannot be changed and fighting it is what hurts: a fact about the past or the present, or a real limit on the future. Rejecting reality doesn't change it; it turns pain into suffering. Acceptance is not approval, not giving up, and not against change. Changing something starts with accepting that it is as it is.

How

1. Notice that you are fighting reality: "it shouldn't be this way", "why me".
2. Say the fact plainly: "She is home now. The insurer said no." Remind yourself it has causes; given everything that led here, it happened this way.
3. Accept with the whole of you, not just your head: breath, a half-smile and open hands, prayer, imagery, whatever gets the body on board.
4. Act as if you had already accepted it. List what you would do if you had, and do those things. Rehearse ahead for the parts that still feel unacceptable.
5. Let the sadness or grief that comes with it be there. Acknowledge that life can still be worth living with this in it.
6. If you find yourself refusing, do pros and cons on accepting versus not.

For example

The residency ended early and that is not going to un-happen. Accepting it is what frees the energy for what comes next.

On your card

Note it when you chose to stop fighting a fact, even for an hour. It usually has to be re-chosen, which is the next skill.

Turning the mind

When

Every time acceptance slides off, which it will. Deciding to accept is not the same as accepting; it just puts you back on the road.

How

1. Notice that you are not accepting: anger, bitterness, "I can't stand this", avoiding the feeling altogether.
2. Make an inner commitment to accept reality as it is. A choice, not a feeling.
3. Do it again. And again. It is a fork in the road you come back to many times a day.
4. Make a plan for catching yourself next time you drift off the road.

For example

Mid-afternoon the "this is so unfair" starts up again about the residency. Noticing it, and choosing acceptance again, is the whole skill.

On your card

Note it when you caught yourself fighting a fact and chose acceptance again. Counting the re-choices is more useful than counting the first choice.

Willingness

When

When you notice willfulness: refusing to tolerate the moment, refusing to make a change you know is needed, giving up, digging in, insisting on being in control, "me, what I want, right now". Willingness is doing just what the situation needs, wholeheartedly, without dragging your feet.

How

1. Observe the willfulness. Label it. Feel it in the body.
2. Radically accept that right now you feel willful. You can't fight willfulness with more willfulness.
3. Turn the mind toward acceptance and willingness.
4. Try a half-smile and open, willing hands.
5. If it won't move, ask: what's the threat?

For example

Being asked, again, to drive to the clinic, and feeling the whole body say no. Naming it as willfulness, then doing the drive properly rather than resentfully.

On your card

Note it when you noticed willfulness and chose the willing version of the next thing.

Half-smiling and willing hands

When

Any time, and especially while thinking about the thing that feels unacceptable. Acceptance with the body: the face and hands tell the brain how you feel, so change them first.

How

1. Relax the face from the forehead down: eyes, cheeks, jaw, tongue, teeth slightly apart.
2. Let the corners of the mouth lift just enough that you can feel it. Nobody else needs to see it. A tense grin is the opposite of this.
3. Willing hands: unclench, turn the palms up, fingers relaxed. Standing, arms loose at your sides; sitting, hands open on your thighs.
4. Breathe three slow breaths like that. Practise it on waking, in a queue, while listening to something irritating.

For example

Clenched fists and jaw in the insurer's hold music. Palms up on the desk, face loose, three breaths. The hold music does not change; the body does.

On your card

Note it when you used it on purpose, and whether anything shifted.

Mindfulness of current thoughts

When

When a thought keeps coming back and you are starting to treat it as a fact: "this will never end", "I've ruined everything". You are not your thoughts, and you don't have to act on them or push them away.

How

1. Observe the thought as a thought: "the thought that this will never end just went through my mind." Let it come and go like a wave. No pushing it away, no analyzing it.
2. Get curious: where did it come from? Watch it arrive and watch it leave. Every thought that comes also goes.
3. Remember you have thought very differently on other days. Catastrophic thinking is emotion mind talking.
4. Don't block it. If it keeps pulling, ask what feeling it is helping you avoid, turn toward that sensation for a moment, then come back. Or say it out loud ten times fast, or sing it, until it is just sounds.

For example

"She will never get back on track." Said as "I'm having the thought that she will never get back on track", it is suddenly something you are having, not something that is true.

On your card

Note it when you caught a thought and watched it instead of believing it or fighting it.