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…

It’s time to move into the next DBT module, but first I want to tie a couple of things together.

1. Emotions ARE – emotions aren’t good or bad, right
   or wrong; they are information about how we feel.
2. Some emotions are secondary – anger is always a result of some other primary emotion such as fear, disappointment, hurt, sadness, grief.
3. One instructor told us, Anger is like a flashing sign saying, “Someone has crossed my boundary.”
4. We are the only ones that can control our thoughts, behaviors, and emotions; no one can control ours and we can’t control others.
5. Using the Nonjudgmentally piece of Mindfulness, we can learn more about anger – how we express it, how it affects us, and what we can do to work on it.

At Timberline we worked through some information from a book called Mindfulness for Teen Anger: A Workbook to Overcome Anger and Aggression Using MBSR and DBT Skills by Mark C. Purcell MEd, PsyD and Jason R Murphy MA.  (Long name, but I want to give credit!)  Basically, we looked at anger patterns and styles of how we express anger.  It’s another piece to understanding ourselves, how we function, what we can do to improve life, and learn ways to move on.  I’ve posted – under Lists – their Anger Style Assessment and a summary of the styles from the information we were given.

Here’s an excerpt from the introduction:

“People don’t usually have problems with what you feel, they have problems with what you do. So many anger-management strategies fail because all the attention is on making you change what you do: arguing, fighting, out-of-control behaviors. If people knew all the thoughts and feelings you were experiencing underneath your actions, they would probably be more understanding, but no one (including you sometimes) has all that knowledge.”

This couldn’t be more true!  I know for myself, I get frustrated by things I do when I’m angry. I have to remind myself that anger is natural and normal in situations of sadness, fear, hurt, etc.  AND I need to work on how I act and react. That’s part of the Nonjudgmental mindfulness too – emotion is normal; anyone would feel that way if they were in this situation.

Feel free to look over the anger
styles and take the assessment.
Tomorrow I plan to do the same
exercise about shame.