DISTRESS TOLERANCE SKILL

HELPS TO MAKE THE SITUATION EASIER TO DEAL WITH

WHEN YOU CAN'T ESCAPE.

IMPROVE
I Imaginary : Visualize a relaxing place.

M
Meaning: Make meaning from the difficult
situation.

P Prayer: Prayer for something greater, and ask

strength to bear the pain.

R Relaxation: Do a relaxing activity.

O
One thing in the moment: Focus your entire
attention on just what you are doing right
now.

V Vacation: Take a brief mental vacation.

E Encouragement: Remind yourself "I can

Stand it"
 DISTRESS TOLERANCE SKILL
CHANGE YOUR COPT CHEMISTRY AND CALMDOWN IN
EXTREME DISTRESS.

TIPP
T Tip the temperature: Holding your breath put your
face in bowl of cold water,or hold a cold pack on
your eyes and cheeks.Hold for 30 sec keep
waterabove 50 f.

I Intense Exercise: Engage in intense exercise ,

only for short while.

P
Paced breathing: Breath deeply into your
belly.Slow your pace of inhaling and exhaling way
down breath out more slowly than you breath in.

P
Paired muscle relaxation: While breathing into
your belly,deeply tense your body muscle. Notice
the tension in your body. While breathing out , let
go of the tension notice the difference in your
body.
 DISTRESS TOLERANCE SKILL
HELPS YOU TO MAKE IT THROUGH A CRISIS SITUATION.

STOP
S Stop: Freeze don't move the muscle ! Don't just
react.Your emotion may try to make you act
without thinking. Stay in control

T Take a step back: Take a break .Let go . Take a

deep breath.

O Observe : Notice what is going on inside and

outside you.What is situation? What are your
thoughts and feelings?

P Proceed mindfully: Use wise mind to proceed with

awareness. Consider your goals your thoughts
and feelings, the situation and other people
thoughts and feelings.
Emotional
Regulation
PLEASE
P Treat Physical illness

L See Doctor take Med

E Eating Balanced

A Avoid Mood Altering

S Sleep Balanced

E Exercise
 DISTRESS TOLERANCE SKILL

PROS & CONS

Use DBT pros & cons any time you have to
decide between two or more options in DBT,
you consider the pros & cons of one options.
Or the pros & cons of acting on a behavior,
and pros & cons of not acting on that
behavior . For example a DBT pros & cons on
procrastinating :

PROS CONS
Time commitment for
Structured framework for skill
learning and practice.
implementation.
Limited access to qualified
ACTIONS

Guided by trained therapist for

TAKING

therapists.
effective use.
HOW

Initial learning curve and

Tailored techniques for various
potential frustration.
needs.
Ongoing practice demands
Mindfulness emphasis for
dedication.
present awareness.
Techniques might vary in
Holistic well-being approach.
effectiveness.
Positive habits and lifelong
Applying skills during high
benefits.
stress can be tough.
VS

Empowerment and control Initial discomfort and

over emotions. resistance.
ACTIONS

Development of healthy Requires consistent

TAKING

coping strategies. effort and patience.

Improved emotional Relapse risk during
regulation and resilience. stress.
Reduced impulsivity and Not immediate results;
better decision-making. need for patience.
Enhanced self-awareness Integrating skills into
and relationships. daily life can be
challenging.
 Emotional
Regulation
VITALS to Success

V Validate yourself
I Imagine Success
T Take Small Steps
A Applaud yourself
L Lighten the load
S Sweeten the pot
 LOVING
KINDNESS
MEDITATION
Sit quietly and relax while breathing
deeply. Keeping your eyes closed
,think of person close to you very
much. It could be some one from the
past or the present.
These explain what we do when
we are mindful

MINDFULNESS
"WHAT" SKILLS

BE KIND
to your
MIND
"DESCRIBE"
Attach words
to your
experience
 DBT
MINDFULNESS SKILLS

Mindfulness is being in control of

your mind rather than letting your
mind be in control you.
INTERPERSONAL SKILLS

T.H.I.N.K
T THINK: about the situation from the
other person's perspective.

