Image credit: https://www.barringtonbhw.

com/dbt-skills-training-groups/

DBT Skills Training: Distress Tolerance

PRESENTED BY: SUSAN SHADLEY, LMSW
PREPARED BY: SUSAN SHADLEY, LMSW & JESSICA WORTINGER, MS LLP CAADC
CONTENT TAKEN FROM SKILLS TRAINING MANUAL FOR TREATING BORDERLINE PERSONALITY DISORDER, LINEHAN, 1993 AND COGNITIVE BEHAVIORAL TREATMENT OF BPD,
LINEHAN, 1993
 Masters of Social Work from University
of Michigan
 Mental Health Interpersonal Practice
 5 years experience in Department of Presenter
Corrections
information
 1 year with Department of Veterans
Affairs and
 BetterHelp Credentials
 5 years co-running a DBT Program
facilitating groups and using DBT in
individual sessions
What are Distress Tolerance
Skills?
 Skills to tolerate and survive a crisis

 Skills to accept life as it is in the moment

 Why do we want/need Distress
Tolerance Skills?
 Everyone must tolerate some distress in life because life is
not pain-free
 Attempts to avoid pain often lead to more problems than they
resolve…
 Avoiding pain can lead to problems like PTSD or pathological
grieving.
 Trying to avoid painful thoughts, often makes them more
painful.
 When to distract yourself from your pain?
DISTRACTION IS NOT AVOIDANCE!

THIS NOT THAT…

Think of times when pain is intense, but it is not a good time to work on changing the source
of the pain

In a crisis sometimes you need to take a time out and NOT focus on the crisis at
that moment….
This doesn’t mean you avoid it forever.
 Activities
Contributing
Distract with Comparisons
Wise Mind Emotions (other)
ACCEPTS Pushing Away
Thoughts (other)
Sensations
Self-soothe with the 5
senses
Self-soothing is engaging in a behavior
that helps you feel calm, comfortable,
safe and relaxed
Generate a list for each category of
things that are soothing to you.
When might you need to self-soothe?
What gets in the way?
Should you have a self-soothing kit?
 What does it mean to improve the moment?
 Replacingimmediate negative events with
IMPROVE the more positive ones

Moment
 Changing body responses
 Changing thoughts – about yourself
(encouragement)
 Changing thoughts about the situation
(positive thinking, meaning,
imagining)
Imagery
Meaning
Prayer IMPROVE
Relaxation the
One thing at a time Moment
Vacation
Encouragement
 Cloud of
Cloud of Unknowing
Ruminating
NOW

One thing in the moment Activity

WHEN IN DISTRESS STAY IN THE NOW!
TIPP Your Body Chemistry
Shocks your mind into awareness
Temperature Try running your hands under cold water, take a
hot/cold shower, or step into the winter weather

Intense Exercise Takes the edge off your emotions

Progressive Muscle Relaxation

Paced Breathing

DONE IN SUCCESSION THESE STEPS CAN CALM YOU DOWN QUICKLY AND BRING YOU
BACK TO THE HERE AND NOW
Skill: Pros
and Cons of
Tolerating
Distress
Skill: Pros and Cons of TOLERATING DISTRESS

PROS CONS
Tolerating Distress

SITUATION: A coworker
drank the last of the
coffee and didn’t make
more. You feel like NOT TOLERATING THE DISTRESS (ACT NOW)
swearing at them due to PROS CONS
frustration.
Questions & Discussion