The first skill in the Distress Tolerance Module is STOP.

S – Stop; do not react.  Just freeze.  Your may be tempted to act, but that would be acting on emotion and impulse instead of mindfully.

T – Take a step back.  Take a break; take a breath.

O – Observe. Notice what’s going on around you.  Notice what others are doing and saying. Tune into your thoughts, feelings, and sensations.

P – Proceed mindfully; act with awareness.  Think about your goals and consider how your actions will line up with them, especially your long-term goals. Use your wise mind, with emotions and reasoning.

This may seem like common sense, but I’ve found that if I’m in a conversation where I react strongly to something said, it’s a valuable tool.  I don’t always think to use it, but when I do, it works!

Many of the Distress Tolerance skills are meant to be internal as a way to regulate moods and responses to the situations we encounter.

I thought this picture was interesting!

The second module in DBT is Distress Tolerance – strategies to use in situations that feel unbearable.  These skills are supposed to be reserved for crisis situations, not for every day, ongoing problems.  A crisis situation would be one that is short term and stressful, creating intense pressure to resolve it now.  Here is a quote from Marsha Linehan, PhD. (creator of DBT) found on the dbtselfhelp.com website…

“DBT emphasizes learning to bear pain skillfully. The ability to tolerate and accept distress is an essential mental health goal for at least two reasons. First, pain and distress are a part of life; they cannot be entirely avoided or removed. The inability to accept this immutable fact itself leads to increased pain and suffering. Second, distress tolerance, at least over the short run, is part and parcel of any attempt to change oneself; otherwise, impulsive actions will interfere with efforts to establish desired changes.”

So, distress tolerance strategies are designed to help in the immediate such that bad choices don’t cause long term consequences.

There are three reactions to distress:

1 Hyperarousal – overreactions,
lack of emotional control, too
much energy, mind racing

2. Tolerance – using distress tolerance strategies to cope

3. Hypo-arousal – lethargic, no emotions/numb, too little energy
or motivation, depression

At ACCFS we talked about the “therapeutic window” or, as this illustration shows, the “window of tolerance.”  We talked about how to recognize when I’m headed toward the top or bottom or already there.  We talked about ways that worked for me to tolerate different situations, accept what what was happening, and cope well. I plan to share the DBT strategies that we were taught (at ACCFS and) at Timberline.  It’s unrealistic to expect to be centered all the time, so the goal is to recognize when we’re not and know how to come back, because It’s in the therapeutic window that healing can take place.

Well, I’ve been able to take some baby steps toward better self-care.  How about you?

In the last post, we took a look at Anger; we can look at Shame the same way.  I confess that this is hard for me to write as I’m dealing with some of this right now.  Part of my intensive treatment at ACCFS was to reprocess memories and thought processes that cause shame, and I’ve found that while it helped a great deal, I still have cycles of shame, depression, and recovery.

Shame and guilt are closely related and can easily be mistaken for each other.  Hopefully this helps explain the difference…

Guilt arises when we violate the values we hold or go against God’s desires for us.  It’s positive in that the Holy Spirit uses it to guide us, to help us see where we need to turn back, and we are able to fully embrace our Christian walk when staying close to the Spirit.  Guilt is a normal emotion.  Everyone feels guilt at some time.

Shame is a feeling bad about ourselves, not what we’ve done.  It’s feeling like how we’re made is flawed, that we are inadequate, and/ or that we don’t deserve to be loved or to belong. It can lead to depression or despair.  It may be disguised as anxiety, depression, PTSD, and even show up in physical symptoms that seem to have no explanation. It can lead to giving up.  Shame can be so painful, it looks like there’s no way to come out of it. There is nothing positive about shame.

I posted the Shame Indicator Inventory (that we took) under Lists; it’s also here.  Below it are some lists of causes, signs and symptoms, and how to dissolve shame.  I would encourage anyone that scores high on the inventory to seek help.

Satan will tempt us and torment us as long as we live on this earth.  Sometimes he gets us twice by our failing to overcome and then feeling shame about it instead of guilt. If we can learn to recognize shame, it’s easier to turn that into guilt and take the right steps to make that right.  Recognizing shame is the first step to healing.

Brené Brown has studied shame for over 15 years.  She has a couple of fantastic TED talks on YouTube, if you’re interested.  Here are a couple of quotes from her…