H Have empathy: What does it feels like to

be the other person ?

I Interpretations: of the other person's

behavior .Think about possible reasons
why she did the things that upset you.

N Notice : the other person. Notice when

she is trying to be kind improve the
relationship.

K Kindness: in your response. This doesn't

mean you have to forgive and forget
immediately.
 DIALECTICAL
THINKING
OPPOSITES CAN CO-EXIST

I am doing my best AND I can try harder

I am capable AND I need support

I am angry AND I can be respectful

I understand your
I disagree with you AND perspective

I hate what they did AND I still love them

I don't want to do I am going to do

this AND this anyway

I am afraid of
I want to change
AND change
 TRACING
Trace the swirl below with your finger.
Breath in slowly through your nose
and out through your mouth as you
trace.
These explain what we do when
we are mindful

MINDFULNESS
"WHAT" SKILLS

"PARTICIPATE"
Give your full attention to the moment,
experience it completely without worry
or distraction
 BOX
BREATHING
TECHNIQUE
Repeat 3 times

Inhale through your

nose for 4 seconds

Hold your breath for 4

Pause for 4 seconds
before repeating

seconds

exhale through your

nose for 4 seconds
 ACCEPTANCE
MINDSET
"IT SHOULD BE THIS WAY " "IT IS WHAT IT IS "

" I CAN'T PREDICT THE

" WHAT IF I FAIL ?"
FUTURE"

" UGH , I HATE

THE RAIN." " IT'S RAINING "

" I CAN'T
HANDLE THIS "
" I AM STRONG I WILL
SURVIVE THIS "
" I WISH THINGS
HAD GONE
DIFFERENTLY" " THINKING OF PAST
JUST ROBS ME OF THE
PRESENT "
 LOVING
KINDNESS
MEDITATION
Sit quietly & relax while breathing
deeply.Keeping your eyes
closed,think of a person close to
you very much.It could be
someone from the past or
present: some one still in life or
who has passed .Feel the warm
wishes and love coming from
that person towards you .Then
send warm wishes to all living
beings & try to be happy.
INTERPERSONAL EFFECTIVENESS SKILLS

DEAR MAN
ASK FOR WHAT YOU WANT & GET IT MORE OFTEN

D Describe the currentsituation stick

to the facts

E Express your feelings & opinions

about the situation. Don't make
assumption.

A Assert yourself by asking for what

you want .B e specific.

R
Reinforce the person ahead of time
by explaining the pros of getting what
you want.

M Mindful keep your focus on your

goals.

A Appear confident , effective , and

competent.

N Negotiate , be willing to give to get.

Dialectical Behavior Therapy

HOW
H
Honest;This skill encourages individuals to be
honest and truthful in their communication
while avoiding exaggeration or deceit.

O
Open: Openness in this context means being
open to both your needs and the needs of
others. It encourages individuals to be
receptive and understanding of different
viewpoints.

W
With Appearances: This skill suggests that
individuals should behave in a way that
maintains appearances, especially in social or
professional settings. It involves using
appropriate social behaviors and showing
respect for social norms and customs.
 Dialectical Behavior Therapy

OPPOSITE
ACTI0N
In Dialectical Behavior Therapy (DBT), the
concept of "opposite action" is a strategy
designed to help individuals manage
intense and distressing emotions. It
involves deliberately choosing to act in a
way that is opposite to the emotional
impulse they are experiencing. For
example, if someone feels the urge to avoid
a social situation due to anxiety, opposite
action would encourage them to attend the
event and engage with others. The goal is to
change the emotion by changing the
behavior associated with it. This skill
promotes emotional regulation by
encouraging individuals to challenge and
modify their emotional responses, leading
to more adaptive and positive outcomes.
INTERPERSONAL EFFECTIVENESS SKILLS

HALF SMILE
When you notice yourself feeling
overwhelmed or anxious, take a moment
to pause, close your eyes if possible, and
gently turn up the corners of your mouth.
This physical act signals to your brain
that you are safe and in control,
promoting relaxation and emotional
regulation. As you maintain the half-
smile, focus on your breath and the
sensations in your body, bringing your
attention to the present moment. This
practice can help you navigate difficult
emotions with greater ease, fostering a
sense of calm and acceptance in various
situations
I CANNOT CONTROL
( So i can LET GO of these things )

The circumstances
What other
I am dealt
people think?

My words
Learning from mistakes
How others
react I CANNOT CONTROL
( So i focus on these things ) What other
people say?
choices i make
My boundaries My attitude
My thoughts My beliefs &
What other opinions
people do ? How i respond
The past

How other The weather

people feel ?
INTERPERSONAL EFFECTIVENESS SKILL

FAST
Keep your self - respect.

F Be FAIR to yourself and to the other person .

Remember to validate yourself.

A
Apologies. Don't overapologize . No
apologizing for making requests or having
an opinion.

S
Stick to your values. Don't change your
values to be liked .Stand up for what you
believe in .

T
Truthful. Don't lie . Don't act helpless,
exaggerate or make up excuses.
 Dialectical Behavior Therapy
Criteria for a Life
Worth Living
Reducing Suffering:
Striving to reduce emotional pain and suffering by learning to effectively
manage distressing emotions and situations.

Increasing Joy and Vitality:

Actively seeking out and embracing experiences that bring joy, fulfillment,
and vitality into one's life.

Enhancing Relationships:
Nurturing and developing healthy, fulfilling relationships with others,
including effective communication and interpersonal effectiveness skills.
Pursuing Personal Goals:
Setting and pursuing meaningful goals that align with one's values and
desires, creating a sense of purpose and direction.

Practicing Mindfulness:
Cultivating mindfulness and staying present in each moment, fostering
a deeper connection with oneself and the world.
Improving Self-Respect:
Engaging in self-compassion and self-acceptance, treating oneself
with kindness and respect.

Maintaining Physical and Emotional Well-being:

Prioritizing self-care and well-being, including proper nutrition, exercise,
and emotional regulation techniques.
 IMAGINE YOUR
EMOTIONS AS A WAVE

Say to yourself "I am feeling

anxious" or "I am feeling ____.
Imagine those feelings like waves
in the ocean. You can't stop a
strong wave from coming towards
you. Don't try to get rid of the
emotions or push it away. Don't
block or suppress it .
 MINDFULNESS SKILL

WISE MIND
We each have innate wisdom that can
guide us actions and pursuits. It is a
balanced aware perspective that help us
move towards our goals , using
knowledge and experience . Wise mind is
a synthesis of reasonable mind and
emotional mind.

Emotional Reasonable
Mind Mind
Wise Mind
Ruled by facts , reason
Ruled by your moods
Intuitive thinking and logic
,feelings and urges

Common Sense
Dismissing values and
Dismissing facts and Balance feelings
logics

Wisdom Cool Rational , and

Reactive and task-focused
impulsive
DIALECTICAL
BEHAVIOR THERAPY
Mindfulness

Distress Tolerance

Emotional Regulation

Interpersonal Effectiveness
 VITALS
TO
SUCCESS
V VALIDATE YOURSELF

I IMAGINE SUCCESS

T TAKE SMALL STEPS

A APPLAND YOURSELF

L LIGHTEN THE LOAD

S SWEETEN THE POT

 Dialectical Behavior Therapy (DBT)

COMPONENTS
Individual Therapy:
In DBT, individual therapy involves one-on-one sessions between a client
and therapist. These sessions focus on addressing the client's specific issues,
setting treatment goals, and providing guidance and support in applying DBT
skills to their unique challenges.

Group Skills Training:

Group skills training is a central component of DBT. Clients attend group
sessions to learn and practice essential DBT skills, including mindfulness,
emotion regulation, interpersonal effectiveness, and distress tolerance.
These skills are vital for managing emotions and improving relationships.

Phone Coaching:
DBT includes phone coaching, allowing clients to reach out to their
therapist for brief support between sessions. This helps individuals
apply DBT skills in real-life situations, manage crises, and prevent
impulsive or harmful behaviors.

Consultation Teams:
DBT therapists participate in consultation teams where they meet regularly
to support each other in delivering effective treatment. These teams help
therapists maintain their adherence to the DBT model and ensure high-
quality care for clients.
 Emotion Regulation Skill

PROBLEM
SOLVING
Take slow, deep breaths to calm down
your brain and body to help you think
more clearly.

What is the situation or problem?

What is your goal for solving the

problem?

Brainstorm some solutions to solve the

problem.

Choose the best solution.

If the solution doesn't work, try a different

solution.
 Emotion Regulation Skill

A.B.C
PLEASE
Helps to increase positive emotions and reduce
chances of falling into Emotional Mind.

Accumulate positive emotions

1) Short term goal = experience pleasant events mindfully

2)Long - term goal Make changes in your life so that

positive events will happen more often in the future.

Build mastery

Do things that make you feel competent and

effective each day such as hobbies , skills , home or
school tasks . Gradually increase difficulty

Cope ahead of time with emotional situations

Rehearse a plan ahead of time so you are prepared

to cope skillfully with emotional situations.
 Emotion Regulation Skill

CHECK
THE
FACTS
Ask yourself the following questions to
check the facts:

What event triggered my emotion?

What interpretations or assumptions

am I making about the event?

Does my emotion and its intensity

match the facts of the situation? Or
does it just match my assumptions of
the situation?

** Remember that Thoughts, Feelings ,

and Emotions are Not facts
 Emotion Regulation Skill

RADICAL
ACCEPTANCE
Radical acceptance is the skill of
accepting the things you cannot
change . Practice saying Radical
Acceptance Coping Statements
such as :

" It is what it is. "

" I can't change what's already

happened.

" It's no use fighting the past.

" Everything happens for a reason."

 OPPOSITE
ACTION
When an emotion is doing more harm
than good, practice Opposite Action by
acting opposite to the usual behavior
associated with the emotions. This can
help you change your emotion.

Common Opposite
Emotions
Behaviors Action
Gently Avoid, Talk
Angry Attack ,Yell, Argue
Quietly and Politely

Sad Withdraw, Isolate Get Active, Interact

With Others

Fear/Anxiety Escape, Avoid Approach, Gradual

Exposure

Envy To Destroy What Be Grateful for what

Someone Has you have, Be Kind And
Generous
 I embrace radical
acceptance of the things I
cannot change
There is enough time in the
day to do all that i want to
do.
I am willing to take the risks
necessary to be happy and
live the kind of life i have
chosen for myself
I am able to express my
emotions in a healthy ,
positive way.
I have many options and
always make the best
decisions i can .
I honor my emotions and
use them as valuable
signals
I have a lot to be
proud of.
I am in control
of my life.
I am open to learning and
growing from my
experiences, even the
challenging ones
 I am the author of my
own story, and I choose
to write a positive one
I am in control of my
thoughts;
my thoughts do not
control me
I choose to communicate
effectively and
assertively in my
relationships
I can tolerate discomfort and
uncertainty, knowing that
they are temporary.
 I choose to
communicate
effectively and
assertively in my
relationships
I trust my ability to make
wise decisions for my
well-being
I am worthy of love and
acceptance just as I am
 I acknowledge my
accomplishments and
celebrate my successes,
no matter how small
I choose to forgive and let
go of resentment, freeing
myself from negativity.
 I am a magnet for
success, and I am open to
all the opportunities that
come my way
 I am free from
judgment, both of
myself and of
others
 I am a source of
inspiration and
positivity for those
around me
 I am grounded,
centered,
and
at ease
with the present moment
INTERPERSONAL EFFECTIVENESS SKILL

GIVE
G
Gentle: Approach interactions with a non-
confrontational and kind tone to avoid
escalating conflicts and create a safe
atmosphere.

I
Interested: Show authentic curiosity and active
listening to demonstrate a genuine interest in
the other person's perspective, fostering
meaningful connections.

V Validate: Acknowledge the emotions and

experiences of others, even if you don't
agree, to promote empathy and
understanding in your interactions.

E
Easy Manner: Maintain a relaxed and
approachable demeanor to reduce tension
and defensiveness, facilitating smoother
and more productive conversations.